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PORTAGE — Dr. Timothy Ames had a traditional primary care practice for a quarter of a century, starting in 1987. He grew increasingly incensed by the bureaucratic obstacles being put in the way of doctors caring for patients.

So he went nontraditional.

At his new practice, he doesn't accept insurance of any kind. He charges patients a monthly subscription fee for unlimited visits. He is available by phone, by text, after hours.

He explained the difference between the two approaches:

"In fee-for-service medicine, paid by insurance companies, there is a lot of emphasis on recordkeeping and billing codes. If all the bookkeeping is not done precisely right, insurance companies can deny or delay payment. That really just distorts the physician-patient relationship.

"In this practice, if it does good to talk to a patient for an hour, I will. If the very best thing is to see them today, I have the flexibility to do that. If a telephone call is helpful, I don't have to worry about how to bill and code for a telephone call. It really allows me to think creatively about how I deliver care to my patients without worrying about how to document my appointments to meet the requirements of the insurance companies."