Concierge Medical Care - Specialists

[Vincenzo Corleone]

Does anyone have any experience or knowledge regarding medical specialists as they relate to concierge service? Are there any medical specialists who provide this service or does your concierge service make arrangements to have a non-concierge specialist squeeze you in who otherwise wouldn't provide priority care? And is there an extra fee for the specialist?

I have a chronic condition for which I see a specialist. The thing is, I don't need them very often, but when I do it's an immediate need. Currently, I have to wait a month to see my specialist - who now considers me a new patient because it's been so long since i needed to see him. So he won't "squeeze me in".

 

[MichaelB]

In South Florida I’ve seen a few ads for specialist concierge practices. I’ve also seen a couple of the local hospitals advertise concierge practices, which supposedly assure immediate access.

 

[Amethyst]

Since moving to Florida in 2019, I have had 3 of my specialists go concierge ($250 a month retainer to have ready access to the doctor).

Specialists who take my insurance are so oversubscribed (no doubt the result of living in an area with lots of elderly people, who see multiple doctors every week) that I've been having trouble getting an appointment with anyone but a nurse practitioner.

 

[Sunset]

Does anyone have any experience or knowledge regarding medical specialists as they relate to concierge service? Are there any medical specialists who provide this service or does your concierge service make arrangements to have a non-concierge specialist squeeze you in who otherwise wouldn't provide priority care? And is there an extra fee for the specialist?

I have a chronic condition for which I see a specialist. The thing is, I don't need them very often, but when I do it's an immediate need. Currently, I have to wait a month to see my specialist - who now considers me a new patient because it's been so long since i needed to see him. So he won't "squeeze me in".

Just go see him on a regular basis, even if you don't "need" him, that way you will be a regular and can get squeezed in.

You didn't say how long an interval between visits currently is, but if it's been a year or two, then perhaps every 6 months would keep you on the list. A lot cheaper than concierge service.

 

[LateToFIRE]

Used a concierge physician for an aging parent many years ago. I don't think specialists typically work this way - as they are usually obtaining patients via referrals. The whole idea seems to be that you get a generalist who is readily available at all hours, who then has close connections to whatever else you might need. In our case, we had the doc's 24/7 cell and he would also make house calls, even to a nursing home. Expensive yes (I forget just how much, but was like an annual fee on top of the usual medical charges).

It was oddly controversial at the time (probably still is). The idea that anyone could "jump the line" or receive special care because their checkbook might be more padded than most others is offensive to more people than I would have thought, including other medical practitioners.

One other option (though possibly a bridge too far cost-wise) is to be a significant donor to a large non-profit medical facility - a wealthy buddy of mine does this, said it costs less than you'd think it would - and gets access to the entire staff/facility on an expedited basis. But, I have no idea what "costs less than you'd think it would" really costs. I do know that if you know board members or have key connections, it helps greatly in terms of access. Someone suggested seeing your specialist more often, and even that right there, establishing yourself as a regular patient would probably pay dividends in terms of access.

 

[Katsmeow]

My understanding is that most concierge primary care doctors do refer you to non-concierge specialists and can get you in more quickly. I haven't tried it myself. If you want to have a concierge doctor talk to them about how they handle specialists. Of course, if they don't know your specialists they might refer you to someone else.

 

[OldShooter]

We have been in a concierge program embedded in a large health care organization for maybe 5 years. The concierge nurse books us for specialists when they are in that organization but she doesn't seem to get a lot of special attention for future appointments. That's a little disappointing as we lose our "special" status when we leave the concierge offices. Overall we are very happy with the program, though.

That said, when we were shopping concierge programs we found that every one was different and not in small ways. For example, some will bill Medicare and others are effectively private pay. Part of the problem is that absent a very well designed concierge contract, the concierge payment may be considered illegal under Medicare rules. My point here is that if you interview three or four concierge practices you are likely to get three or four alternatives for dealing with specialists. I think you'll just have to do the dog work and compile the answers you get.

 

[ivinsfan]

Comments like the ones above are the main reason we didn't snowbird when my DH mitral valve repair started acting up. We had a cardio doc and a valve repair surgeon who were nationally ranked and caring for DH. If something went wrong while we were snowbirds no way we would have immediate access to that quality of care.

 

[jrgators]

My understanding is that most concierge primary care doctors do refer you to non-concierge specialists and can get you in more quickly. I haven't tried it myself. If you want to have a concierge doctor talk to them about how they handle specialists. Of course, if they don't know your specialists they might refer you to someone else.

My concierge doctor is my primary care doctor. I also see 2 specialists which are non-concierge and do not notice being able to get appointments with them any quicker. Only thing I havent figured out yet is how to apply my yearly "fee' to my flexible spending account. Havent had to deal with that in past years since it always seems like I have a major dental expense but this year might be different so will need to file a claim so I get my FSA money back

 

[RetiredHappy]

We both have a concierge doctor who is a PCP. The value is really in that he is extremely well connected to top specialists and does get us in sooner with his help. For instance, in early May 2022, my husband who had never had an endocrinologist for his type 2 diabetes was in a crisis situation with his blood sugar being out of control. Unknown to us at that time, it was caused by a cortisone shot to his shoulder and the orthopedist did not warn him about it. Our concierge PCP gave him the name of a top endocrinologist but when we called, we could only get an appointment in July. We texted our PCP of the situation and he got my husband to see the endocrinologist the following day.

Most recently, I caught COVID and while being generally recovered, I had a cough that was extremely bad and my throat was raw. I was pretty much coughing all day and I texted my PCP and he got on the phone right away with the Infectious Disease Specialist, and got me in to see this specialist the following day for my cough. He quickly diagnosed the COVID cough and prescribed a course of steroid which fixed my cough.

I could go on and on about how many times the concierge PCP has helped us get into the right and best specialist in a timely manner. The main value is the connections that he has.

 

[RetiredHappy]

To add on to my post above, there are no additional charges that get paid to the specialists.

IRS rule is that if the concierge fee includes services and not just a membership fee, then it is tax deductible. We get a Mayo type full physical each year with our concierge doctor and is not billed to insurance. It includes cognitive tests, hearing tests, muscle-fat body analysis (using a machine) and EKG. We get twice a year blood work, and the blood work associated with the annual is not billed to insurance. I think concierge doctors do these extras to ensure that patients can itemized the concierge doctor fee.

 

[Poopycat]

I’m extremely interested in this thread because I have been thinking about concierge doctors because at least one of the areas I’m considering as a long-term destination doesn’t have a great reputation for availability of medical services, especially PCP’s. The question I have is about finding specialists who (1) the concierge might refer me to and who (2) accepted my insurance.

I wouldn’t mind paying extra for a concierge PCP; I could pay the PCP out of pocket and get an ACA plan to make sure I’ve got some coverage for specialist care. It’s not usually PCP visits that break the bank; it’s the surgeries and procedures. But I know that specialists don’t do the concierge thing, and I wonder whether I’d be able to be referred to a specialist who took the ACA insurance. I get frustrated with having to find doctors who accept my insurance, and I currently have decent employer-based insurance. I have noticed lately that when I ask whether a doc is accepting new patients, the first thing the clerk says is “what kind of insurance do you have” and the second thing is “is that with an employer or an individual plan.”

Anyway, one of my big internal debates is concierge or an HMO like Kaiser. When I was a kid, Kaiser didn’t have the best reputation in my family, but now I know a ton of people who love it. It’s a moot point now since I’m not anywhere near a Kaiser service area, but healthcare access is playing a big role in my determination of where to relocate.

 

[RetiredHappy]

@Poppycat, I signed up with an ACA plan for only one year, which was the year immediately after I retired. After that year, that insurer (Blue Cross Blue Shield) pulled out of our state for individual plans, including ACA plans. Because of the "lousy" plans that were offered by ACA that top specialists shun, I switched to buying the best off-exchange private individual plan after that one year. I get no ACA subsidy but I have access to the best specialists with my health insurance. Health care is very important to us. I have paying full freight since the age of 55 and essentially, pay alot of premiums for 10 years until Medicare kicks in. We also make too much to get ACA subsidies anyway if I were to buy from health exchange plans, so it is a moot point.

 

[Sunset]

.....
Anyway, one of my big internal debates is concierge or an HMO like Kaiser. ..

To me , after a couple of HMO's , I finally understood what it means:
Horrible Medical Option !

 

[RetiredHappy]

I agree with @Sunset. I had Kaiser (HMO) in California and that was they only system which I had been in. My specialists were to worst, either they don't want to see you, or scold you for wasting their time. When we moved to Nevada, our PPO experience is night and day. We now have the best specialists, and they want to help you get well. What a concept.

 

[MrsHaloFIRE]

I had a long call with Mayo clinix exec med. If youre interested in traveling. you pay them a eyarly fee. you can then go to them and have a custom exec workup which appears to be standard testing that you can do with a decent PCM at home. BUT. If you need a specialist, they will get you in right away no questions asked same day or nextday. Might be worth a call if yorue iterested. YOuc an ask more specific questions.n

 

[MrsHaloFIRE]

I could go on and on about how many times the concierge PCP has helped us get into the right and best specialist in a timely manner. The main value is the connections that he has.

Im very interested in this. Im in south texas. anyone have any leads with a connect concierge dr like this?

 

[RetiredHappy]

Im very interested in this. Im in south texas. anyone have any leads with a connect concierge dr like this?

I don't have recommendations for your location. My doctor is not here but some of my friends use concierge doctors off MDVIP.com. I believe they are nationwide.

This maybe a place for you to start exploring.

 

[Poopycat]

@Poppycat, I signed up with an ACA plan for only one year, which was the year immediately after I retired. After that year, that insurer (Blue Cross Blue Shield) pulled out of our state for individual plans, including ACA plans. Because of the "lousy" plans that were offered by ACA that top specialists shun, I switched to buying the best off-exchange private individual plan after that one year. I get no ACA subsidy but I have access to the best specialists with my health insurance. Health care is very important to us. I have paying full freight since the age of 55 and essentially, pay alot of premiums for 10 years until Medicare kicks in. We also make too much to get ACA subsidies anyway if I were to buy from health exchange plans, so it is a moot point.

So there still are off-exchange plans? That’s good to hear. I’d be willing to skip ACA plans if there were an alternative that made access to doctors easier. I’ll likely participate in COBRA to start, until I know where I plan to move. Apparently I have more to learn about how to obtain off-exchange plans. When I was on COBRA a couple of years ago, it sounded like the insurer offered the opportunity to convert to an individual plan after COBRA ran out but I had just taken a new job with new insurance so I never found out more.

 

[Poopycat]

I agree with @Sunset. I had Kaiser (HMO) in California and that was they only system which I had been in. My specialists were to worst, either they don't want to see you, or scold you for wasting their time. When we moved to Nevada, our PPO experience is night and day. We now have the best specialists, and they want to help you get well. What a concept.

Interesting POV’s. When I was a kid living in CA, my dad's employer offered the choice of Kaiser or a PPO, not sure which company…probably BCBS. My mom was clear that we would never choose Kaiser, but I think it was more because of her political views, which I won’t get into here.

I have known several people who swear by Kaiser and would never use any other organization. I have a family member who is on it now and she won’t even consider moving somewhere that doesn’t offer Kaiser. She did have one time where it was difficult to get her PCP to let her see a specialist, but she switched PCP’s and hasn’t had trouble since.

I’m guessing I’ll end up in an area not served by Kaiser so it’s probably a moot point.

 

[RetiredHappy]

@Poopycat, yes, there are off-exchange private individual plans that co-exist in the world of ACA. Unlike ACA plans, in the first year, they can reject your application for significant pre-existing conditions. But once they accept you, they will keep you on unless they pull out of the market. The interesting thing is that if you compare unsubsidized ACA plans, the better off-exchange private individual plans are actually a little cheaper than ACA, because they don't have to accept the very sick people when they are applying for the very first time.

We both had great PCPs at Kaiser and they had no qualms in referring us to the specialists. It's most of our specialists who were terrible. Mind you, I had probably the very best OBGYN in Kaiser. But their Allergist, Dermatologist, Gastroenterologist, Podiatrist (first was really bad and I limped for 15 years, the 2nd was great who identified the cause and fixed me), Urologist etc etc who were the worst. The spine doctor refused to see me and the Dermatologist told me that I was wasting his time. The GI doctor said I didn't need to see him. My Allergist was so incompetent that I came close to quitting from this world because nothing that she prescribed had worked and I couldn't see a way out of my misery. I had the best Allergist here in Nevada who stopped the 16 pills which the Kaiser Allergist had prescribed (16x FDA recommended dosage and she said I wasn't taking enough to keep my condition under control), and replaced with a single drug. I no longer suffer.

Kaiser is good for simplicity because it is generally a one-stop shop. Kaiser is suitable for my son who still lives in Northern California and has high functioning autism. He needs that simplicity and not need to stress over looking for PCP and specialists.

 

[Aerides]

So there still are off-exchange plans? That’s good to hear. I’d be willing to skip ACA plans if there were an alternative that made access to doctors easier. I’ll likely participate in COBRA to start, until I know where I plan to move. Apparently I have more to learn about how to obtain off-exchange plans. When I was on COBRA a couple of years ago, it sounded like the insurer offered the opportunity to convert to an individual plan after COBRA ran out but I had just taken a new job with new insurance so I never found out more.

I think you used to live in Florida so I'll share my ACA thoughts:

Those total non-ACA plans are not always great. They are temporary, they have annual caps. Lots more fine print.

In FL, I don't find it any harder to find stuff on my plan than I did when working with a gold-plated employer plan. I have a PPO, so I don't have to bother with referrals. Between DH and I we've seen plenty of quality specialists since retiring (ortho stuff, cardio, gyno, gastro, PT, you name it.)

The only other worry, as someone close to you in age, is "what happens if the ACA goes away before Medicare?" and with each year that passes I worry about that less and less. Personally I worry about it no more than I worry about Medicare going away - both are equally out of my control and equally catastrophic to too many people to be realistic IMO.

There are 10's of millions of people on the ACA. I don't see a world where that rug is literally pulled away. And if it were, into the void would come private plans again, and there would be ways to get coverage. We are all customer$ to the insurance companies above all else. Money finds a way, and you have a lot of it.

 

[RetiredHappy]

@Aerides, our non-ACA plans, not the catastrophic ones, are superior to ACA plans here in Nevada. No annual caps and are not temporary. If there is such a thing as cadillac plans in the individual health insurance world, my off-exchange plan is the cadillac of the individual health insurance plans. It even includes a wide network of hospitals and doctors, including UCLA which I go to a rheumatologist in S. California.

 

[Another Reader]

I’m extremely interested in this thread because I have been thinking about concierge doctors because at least one of the areas I’m considering as a long-term destination doesn’t have a great reputation for availability of medical services, especially PCP’s. The question I have is about finding specialists who (1) the concierge might refer me to and who (2) accepted my insurance.

I wouldn’t mind paying extra for a concierge PCP; I could pay the PCP out of pocket and get an ACA plan to make sure I’ve got some coverage for specialist care. It’s not usually PCP visits that break the bank; it’s the surgeries and procedures. But I know that specialists don’t do the concierge thing, and I wonder whether I’d be able to be referred to a specialist who took the ACA insurance. I get frustrated with having to find doctors who accept my insurance, and I currently have decent employer-based insurance. I have noticed lately that when I ask whether a doc is accepting new patients, the first thing the clerk says is “what kind of insurance do you have” and the second thing is “is that with an employer or an individual plan.”

Anyway, one of my big internal debates is concierge or an HMO like Kaiser. When I was a kid, Kaiser didn’t have the best reputation in my family, but now I know a ton of people who love it. It’s a moot point now since I’m not anywhere near a Kaiser service area, but healthcare access is playing a big role in my determination of where to relocate.

HMO's are all about cost containment, not care. I know fellow Long Covid patients that are stuck with Kaiser. We used to call them the witch doctors of Kaiser when I was a kid and lived near the original location. I can confirm they are not much better now, especially with a new and unknown disease. It took one person multiple hospital visits and tests to get treatment for a dying gall bladder. The staff simply did not believe her. She could have died with a gangrenous gall bladder. No, thanks!!

 

[SumDay]

Our doc switched to concierge, with a $150 a month fee for EACH member of the household. I couldn't justify $300 a month on top of Medicare & Supplement payments.

I'm Facebook friends with her, and she makes house calls, conducts yoga and relaxation classes, has cooking classes for diabetic and weight loss, and only accepts a fixed number of patients. When someone leaves she announces she has a spot. She brags that the can get a high percentage of her clients in on the same day.

It's tempting, and yes we could afford it, but I already feel like we spend enough on health care.