Q: What is The Wedge of Health Freedom?
A: The Wedge of Health Freedom (“The Wedge”) is a nationwide disruptive innovation for health care initiated by the Citizens’ Council for Health Freedom to restore the caring heart, ethical principles, affordability and patient-centered focus of medicine in America. Using The Wedge, CCHF will advance a new vision of medical care for patients and doctors — a vision of patient-friendly, price-friendly and privacy-friendly medical care.
The Wedge is CCHF’s identification of the free-trade zone for health care – a legally-protected space. The zone exists today – there are pockets of doctors and patients nationwide interacting freely – but it is not widely known by patients or participated in by doctors. CCHF has simply branded this zone as The Wedge to capture the attention of the American public.
The Wedge is a zone of deregulation into which patients and doctors can escape from government and health-plan controls over care — and find each other. As we advance The Wedge and build public awareness, we expect more and more physicians, dentists and other health care practitioners to feel comfortable moving away from managed care and government contracts and back to independent practices that are patient-centered, directly between a patient and a doctor, affordable and based on health freedom.
The Wedge is also a grassroots initiative that engages patients. We ask patients to plant the seeds of freedom in their own doctor’s minds by reaching out with a “Join the Wedge” message (click on SHARE). Joining The Wedge is a voluntary collaborative venture between third-party-free practices and the non-profit CCHF.
The Wedge was launched at a press conference at the National Press Club in Washington, D.C. on June 28, 2016. The first wave of Wedge practice sign-ups was announced on August 31.
Q: Why is it called The Wedge of Health Freedom?
A: Within the sphere of health care, there is a space of health freedom that exists today in third-party-free practices. We wanted to protect and grow that space of freedom so that patients and doctors would always have a place to escape into out of the current system of corporate and government controls. We branded it The Wedge of Health Freedom. We want this free-trade zone to be: 1) identified and recognized as a space of freedom, 2) made visible to the American public, 3) legally-protected and 4) greatly expanded for the sake of individualized patient care, medical excellence and health freedom for all.
Q: Is The Wedge a form of insurance?
A: No. The Wedge does not take the place of health insurance. We established The Wedge as a way for patients to find, and doctors to practice, affordable, confidential, patient-friendly care regardless of the patient’s insured status. This website’s “Finding a Practices” page serves as a window into the current free-trade zone where doctors, clinics, and surgery centers are practicing freely together with patients without interference from insurers or government.
Q: Can I use a Wedge practice if I’m insured?
A: Yes, Wedge practices are based on direct payment — the way you buy groceries, baseball tickets, cell phones, theater tickets, cars, haircuts, plumber services and more. No one else is involved in your purchasing decisions. Whether you are insured, uninsured, or publicly subsidized (e.g. Medicare, Obamacare, Medicaid), you can use a Wedge practice. Payment by cash, check or charge (or HSA) is your responsibility. Some Wedge practices may assist you with submitting a claim to your insurer for out-of-network coverage. Some may provide services for charity. If so, that is their independent choice to do so.
Q: Can I use my insurance in The Wedge?
A: No. However you can ask your insurer to reimburse you for the cost. Wedge doctors practice independently and contract directly with you, the patient. They have no relationship and do not contract with any insurers. Patients pay by cash, check or charge according to the transparent price structure of the independently-operated practice. If you have out-of-network coverage, you may seek reimbursement from your insurer for out-of-network care as allowed under the contract you have with your insurer. If you have a Health Savings Account (HSA), you may use it to cover your costs or get reimbursed for care.
NOTE: Many people will never reach the high deductibles now common under the Obamacare-based price structure. Wedge practices offer patients a more affordable option for care. In short, you will likely get more care for your dollar and have more money left over in your pocket.
Q: What if I have Medicare or Medicaid?
A: Wedge practices welcome all patients, but do not contract with the government to participate in Medicare or Medicaid programs. Thus, these practices are not subject to the government’s treatment controls, reporting requirements, or penalties and fines. Cash-based practices report seeing both Medicare and Medicaid patients. NOTE: A recently proposed Medicare rule (related to the 2015 “MACRA” law) would require doctors participating in Medicare to open ALL their medical records to the government, including the records of patients not on Medicare.
Q: Are Wedge practices more affordable?
A: Every practice chooses their own prices structure, and makes it transparent to patients. Wedge practices can offer prices closer to the actual cost of doing business because these practices do not sign restrictive contracts with insurance corporations and do not participate in Medicare. As a result, they are not strapped with time-consuming and costly managed care and government regulatory and reporting requirements (e.g. 132,000+ pages of Medicare regulations, 20,000+ pages of Obamacare regulations, and $32,500/doctor/year to maintain government-mandated electronic medical record to avoid Medicare penalties) or the staff, lawyers, coders, scribes, data reporters, data systems, IT staff and administrators needed to comply with them.
Therefore, the cost of operating a Wedge practice is significantly reduced and that savings can be passed onto patients in lower prices, individualized care, high-quality time with the doctor — including time to get all your questions answered — and true patient privacy.
Q: Can my health plan prevent me from using a Wedge practice?
A: No. We are not aware of any laws that allow any health plan or insurance company to prohibit you from freely accessing any doctor or practice of your choice. However, your insurer may refuse to pay for your visit or limit its reimbursement for prescribed services because the doctor’s office is considered out-of-network or because they deem the care “medically unnecessary” or “experimental.” Furthermore, except in emergency situations, Medicare will not pay for care given by doctors who have opted-out of participation in Medicare.
That said, given the often-lower costs and higher-quality benefits of Wedge practices, you may find the insurer’s or government’s lack of payment an increasingly insubstantial consideration when deciding whether to choose a Wedge practice. As Brenda Jones, a patient of Dr. Brenda Arnett, M.D. in West Virginia, told Scripps Howard News Service:
“Paying her up front doesn’t matter to me at all. The level of care that I get is worth twice what she’s charging.”
NOTE: Although health insurers cannot prevent you from paying an out-of-network Wedge practice for care, few patients realize that contracts between network practices and insurance companies often prohibit doctors from accepting payments from patients for care that is denied by the insurer. This troubling restriction, typically called a “hold harmless” provision, may discourage contracted doctors from disclosing and discussing all possible treatment options with patients. Wedge practices are free from these hidden contractual impediments to patient care.
Q: What are some examples today of Wedge-like practices?
A: Examples include: AtlasMD (Kansas), internist Brenda Arnett, M.D. (Virginia), NoInsuranceSurgery.com, PATMOS Emergiclinic (Tennessee), Robb Oto-Neurology Clinic (Arizona), Davis Orthopedics (Alabama), Muscala Chemical Health Clinic (Minnesota) and Empower Family Medicine (Georgia). Wedge-like practices are located in all 50 states. We will strive to invite them all into The Wedge so patients can easily locate them…and so doctors who want to escape into freedom will realize that it’s possible to do so.
Q: How many ‘Wedge practices’ do you envision?
A: Thousands. As more and more ‘Wedge practices’ emerge online nationwide — and as patients discover and use them — we look forward to the day when the current small but growing Wedge becomes a hemisphere of health care freedom and then eventually a full circle of patient and doctor freedom. In the future we also envision affordable, confidential ‘Wedge hospitals’ free of costly third-party-payer restrictions and onerous reporting requirements. Check out the Surgery Center of Oklahoma to see how low prices could go without the costly bureaucracy of health plan contracts and government regulations.
Q: How will ‘Wedge practices’ be legally protected into the future?
A: To our knowledge, there are no laws limiting physicians and others from engaging in a private practice, however certain state and federal laws and regulations make that practice more difficult. To ensure health freedom, we will encourage state legislatures and Congress to support the private practice of medicine and to refuse to enact licensure laws or other regulatory restrictions that could impede the constitutional right of physicians and other practitioners to practice in a direct, private contract, third-party-free relationship with their patients.
Q: How will my medical data be protected?
A: The practice may or may not have an electronic health record, however, in a Wedge practice, that patient record will not be hooked up to a state health information exchange, corporate health information exchanges (e.g. CommonWell Health Alliance or Carequality) or the federal government-established national medical records system called eHealth Exchange. Because the doctor’s office has a direct contractual private relationship with you, the patient, your health information will not be shared without your express voluntary, written consent.
Q: How does a practice become a Wedge practice?
First, look at our list of eight Wedge Principles. Second, if you follow these principles, simply use the website form for doctors to request that your practice be added to our online map of Wedge practices. As our disclaimer notes, CCHF does not make any claims about the practices that request us to add them to our map. This list is a voluntary collaboration with third-party-free practices nationwide that want to participate in the movement back to health freedom. We reserve the right to limit the map to third-party-free practices and to de-list a practice for any reason at any time.
Q: What can our practice do to encourage our patients to join us as we move to become a Wedge practice?
A: Please request Wedge materials to share with your patients, including cards that patients can use to invite their doctors to join The Wedge, and include a ‘participation sign’ for your office (as soon as they are made available). NOTE: While we are happy to put them in your hands, given that CCHF is a non-profit dependent on the generosity of donors, we will ask practices to pay for the cost of printing, shipping and handling of these Wedge materials.
In addition, encourage your patients to visit JoinTheWedge.com and discuss the benefits that come from having a doctor or using a practice that is free from outside controls on the practice of medicine; a practice that is free to work with the patient as an individual. These benefits include lower costs, more time with you, a trusted confidential patient-doctor relationship, an advocate when they cannot advocate for themselves, and privacy of medical records.