Concierge. HP/HPE Alumni

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Concierge care. (Nov 21, 2021) Question? Email: info@hpalumni.org

Basics. (This information is from the official Medicare site. However, the concierge business model is used by primary-care doctors who see families and adults of all ages.)

What it is

Concierge care is when:

- A doctor or group of doctors charges you a membership fee.

- They charge this fee before they’ll see you or accept you into their practice.

- Concierge care may also be called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care.

- When you pay this fee, you may get some services or amenities that Medicare doesn’t cover.

Things to know

Doctors who provide concierge care must still follow all Medicare rules:

- Doctors who accept assignment can’t charge you extra for Medicare-covered services. This means the membership fee can’t include additional charges for items or services that Medicare usually covers unless Medicare won’t pay for the item or service. In this situation, your doctor must give you a written notice called an "Advance Beneficiary Notice of Noncoverage” (ABN) listing the services and reasons why Medicare may not pay.

- Doctors who don’t accept assignment can charge you more than the Medicare-Approved Amount for Medicare-covered services, but there’s a 15% limit called the "limiting charge."

- All Medicare doctors (regardless of whether or not they accept assignment) can charge you for items and services that Medicare doesn’t cover.

Medicare doesn't cover membership fees for concierge care.

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

We investigated one HPAA member's concierge-related case...

The doctor's public web page lists the specific Advantage plan.
The doctor's personal comments mention "...developing a long term relationship with my patients." Apparently, that is the notification of the concierge fee.
In faint gray type at the bottom of the page it says: "XXXXX Health does not manage the insurances accepted for this doctor. Please contact the office directly to confirm coverage."

Going to the website for the specific Advantage plan, the lookup database of in-network doctors for that plan lists the doctor.

HPAA member Question? Email:

"I've been with a concierge doctor for the last 15 years. For the fee, they offer a set of services that I find very useful but you'll still need medical insurance. You will have no access to them, in or out of network, if you don't join their practice and pay their fee. My doctor is with MDVIP (https://www.mdvip.com) and the fee just went up to $1,800/year. When I started with a concierge doctor in 2006, it was only $600/year."

"My parents had a concierge doctor. Was well with it. We had his personal cell phone # and were able to call 24hr and could get appointments on the same day."

"She told me of her new business model at the end of 2019 and I declined to stay with her, but recently a medical scare prompted me to pay her and use her again as PCP. [The Advantage plan] did not show her as in-plan for 2020 but, as you saw, they do list her now. She submits bills and they pay."

"The ACA [and sites like Aon] lets users sort plans by cost. The unwary can get roped in, sign up for a plan and only later get a nasty surprise about the PCP they intended to use."

"Do they serve wine and cheese in the waiting room?"

--cg, moderator
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