Hampton Roads doctors embrace direct pay healthcare

NORFOLK, Va. — More and more doctors are choosing to step away from regular health insurance payments, and are instead opting for a direct pay system made by patients. Here in Hampton Roads, there are now seven providers that follow this model. 

It’s part of a growing trend as doctors say they are cutting out the middleman in favor of getting cheaper prices for their patients, and with better access to care.

“Not only do we have to be a good doctor, but we have to make it affordable,” said Dr. James Tinsley. “One lab at a hospital may cost $200, but when they get it here, it’s $4.”

Tinsley was one of the first to open a “DNC” model in Newport News, called Lighthouse Direct Primary Care. He told 13News Now that over the years, he has seen a dramatic increase in patients, and expects that number to go up soon.

As part of the “Big, Beautiful Bill,” Medicaid legislation is expected to take hold in January 2026.

The enhanced Federal Medical Assistance Percentage (FMAP), which incentivized states to expand Medicaid under the Affordable Care Act, will expire in January. This will increase the financial burden on states, potentially forcing them to reduce spending or benefits to offset the loss of federal funds.

This could then have a direct impact on some insurance rates, leading some patients to explore other options.

“For the majority of people, the true costs of medical care is around $2,000, but we are spending $10,000 per person because $8,000 of the $10,000 is going to administrative costs,” said Dr. Emily O’Rourke with Fountain Direct Primary Care.

According to the Kaiser Family Foundation, around 1/3 of Americans will forgo needed medical care because of the price, and almost half of Americans said paying medical bills is “difficult.”

O’Rourke told 13News Now she stepped away from insurance-based payments to this direct pay system in order to provide more accessible care.

“You may go get an ultrasound at an outpatient imaging center, and it is around $100, and if you get that same procedure at a hospital, it may be $1,000,” said O’Rourke. “That is crazy.”

Both Tinsley and O’Rourke still recommended that everyone carry health insurance, as you never know what may happen down the road. However, studies have shown that paying for a direct primary care membership with a high-deductible health plan can lower overall costs by almost 30%.