Concierge Medical Care - Specialists

[RetiredHappy]

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.

She does not sound mainstream. Maybe she has problem getting people to sign up with her. My concierge doctor doesn't do these non-medical stuff. He also has a long wait list and he interviews them before he accepts them.

 

[RetMD21]

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?

IDK if you are using an institutional or small practice doc. Essentially everybody has staff screening patients but independent an doc might have a more flexible system. I might just try a different one.

 

[Markola]

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.

These are all brilliant ideas! Use your money and connections to board members to make some other poorer and less-connected slobs lose their spots in line. And because your rich friend takes a charitable deduction for his “gift” (what a word), you and all other tax payers get the privilege of subsidizing his first-priority doctor appointments! Love it.

 

[OldShooter]

These are all brilliant ideas! Use your money and connections to board members to make some other poorer and less-connected slobs lose their spots in line. And because your rich friend takes a charitable deduction for his “gift” (what a word), you and all other tax payers get the privilege of subsidizing his first-priority doctor appointments! Love it.

Life is not fair. The statistical fact is that people with more money are healthier. I am hoping that our concierge program membership helps to make that true for us as well. So far, so good,

 

[Katsmeow]

We just moved to new state (Delaware) where we know no one. I am thinking we will sign up for a concierge doctor. We would need one who takes Medicare.

Just a few years ago I would thought it was a waste of money. I rarely saw a primary care doctor and took no prescriptions. DH saw a bit more but not a lo. Now...time has passed and we have more regular stuff we need. And there is more of a desire to make sure that we are coordinating everything among different doctors.

I am thinking we might try it for a year and see if we get enough use out of it. Our main priority right now is finding someone who can see us relatively soon and can give us good referrals to the specialists we need. We have ongoing medication and visit needs so don't want to mess around for months trying the find a primary care doctor, get an appointment a long time from now, get hurried referrals and then have to wait for specialists. If we can shorten all that then it is worth it to us.

Of course, we have to first find a concierge doctor. I've heard of MDVIP and there are several in this area. I also think from searching online there are others who aren't part of MDVIP. I have in mind to research the doctors that I can find and then set a meet and a greet with a few of them and then decide.

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

I think what was being talked about are ACA compliant plans that are sold off marketplace. They are not the termporary short term plans. The plans sold off marketplace have to meet at least the same coverage requirements of ACA plans and comply with them. They are sold off marketplace so are not eligible for subsidies so the people choosing them are all paying on their own (they are priced according to ACA rules). One of my kids had one of these plans one year and it was overall a bit better network and better coverage.

 

[teej1985]

Concierge charges you a fee and bills your insurance, With direct primary care- you bypass insurance altogehter:

https://www.dpcare.org/dpc-practice-locations

 

[RetiredHappy]

Concierge charges you a fee and bills your insurance, With direct primary care- you bypass insurance altogehter:

https://www.dpcare.org/dpc-practice-locations

Why in the world would anyone go to "direct primary care"? I can find zero reason to go there.

Concierge charges an annual membership fee. When you see them, it is like a normal visit, where you pay a co-pay if applicable and they bill insurance for the rest.

 

[OldShooter]

... Concierge charges an annual membership fee. When you see them, it is like a normal visit, where you pay a co-pay if applicable and they bill insurance for the rest.

Be careful with generalizing. That's the way our concierge program works. Other programs we looked at handled things differently. AFIK there is no "standard" for these programs. For example we have reserved parking; others may not.

 

[RetiredHappy]

Be careful with generalizing. That's the way our concierge program works. Other programs we looked at handled things differently. AFIK there is no "standard" for these programs. For example we have reserved parking; others may not.

I see that you are on a concierge program which is part of a health organization. I would think that that is more restrictive in terms of getting the "best" specialists who are not part of the health organization. The model that we have here in Nevada is that it is not a concierge program, but rather, a concierge PCP. The Concierge PCP collects the annual membership fee. The PCP maintains a close with the top specialists so that his/her patients can get in with those specialists in a timely manner.

There is also no question of legality with Medicare, since a medical consult in office or through Telehealth is billed as standard visit. Phone calls, texts and emails incur no cost/billing to Medicare or health insurers.

https://www.medicare.gov/coverage/concierge-care

 

[OldShooter]

... I would think that that is more restrictive in terms of getting the "best" specialists who are not part of the health organization. The model that we have here in Nevada is that it is not a concierge program, but rather, a concierge PCP.

I have not had any problems getting referred outside the organization. Re solo concierge PCPs I interviewed two or three when we were shopping, but felt that one isolated doc was more likely to have availability issues due to workload, vacations, etc. Also his/her access to resources is necessarily limited to people he knows.

Our program has three docs plus two nurse support troops in a private office area. We are on a first-name basis with all of them. Same day/next day appointments have never been an issue. One of the three always carries "the cell phone," giving us 24x7 access. Lab, x-ray, and imaging are just a short walk down the hall and usually no waiting. By the time I return to the doc's office the images are already on his/her screen.

 

[RetiredHappy]

I have not had any problems getting referred outside the organization. Re solo concierge PCPs I interviewed two or three when we were shopping, but felt that one isolated doc was more likely to have availability issues due to workload, vacations, etc. Also his/her access to resources is necessarily limited to people he knows.

Our program has three docs plus two nurse support troops in a private office area. We are on a first-name basis with all of them. Same day/next day appointments have never been an issue. One of the three always carries "the cell phone," giving us 24x7 access. Lab, x-ray, and imaging are just a short walk down the hall and usually no waiting. By the time I return to the doc's office the images are already on his/her screen.

My doctor's practice has 4 staff, 2 MA/tech and 2 support staff. He also has a contracted 3rd party lab with the phlebotomist in his office. My PCP is always accessible by text even in off hours. I caught COVID a month ago while in London and when I texted him, it was at 10:30pm on Saturday back here. We continued to text on and off until about midnight before I gave him a break. When he is on vacation, his full staff is always in the office to continue to work. When we had our annual exam, EKG and other cognitive tests were done with his staff and he was on vacation then. My husband got a nasal swab done at his office for a non-COVID coronavirus infection while the PCP was away. Overall, we are very pleased with the professionalism and accessibility.

There are a few practice here with 2 concierge doctors.

 

[Vincenzo Corleone]

So I corresponded with my PCP who made a recommendation for a specialist who doesn't participate with any insurance. My PCP said that's as close to concierge as possible in this particular specialty - at least in my part of the country.

 

[Markola]

Life is not fair. The statistical fact is that people with more money are healthier. I am hoping that our concierge program membership helps to make that true for us as well. So far, so good,

You missed my entire point. A forthright concierge program is entirely different from a wink, wink, nod, nod “You give us a fat ‘gift’ and schmooze our board members and we give you privileged care.” The fact that tax payers subsidize these under the table, often informal and unspoken, programs, in which these quid pro quo “philanthropists” take tax dedications for their “gifts” is what self-dealing laws are meant to prevent. It is certainly unseemly and my bet is that a judge would find them illegal.

 

[Katsmeow]

So I corresponded with my PCP who made a recommendation for a specialist who doesn't participate with any insurance. My PCP said that's as close to concierge as possible in this particular specialty - at least in my part of the country.

I would be very careful going to a specialist who doesn't participate with any insurance unless the specialist is a psychiatrist.

Most other specialists make money through doing procedures and those can cost a lot of money. I would hate to see a cardiologist who didn't take insurance.

Primary care providers often do concierge because it works well with their practice. They do few procedures and mostly have patient visits.

 

[teej1985]

Why in the world would anyone go to "direct primary care"? I can find zero reason to go there.

Concierge charges an annual membership fee. When you see them, it is like a normal visit, where you pay a co-pay if applicable and they bill insurance for the rest.

Because the DPC membership fees are less than most Concierge Medical memberships?

 

[RetiredHappy]

Because the DPC membership fees are less than most Concierge Medical memberships?

With this particular thread, we are not talking about cost savings. Instead, we are talking about getting the best possible care, where money can buy within reason.

 

[teej1985]

With this particular thread, we are not talking about cost savings. Instead, we are talking about getting the best possible care, where money can buy within reason.

Whos to say that the DPC doctors who don't want to mess with insurance companies don't provide the best care?

 

[RetiredHappy]

Whos to say that the DPC doctors who don't want to mess with insurance companies don't provide the best care?

No billing to insurance, I will stay away from it. No incentive to provide you more than $70 per month worth of care. You pay what you get for.

 

[Mansderm]

My recent experience

If you can afford it, do both. As a retired healthy medical provider who became Medicare eligible, I had a PCP in one state who accepted Medicare. However I was moving to another state. Getting into a PCP as a new Medicare patient is difficult and can take months. I did find one in the new state, but ended up having to go concierge for some hormone therapy. So I was "all established" with 3 practices while I transitioned my move.

After avoiding COVID for almost 3 years, I finally got it in June while staying with my son and helping with my new grandson. I was very sick. Calling the PCP was impossible to get thru to a person. I used portal for both explaining I'm very sick, do I come in, should I go on Paxlovid, etc. Never got a response from first PCP office. I contacted the concierge last thinking that since their specialty was hormones, they wouldn't want to deal with COVID. My concierge practice is who called me right back and called in Paxlovid. The new PCP got back to me the following afternoon on the portal saying a script was called in and "per protocol" they were billing Medicare for a "telemedicine visit." That script never made it to the pharmacy and by the time I would have gotten thru again and waited, I would have been beyond the window of treatment.

If you can afford having a concierge provider, it cost very little to remain established with a PCP that is not concierge. This is in case your situation changes...such as you move, your provider dies, retires, or changes practice, and/or you want to see a certain subspecialty and only one can get you in quickly. If they have an objection to that, I say, I travel a lot so need to make sure I have access. If they still object, keep looking. You do have to keep them both informed of what the other is doing so you do get the best care.

As far as the comment about staying away from a provider that doesn't take insurance, I disagree. Our practice only took traditional Medicare. The first 3 years, we were in contract with several insurance companies but insurance companies do not play fair, so we dropped them all. We did submit claims and charged a fair price, but patients were responsible for the full fee. Medicare rules are very straight forward, only change once a year and you are given time to consider the new rules. Insurance companies deny claims to delay payments, misrepresent what they do and do not cover or make it difficult to find out until you file the claim, the practice has to negotiate a fee schedule every year, the list can go on and on. Insurance companies are in the business of making money; Medicare is trying to make best use of the money they are given.

 

[RetMD21]

The new PCP got back to me the following afternoon on the portal saying a script was called in and "per protocol" they were billing Medicare for a "telemedicine visit." That script never made it to the pharmacy and by the time I would have gotten thru again and waited, I would have been beyond the window of treatment.

I probably world have reported them for fraud