Concierge Medicine: How It Works, What it Costs and What Is Offered When the Doctor Calls

By Amy Phariss of Aging Outreach Services

NOTE: This is the first of our Local Resources series intended to engage with local professionals from various fields to provide our clients with trustworthy information on a variety of topics. In the future, more content will be uploaded from other local professionals in a variety of fields that we hope will prove useful.

Concierge medicine is often described as a subscription-based medical service and is growing in popularity throughout the United States.

According to research from Concierge Medicine Today, “Concierge Medicine Doctors and Membership Medicine programs have become more popular in the past five to ten years, particularly among the middle-class and upper-middle class.”

Concierge medicine is associated with doctors who spend more time with patients, offer a greater variety of services and often offer greater access for patients to contact the doctor outside of office hours. Rather than long wait times, short office visits and limited ability to ask questions or address concerns outside office visits, doctors who participate in concierge medicine want a better experience for both themselves and their patients. Rather than spending time billing insurance companies and adhering to the restrictions of what many view as a high quantity/low quality practice of medicine, doctors practicing concierge medicine offer screenings, services and (perhaps most valuable of all) time not traditionally covered by many insurance programs. However, as appealing as this sounds for both doctor and patient, concierge medicine comes at a cost, and the price can climb as high as the services offered.

What is concierge medicine and what is included in specialty services?

There are three basic concierge medicine models, including low fee, medium to high fee and very high fee models. Each model provides a baseline level of service, and the cost of service increases with the level of service.

1. Low Fee Models include services such as:

same or next day appointments
extended office visits (more than the typical 15-minute allotted with many insurance plans)
physician email addresses for direct contact

2. Medium to High Fee Models may include:

wellness services
24/7 physician phone access
advanced assessments

3. Very High Fee Models (also known as Luxury Medicine or VIP Medicine) may include:

Private rooms/wings at hospitals
Fast track access to emergency doctors and/or specialists
House calls
Travel accompaniment
Personal hospital physician (rather than floating between providers)

These are just some of the perks associated with concierge medicine. Everything from at-home IV fluids for dehydration to 60-minute office visits are on the table when it comes to concierge medicine.

What does concierge medicine cost and does insurance cover any of it?

There is no doubt: concierge medicine costs more than traditional medical care. Concierge physicians often work on a membership model, where the physician receives a monthly or annual fee to cover the cost of the amenities described above (longer office visits, focus on preventative care, greater physician access).

Yearly fees, according to Concierge Medicine Today (CMT), range from $1,200 to $2,700 annually to retain a concierge physician. These fees can be higher than $15,000 per annum for luxury concierge physicians, and these costs do not cover the costs of procedures, travel and other services.

Many concierge physicians do bill insurance, however, which often pays for the cost of covered services set up by the doctor (mammograms, medications, etc.). CMT reports 80% of concierge doctors accept insurance for both routine appointments and services. Though some services provided will not be covered by insurance, doctors discuss this with patients.

Specific costs of practitioners vary, but many list their prices online. On MDVIP, for example, a local internist charges $412.50 quarterly for subscription to her practice, making her annual subscription fee just over $1600. This comes out to roughly $135/mo.

What is the difference between Concierge Care and Direct Primary Care?

The terminology and definitions surrounding most of health care can often be confusing, and concierge care is no different. Many people believe concierge care is simply care paid for out-of-pocket. However, as noted above, many concierge doctors work with insurance companies and bill for services. The concierge aspect of their practice comes in the form of an additional fee paid for by patients for the benefit of other perks including more time with the physician (who can work with a decreased patient load), house calls and access other services. The key factor in concierge medicine is time. With fewer patients, concierge doctors spend more time and are arguably better able to focus on patients than those who must adhere to shorter office visits, larger patient loads and payment strictly from insurance companies. The supplemental income from patients (in the annual subscription fee) helps bridge the gap for concierge doctors who wish to see fewer patients for longer periods of time and give patients greater access during non-office hours.

Direct Primary Care is direct-pay care. Physicians who participate in direct primary care do not bill insurance companies for services. This is common in the mental health field but is becoming increasingly popular in other healthcare professions. In direct primary care, a physician is paid by and works for the patient. If the patient wishes to bill an insurance agency on his own, that is entirely possible. According to Fischer Clinic in Raleigh, NC, a patient may use his insurance for anything typically covered outside the office visit. For example, if a patient needs an MRI, Fischer Clinic “can submit that referral with the diagnosis codes needed for insurance purposes.” In this case, insurance is useful for specialty care, hospitalization or other procedures not included in routine healthcare. According to Fischer Clinic’s FAQ page, “You may save money because we are not bound by insurance contracts to charge a minimum rate and our wholesale prices are often lower than the price your insurance has negotiated with other providers.”

Often direct-pay care also provides same and next day appointments and longer appointments if needed (Fischer Clinic sets minimum 30-minute appointments).

What is the Hybrid Model?

Between the full-blown concierge model (where patients must pay the annual subscription fee or be booted from the practice) and direct-pay models lives the hybrid model. In the hybrid model, patients are given the choice of signing up for the concierge service, but physicians continue seeing non-member patients as well. This works well for larger practices with patients of various age ranges. The younger patients may not feel the need for concierge services, while older patients may find the cost of subscription well worth it for longer appointments and more resources including communication options like physician email and cell phone numbers. Most practices accommodate concierge patients on specific days, allowing doctors to see fewer patients that day. Also, separate phone numbers are often given for concierge patients vs. non-member patients. In this way, some physicians feel they can provide options for patients rather than a one-size-fits-all practice (concierge vs. non-concierge).

How do I find a Concierge Physician or Practice?

One of the most prominent resources is MDVIP. MDVIP is affiliated with over 1,000 concierge physicians/practices throughout the U.S. The process is fairly simple. Search through MDVIP’s group of affiliated physicians, find one near you, meet the physician and sign a membership agreement. The doctor works directly with MDVIP, sharing a portion of the annual fee you pay with MDVIP for administrative management and support.

Concierge Choice Physicians (choice.md) also offers a doctor search and supports the hybrid model. For example, Raleigh, NC’s A. Leigh Ibach, M.D.’s Concierge Choice Physician page reads: I offer a concierge program for a limited number of patients who are interested in enhanced service and a more personalized approach to their health management.”

Or, simply call the American Academy of Private Physicians at 877-746-7301.

Editor’s Note: Amy Phariss is a lifestyle writer that contributes to numerous outlets. She is also the Editor in Chief of the Aging Outreach Services monthly magazine and online e-zine. Amy, along with Aging Outreach Services, offers client-driven care to assist you and your loved ones through the many challenges of aging. Read more about Aging Outreach Services here; or you can contact Amy through Aging Outreach Services here.

This information is intended to be educational. Hicks & Associates Wealth Management does not provide tax or legal advice. You should consult with a qualified tax, legal or financial professional before making any decisions.

Investment advisory services are offered through WealthShield Partners, LLC (“WSP”), an investment adviser registered with the Securities and Exchange Commission, doing business as Hicks & Associates Wealth Management. Registration as an investment adviser does not imply a certain level of skill or training. More information about WSP can be found in Form ADV Part 2 which is available upon request.

Past performance is no guarantee of future returns. WealthShield Partners, LLC reserves the right to modify its current investment strategies and techniques based on changing market dynamics or client needs. The visuals shown are for illustrative purposes only and do not guarantee success or certain level of performance. This material contains projections, forecasts, estimates, beliefs and similar information (“forward looking information”). Forward looking information is subject to inherent uncertainties and qualifications and is based on numerous assumptions, in each case whether or not identified herein.

This information may be taken, in part, from external sources. We believe these external sources to be reliable, but no warranty is made as to accuracy. This material is not financial advice or an offer to sell any product. There is no guarantee of the future performance of any WealthShield Partners, LLC portfolio. The investment strategies discussed may not be suitable for all investors. Before investing, consider your investment objectives and WealthShield Partner’s charges and expenses. All investment strategies have the potential for profit or loss.