sunny1ib
Expert
- 57
Doctor charges $500 fee per year
- Thread starter shooter
- Start date
sunny1ib
Expert
- 57
Hi Shooter,
Your provider charged you $500 for the year to see him/her? Doctors are starting to go more and more to a "concierge" type of practice. This is not a concierge practice - $500 is what your doctor is charging you to get you into the office "faster" with "little to no wait time", whether you use his/her services or not. It's another form of revenue stream that providers are using to plump up their practice's income due to reduced payments from Medicare, Worker's Compensation insurances, and employer group & individual insurance carriers.
The next question that is usually asked is, "Is it legal to charge this fee?" Sure. The provider can charge this fee. The fee can be set higher, but the provider has an obligation to advise the patient that this is a new service being offered. You have a choice to pay it or not pay it. If you pay it, great. If you don't - either you can expect to be discharged from the practice or you will quit the practice and find yourself another provider.
The term concierge is rather broad, at least in my opinion. Having worked with patients in various concierge practices, I have separated the practice into two types: a hybrid concierge and a traditional/true concierge.
A hybrid concierge is where you either have a provider who you have been using and he/she has decided that they want to size down their practice a bit and provide more personalized care. The key is this practice will take insurance once the concierge fee has been "spent down". Patients are one of three types: low utilizer, a moderate utilizer, and a high utilizer of medical services. Most fees I have seen start at $1250-1900 for a patient with low medical utilization. The fee encompasses a thorough physical work up (that insurance does NOT cover) which includes lab work, possibly a nutritional assessment, and the ability to get into the office right away. The patient may take little to no drugs. Any type of x-ray or other imaging services are performed at the appropriate location and will bill your insurance. Moderate medical utilizers are people who have more complex but stable medical issues. Fees range from $2000-$3000. Same benefits as the low utilizing patient, but this patient will see the provider 2x a year, have 2 physicals and are watched more closely. Nutritional assessments are encouraged especially if a patient has high blood pressure, pre-diabetes, or Type 2 diabetes that is manageable on medication or diet (as examples). The provider will also note if there is any worsening of a specific symptom, or symptoms and will refer out to the appropriate specialists accordingly. These specialists should be part of your insurance plan's network, of which you would be subject to any deductible, copays, coinsurance, etc. The last group consists of high medical utilizers. These are patients who have multiple chronic conditions that must be managed. The typical annual costs are between $3500 - $5000. These patients receive the benefits that the moderate utilizers receive, but their utilization can be very different. Visits to the doctor can be quarterly or monthly, biweekly or weekly. Lab work is done very consistently depending on the diagnoses. Referrals to various specialists are made. Every year, the office administrator reviews the medical charts of each patient to determine which category a patient may fall in. A bill is created and mailed to the patient advising what the new fee will be. It is either accepted or not. If accepted, the relationship continues. If the contract is not accepted, the patient will have to find a new provider. Patient load may be reduced to a certain number, say to 500 patients. All other patients who do not choose to use this doctor and pay the fee will be assigned to a nurse practitioner or a physician's assistant, or to a new physician that has joined the practice.
A traditional/true concierge provider charges a flat fee that starts at $10,000 annually. I have seen some providers charge as high as $25,000 annually. These providers will have no more than 200 patients. Patients have similar benefits as the hybrid practice, but the fee is not dependent on the patient's utilization. This concierge practice may also sell some form of naturopathic supplements, and some do not. Most patients will see the doctor monthly. The patient has 24/7 care, can have telemedicine, the doctor makes house calls and makes rounds at the hospital to oversee care.
I probably provided you with more than you need, but with the way the providers have been "losing" money due to reduced payments from the federal government and carrier contracts, there appears to be a movement in certain areas, particularly in affluent ones, where practices are switching from accepting any insurance (including Medicare) to private, member only practices.
Your provider charged you $500 for the year to see him/her? Doctors are starting to go more and more to a "concierge" type of practice. This is not a concierge practice - $500 is what your doctor is charging you to get you into the office "faster" with "little to no wait time", whether you use his/her services or not. It's another form of revenue stream that providers are using to plump up their practice's income due to reduced payments from Medicare, Worker's Compensation insurances, and employer group & individual insurance carriers.
The next question that is usually asked is, "Is it legal to charge this fee?" Sure. The provider can charge this fee. The fee can be set higher, but the provider has an obligation to advise the patient that this is a new service being offered. You have a choice to pay it or not pay it. If you pay it, great. If you don't - either you can expect to be discharged from the practice or you will quit the practice and find yourself another provider.
The term concierge is rather broad, at least in my opinion. Having worked with patients in various concierge practices, I have separated the practice into two types: a hybrid concierge and a traditional/true concierge.
A hybrid concierge is where you either have a provider who you have been using and he/she has decided that they want to size down their practice a bit and provide more personalized care. The key is this practice will take insurance once the concierge fee has been "spent down". Patients are one of three types: low utilizer, a moderate utilizer, and a high utilizer of medical services. Most fees I have seen start at $1250-1900 for a patient with low medical utilization. The fee encompasses a thorough physical work up (that insurance does NOT cover) which includes lab work, possibly a nutritional assessment, and the ability to get into the office right away. The patient may take little to no drugs. Any type of x-ray or other imaging services are performed at the appropriate location and will bill your insurance. Moderate medical utilizers are people who have more complex but stable medical issues. Fees range from $2000-$3000. Same benefits as the low utilizing patient, but this patient will see the provider 2x a year, have 2 physicals and are watched more closely. Nutritional assessments are encouraged especially if a patient has high blood pressure, pre-diabetes, or Type 2 diabetes that is manageable on medication or diet (as examples). The provider will also note if there is any worsening of a specific symptom, or symptoms and will refer out to the appropriate specialists accordingly. These specialists should be part of your insurance plan's network, of which you would be subject to any deductible, copays, coinsurance, etc. The last group consists of high medical utilizers. These are patients who have multiple chronic conditions that must be managed. The typical annual costs are between $3500 - $5000. These patients receive the benefits that the moderate utilizers receive, but their utilization can be very different. Visits to the doctor can be quarterly or monthly, biweekly or weekly. Lab work is done very consistently depending on the diagnoses. Referrals to various specialists are made. Every year, the office administrator reviews the medical charts of each patient to determine which category a patient may fall in. A bill is created and mailed to the patient advising what the new fee will be. It is either accepted or not. If accepted, the relationship continues. If the contract is not accepted, the patient will have to find a new provider. Patient load may be reduced to a certain number, say to 500 patients. All other patients who do not choose to use this doctor and pay the fee will be assigned to a nurse practitioner or a physician's assistant, or to a new physician that has joined the practice.
A traditional/true concierge provider charges a flat fee that starts at $10,000 annually. I have seen some providers charge as high as $25,000 annually. These providers will have no more than 200 patients. Patients have similar benefits as the hybrid practice, but the fee is not dependent on the patient's utilization. This concierge practice may also sell some form of naturopathic supplements, and some do not. Most patients will see the doctor monthly. The patient has 24/7 care, can have telemedicine, the doctor makes house calls and makes rounds at the hospital to oversee care.
I probably provided you with more than you need, but with the way the providers have been "losing" money due to reduced payments from the federal government and carrier contracts, there appears to be a movement in certain areas, particularly in affluent ones, where practices are switching from accepting any insurance (including Medicare) to private, member only practices.
- 10,346
I like the idea of the fee based dr office model. You pay a monthly fee and get a set amount of annual service. Basically all you need for insurance is catastrophic coverage.
Helpico_Insure
Super Genius
- 145
I don't think you are on the same page.
- 10,346
I dont think you read my other posts. The one you are replying to is a completely different type of practice vs. the "concierge" practices.
Helpico_Insure
Super Genius
- 145
It is clear that the healthcare system pays insufficiently to our doctors (or they are too greedy) and they cut the time given to us, and of course the care. I have a negative personal experience with my Indian MD. It is so obvious he is doing business, so I can't sustain it anymore. He likes to prescribe medications, even he knows I am allergic to some of them. He is really a businessman. Having and paying for a concierge is like paying a fee to us, because the insurer didn't pay us a commission, or the commission wasn't sufficient.
Based on my often travel to Eastern Europe, I started using medical services there, and honestly, a lot better and on time service. There the nurse doesn't play major role at all. If you visit a doctor, your entire time is with the doctor. They have private and gov hospitals. The difference is in the comfort they are offering on the private site.
There are problems as well. It will be too boring to go through their system.
- 4,040
My doctor just started doing a version of this as of January. As of March 1, he will no longer bill Medicare or other insurance, and is dropping out of all the networks he’s in. He explained his reasoning that boil down to three elements:
1) If he doesn’t make some changes, he just can’t afford to remain in business as an independent private practice because of increasing disparity between what it actually costs to provide patients with care and what insurance companies, especially Medicare, will pay based on what they consider “reasonable and customary”.
2) He wants to provide care that’s best for each individual patient, and not dictated by insurance networks or Medicare.
3) He wants to make sure that there’s plenty of time for each patient visit to provide very thorough quality care, and not just be a “patient mill”. (This is a doctor that already routinely spends 45 minutes with a patient. On semi-annual physicals he may take even longer to go over lab results, findings, and recommendations.)
So he’s charging a $500 annual admin fee, and $200 office visits. (I believe other doctors in this area are charging close to that for an “extended visit” anyway.) All patients will become “self pay” as they’re no longer filing claims. However, they will provide you the necessary documents to file yourself. He’s also assigning a PA to each patient, but making the rounds himself during patient visits to review care plans, answer questions, etc. This is part of making sure there’s plenty of time for each patient.
We went to him initially because our previous doctor left town to join a practice in another city. This doctor is very near our house, but has also been listed multiple years as the best family doctor in our town, and one of the best in DFW.
I wasn’t sure what I would think about the new changes to the practice. But when I went in for an emergency visit in January, I paid the fee and the visit charge because I was really in need of some immediate help. My wife’s been seeing him since last spring, but this was my first visit. I was very impressed with the level of service. The PA that I saw was very knowledgeable and took all the time she needed to do a deep dive on my symptoms, and making sure they were dealt with, including ordering an EKG there in the office. I ended up being there almost two hours, and seeing her twice. She also recommended I see a cardiologist immediately based on my EKG, and had already called one to get me a same day appointment! I’ve never had any doctor spend that much time and energy with me. Our last doctor tried his best, but he was under a bigger corporation and always seemed pressed for time.
So, it’s a thumbs up from me so far. These days I can afford to pay the difference between his charges and what insurance pays, so the level of service we’re experiencing is worth it to me.
(BTW, after about three weeks of various tests, the cardiologist cleared me. He said the results were “far better” than he was expecting, and that my heart was really very strong for my age. The particular issue, along with other symptoms, was apparently just stress related, but that’s another story. I also don’t want to discount the possibility that the Lord may have simply healed me, as my church family and others had been praying!)
1) If he doesn’t make some changes, he just can’t afford to remain in business as an independent private practice because of increasing disparity between what it actually costs to provide patients with care and what insurance companies, especially Medicare, will pay based on what they consider “reasonable and customary”.
2) He wants to provide care that’s best for each individual patient, and not dictated by insurance networks or Medicare.
3) He wants to make sure that there’s plenty of time for each patient visit to provide very thorough quality care, and not just be a “patient mill”. (This is a doctor that already routinely spends 45 minutes with a patient. On semi-annual physicals he may take even longer to go over lab results, findings, and recommendations.)
So he’s charging a $500 annual admin fee, and $200 office visits. (I believe other doctors in this area are charging close to that for an “extended visit” anyway.) All patients will become “self pay” as they’re no longer filing claims. However, they will provide you the necessary documents to file yourself. He’s also assigning a PA to each patient, but making the rounds himself during patient visits to review care plans, answer questions, etc. This is part of making sure there’s plenty of time for each patient.
We went to him initially because our previous doctor left town to join a practice in another city. This doctor is very near our house, but has also been listed multiple years as the best family doctor in our town, and one of the best in DFW.
I wasn’t sure what I would think about the new changes to the practice. But when I went in for an emergency visit in January, I paid the fee and the visit charge because I was really in need of some immediate help. My wife’s been seeing him since last spring, but this was my first visit. I was very impressed with the level of service. The PA that I saw was very knowledgeable and took all the time she needed to do a deep dive on my symptoms, and making sure they were dealt with, including ordering an EKG there in the office. I ended up being there almost two hours, and seeing her twice. She also recommended I see a cardiologist immediately based on my EKG, and had already called one to get me a same day appointment! I’ve never had any doctor spend that much time and energy with me. Our last doctor tried his best, but he was under a bigger corporation and always seemed pressed for time.
So, it’s a thumbs up from me so far. These days I can afford to pay the difference between his charges and what insurance pays, so the level of service we’re experiencing is worth it to me.
(BTW, after about three weeks of various tests, the cardiologist cleared me. He said the results were “far better” than he was expecting, and that my heart was really very strong for my age. The particular issue, along with other symptoms, was apparently just stress related, but that’s another story. I also don’t want to discount the possibility that the Lord may have simply healed me, as my church family and others had been praying!)
- 10,346
This model is whats being called a "fee based" practice. Its different than the "concierge" offices like MD VIP.
Insurance is still billed in a concierge office. Insurance is not billed in a fee based office.
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There are a few in my town that Ive looked at joining. Most charge a monthly fee instead of a per visit fee. I like the monthly fee idea for the kids, but the per visit fee better for myself. Labwork is included in the fees for some of them.
I did say what they SHOULD be doing.
If you always have to wait 30 minutes to an hour to see your doctor, find one that values your time too. If your doctor has a hard time spending more than 15 minutes with you, find another doctor.
If you explain this to your doctor and he doesn't agree that it should be this way without having to pay extra for services he should be performing anyway....find another doctor.
We are letting these doctors get away with crappy service. You shouldn't have to pay extra to get a doctor to do his job. If he does not like doing these basic things...find another doctor.
Ever hear about the patient who sued the doctor for making them wait? They won the lawsuit. We need more of this!
Same as being an agent. If you can't "go beyond" when needed, then get out of the business!
Our internist is affiliated with a large local hospital and their office setup (software, staffing, patient portal, etc) is provided by the parent hospital.
There have been a few glitches in the patient portal when they migrated from one web manager to another, and also challenges (most only the provider side) when new patient management software was implemented. Patient records on the "old" system had to be migrated manually so the office runs parallel programs until migration is finalized. Older records, prior to 2018 or so, are archived on a disk or paper files which creates their own challenges.
Seems like the IT manager(s) are a bit inept when looking to "improve" services . . .
One positive from all this is a follow up survey that addresses efficiency, wait time (patient lobby as well as before you are seen by medical support staff and the doc). The survey was implemented last year and we have not waited more than 10 minutes in the lobby, less than that for medical personnel in the treatment room.
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