How does concierge medicine work with my health insurance?
Written and edited by Michael Tetreault, © 2009-2013 Concierge Medicine Today, All Rights Reserved.
It’s important to know that concierge medicine or a fee paid to a concierge doctor is not considered in any way a type of insurance coverage, company or product. Payment to a concierge doctor in the form of a retainer or subscription fee entitles patients to office-based services and telephone conferences if needed. (See Chapter 6 in The Patient Guide To Concierge Medicine for a complete list of the typical services provided by concierge medicine and direct primary care clinics).
Patients who are under the care of a concierge medicine physician are encouraged to be insured by a PPO, Medicare or a major medical plan. This allows for coverage of services provided outside of your doctor’s office, such as catastrophic accidents, labs, radiology studies, specialty care and hospitalization.
While most (approximately 80% of concierge doctor’s offices) participate in Medicare or various PPO insurance plans, Medicare and other private insurances do not cover the annual fee. This is a completely separate fee that you pay directly to your doctor or doctor’s office in return for the enhanced access and other related services. Out-of-office charges and services provided by specialists and hospitalization expenses are billed directly to your insurance company or Medicare. Many concierge doctor’s offices will bill your insurance company or Medicare for services outside of the service contract your physician gives you when you sign up and pay your fee.