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Old 10-16-2008, 03:17 PM   #21
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You may be right, Coach, not sure. In this case it's more of a membership fee for access to the practice.

But you made me curious. If you retain a lawyer for $10K per year and only use $6k of services, what happens to the difference? I would have guessed that you kiss it goodbye.
You can request it and they wil send you the unused portion .
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Old 10-16-2008, 03:20 PM   #22
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I would not mind paying a co pay and an extra reasonable office charge to a physician but $350.00 a year . What if you only visit him twice a year ? That is quite a mark up .
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Old 10-16-2008, 04:05 PM   #23
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Same thing happened to DH. First the doctor stopped accepting any form of insurance. Then came the letter that talked about the concierge membership fee of $1000. The advantage is supposed to be fewer patients and easier access to the doc.

DH spent a lot of time researching and finding someone who would take on a new Medicare patient. He found someone and tried him out for his annual physical and is happy. (Unfortunately his PSA shot up from 2 -6 in a one year span and so it is back to the urologist for most likely another biopsy.)
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Old 10-16-2008, 04:06 PM   #24
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I would not mind paying a co pay and an extra reasonable office charge to a physician but $350.00 a year . What if you only visit him twice a year ? That is quite a mark up .
I think it's simple supply and demand. The magazine awards (and his skills and reputation) maxed out his practice years ago, and this is about the only way to raise his prices.

I'll go hunt for a younger doc. I was seeing the current doc 1-2 times per year, often just for referrals to specialists for issues with my knee and cornea. I'd also call maybe once or twice a year to ask him to call in an Rx refill "on the house".
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Old 10-16-2008, 04:11 PM   #25
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Since most health ins. is costing 1000+ a month I feel the Dr.'s should charge more to the ins. companies for their services. If the ins. company doesn't want to pay the Dr. can drop them. Simple!

I would send the Dr. a letter back but I won't say here what I would say. I don't want another warning from the mods.
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Old 10-16-2008, 04:15 PM   #26
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I thought it looked like pretty limited services compared to what I had heard about for "concierge medicine". From wikipedia:

"Concierge physicians care for fewer patients than in a conventional practice, ranging from 100 patients per doctor to 1,000, instead of the 3,000 to 4,000 that the average physician now sees every year. All generally claim to be accessible via cell phone or email at any time of day or night. The annual fees vary widely, from $60 to $15,000 per year for an individual, with the lower annual fees being in addition to the usual fees for each service and the higher annual fees including most services. Some concierge practices do not accept insurance of any kind.It should be noted that this annual fee is not a substitute for medical insurance, and generally does not cover consultations outside the practice, laboratory procedures, medicines, hospitalizations or emergency care from other providers."

I must admit though that I really like my doc and would probably pay it. I think it's hard to make a good living in primary care these days.

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Old 10-16-2008, 05:05 PM   #27
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Personally, I think it's worth it. Think of it as a tip.
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Old 10-16-2008, 05:08 PM   #28
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Since most health ins. is costing 1000+ a month I feel the Dr.'s should charge more to the ins. companies for their services.
I am not upset with the Dr, however. He needs to eat too! And while it may cost the consumer a lot of money, how do we know how much gets to the Dr, meaning the "friction loss" to the ins. co? What are his expenses?

One of my friends had gone to a medical practice for years. It was a partnership consisting of 5-6 doctors. They closed shop last year, not even asking for fees like the OP. They simply threw in the towels, period. My friend talked with his doctor, and the reason was simply that they worked too hard for too little money. Better work for hire in a hospital.
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Old 10-16-2008, 05:35 PM   #29
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I would not mind paying a co pay and an extra reasonable office charge to a physician but $350.00 a year . What if you only visit him twice a year ? That is quite a mark up .
We have a $30 copay for primary care and specialists, and a 10 percent copay for all services already. I believe our insurance company also pays $10 or $20 to the doctors' offices for submitting forms. And I guess in lieu of Rich's office visit, we like others would be going to the emergency room after hours and most of that would be covered by insurance.

I could certainly see a group of doctors offering self-insurance--personally I would rather have paid health insurance premiums to doctors rather than insurance companies (and since I never get sick the doctors would have come out ahead on that one). I also don't have a problem with paying for services not covered by insurance (of course I don't need cosmetic surgery, but would definitely pay for it if I did ) or for those cute shoes Rich is now selling in his office.

But I wouldn't pay a concierge services fee for a hotel room or a cruise line, and I don't pay for first class air, so the idea of paying this for medical care seems to be quite the anti-lbym development!
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Old 10-16-2008, 05:50 PM   #30
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I have a hard time with it. We pay for the ins. then pay the co=pay, now they want a tip. Get it from my ins. company.
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Old 10-16-2008, 06:07 PM   #31
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I have a hard time with it. We pay for the ins. then pay the co-pay, now they want a tip. Get it from my ins. company.
Understandable. But in most cases, the big insurance company makes you sign a contract in which the doctor agrees to accept their fees; sometimes but not always you can bill the patient for the difference. And since they own large chunks of market share through aggressive business practice, it is hard for a struggling primary care doctor to decline the contract. And I assure you that they're not pulling down $300K per year - more like mid-100s in most areas - a nice living but not exorbitant in context.

I'm not defending the trend. I'm just observing that if you beat up a profession long enough and "let the market work it out" while simultaneously limiting fees, you'll spawn retail behavior. And you still have 45 million without adequate insurance, and ERs filled with homeless and colds, and life-sustaining drugs at $1,000 a month, and a primary care shortage, and all the rest.

For the record, I have been in large academic medicine for decades. I'm not facing a private practice. But I don't judge my colleagues for wanting some type of supplemental payment to help them provide good care and ample time to those who choose to pay. This type of crap is one reason I am glad to be where I am.
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Old 10-16-2008, 06:18 PM   #32
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And I assure you that they're not pulling down $300K per year - more like mid-100s in most areas - a nice living but not exorbitant in context.
Thanks for info. I always wonder about that. Many professions make that much or more, with less schooling, and none of the headaches, fear of being sued...

It always bothers me as a consumer of health care that I do not know the costs of the middle man. Private insurance or guvmint, there is always the middle man.... Sigh...

I heard that in the old days (30s-50s), before medical insurance was widespread, people paid for doctor's visits out of their pockets, and it was cheap. No paperwork, no middle man. I don't know if people could save and pay for big hospital operations. Maybe they did that too. I appreciate info on this, just for my understanding. Thanks.
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Old 10-16-2008, 06:22 PM   #33
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National health care, here it comes....
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Old 10-16-2008, 06:25 PM   #34
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I haven't read all the other posts, but the one physician who became a "concierge physician" in my area is not at all well regarded by his peers. He doesn't have hospital priviledges, so if you have to be hospitalized, you must pay someone else for the care.
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Old 10-16-2008, 06:35 PM   #35
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I haven't read all the other posts, but the one physician who became a "concierge physician" in my area is not at all well regarded by his peers. He doesn't have hospital priviledges, so if you have to be hospitalized, you must pay someone else for the care.
Fancy does not mean good in medicine (or any other field, IMHO). Membership payments or not, do your due diligence.

A tip: during a non-busy time, call the local emergency room, talk to one of the nurses, and ask her who some good internists (or pediatricians) are. It's often a good start.
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Old 10-16-2008, 09:21 PM   #36
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Whoa. With 3,000 - 4,000 patients in the practice, that $350 is a cool million dollars a year. Even if the practice drops to 1,000 patients that's still $350,000 per year BEFORE even doing one visit with anyone. Wow.
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Old 10-16-2008, 09:28 PM   #37
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I think it's simple supply and demand. The magazine awards (and his skills and reputation) maxed out his practice years ago, and this is about the only way to raise his prices.
You're being told that he's worth more than you're paying him...

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I'll go hunt for a younger doc. I was seeing the current doc 1-2 times per year, often just for referrals to specialists for issues with my knee and cornea. I'd also call maybe once or twice a year to ask him to call in an Rx refill "on the house".
... and now you're telling him that you don't agree.

But perhaps it would be better to be signed up with the new doc before you share this opinion with the old doc...
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Old 10-16-2008, 09:36 PM   #38
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You're being told that he's worth more than you're paying him...

... and now you're telling him that you don't agree.

But perhaps it would be better to be signed up with the new doc before you share this opinion with the old doc...
I'd pay something to stay with him, but not $350 x 2 annually. For the first year...
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Old 10-16-2008, 09:37 PM   #39
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Whoa. With 3,000 - 4,000 patients in the practice, that $350 is a cool million dollars a year. Even if the practice drops to 1,000 patients that's still $350,000 per year BEFORE even doing one visit with anyone. Wow.
I don't know how many patients he is keeping, or what his expenses are, but I know not to judge too quickly. As an engineer, I knew my employers charged a whole lot more to their clients on contract jobs than what they paid me.

Then, when I joined a business venture, I finally understood when I was ultimately involved in writing checks to pay bills. Rent, insurance, utility, attorney and accountant fees, so many things I took for granted before. After working hard for 6 years, we folded. So, it is not what you take in, it's what you get to keep.
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Old 10-16-2008, 09:41 PM   #40
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CB: If you're anywhere near Medicare age, find a new doctor now. Otherwise you might not be able to get one who will accept Medicare. Even if he does accept it, the treatment - as DH and many of our friends have found - can be subpar. As baby boomers retire, if they still can retire, and become Medicare eligible, there will be fewer and fewer doctors who will accept it. I'm assuming the same will be true of Universal Health Care: a great idea if you can see a doctor. But don't count on it.
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