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Doctors fees

cmdmfr

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I had just received a call from a friend of mine he told me that his doctor is going to start charging his patients $1650.00 a year to stay with him. He also said that his doctor is not going to accept his insurance the patient will pay what the doctor wants then get reimbursed from the insurance. The bad part is he will not be able to afford it. The $1650. Is for his family dr only then his heart dr wants about $1500.00 a year that is only him now his wife will also have to pay so he said that if this does happen it means that he will have to pay up front every year about $7000.00 to stay with his doctors I just don't know how this will work. I heard of my doctor going to star it but nothing came of it. Just like to know what do people think of this kind of billing. To top it off his insurance for him and his wife is about $400.00 a month which is about $4800.00 a year with insurance and the other doctors fees he will have to pay almost 1000 a month for doctors and that does not include special test and meds
 

DeniseM

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Easy decision: change doctors
 

ronparise

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do I understand correctly that this $1650 is for the doctors services for a year whether you see him twice a month or twice a year

Or is this an advanced payment like a lawyers retainer

I've never liked the piece work approach that most doctors and insurance companies use so I see a annual bill as a positive thing. I'm just not sure how it interfaces with insurance companies

From what you describe I like it but like any change its going to be an interesting transition

If it doesn't work for you it's time for a new doctor
 

Passepartout

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I'm sure your insurance has a list of doctors in it's 'system' that are approved to accept their insurance, along with a co-pay.

'Subscription' doc's are something for the very wealthy who want a doc 'on retainer' for immediate access.

Find a doc that fits with your use and healthcare budget.

Jim
 

Blues

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This trend toward boutique doctors, or concierge medicine, is becoming more common here in California. We're constantly getting emails here at work, saying "my doctor is going concierge, anybody know of a good doctor that doesn't have these bogus charges?"

The way it usually works here is that the $1500 per year charge is in addition to any charges for office visits or other services. It's simply a fee that allows you access to your doctor in the first place. It sucks. On one hand, I understand that doctors are being squeezed by insurance company reimbursement rates. But I would oppose ever frequenting a doctor with these charges. YMMV.

Bob
 
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geekette

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There is no medical provider I would pay a membership fee to. Um, well, in the here and now. If I develop some rare wacky illness and the only providers that can treat it have this upfront fee, well, I might see my way clear to gaining access to those specialists. Generally, tho, no way.

One thing I am wondering, tho, is if this upfront fee goes into your annual med expenses bucket that goes towards deductibility? IRS might not allow it so paying it might just be down the rabbit hole.
 

Beaglemom3

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Just want to give a little offset to this. No disagreement, but it helps to peek in on the other side.

The best physician I ever had went the "boutique" route too, but it was understandable. This was 7 years ago.

Due to her practice's contractual agreement (capitation) with the insurers, as with all insurers, she was seeing patients about every 15-20 minutes in a normal 9 hour work day. This does not capture call backs, reviewing labs, ordering tests, consults, etc.

She was frustrated that she could not give the care she wanted to due to time constraints. Often times she would call me from home to see how I was feeling if I had seen her that day or the day before. You could tell that she was preparing supper or was holding one of her children when she called. She was beyond wonderful.
So, after 12 years (and her 4 kids), she decided to practice medicine in a boutique practice and the additional charge was $5k/year in Brookline, Ma.

So, I found a new Doc who is good and stepped into her shoes, but did not fill them.

There is a lot written on capitation, but here's one explanation:

DEFINITION of 'Capitation Payments'

Payments agreed upon in a capitation contract by a health insurance company and a medical provider. It is a fixed, pre-arranged monthly payment received by a physician, clinic or hospital per patient enrolled in a health plan with a capitated contract. Monthly payment is calculated one year in advance and remains fixed for that year, regardless of how often the patient needs services.

BREAKING DOWN 'Capitation Payments'

Capitation payments are defined, periodic, per-patient payments (usually monthly) for each individual enrolled in a capitated insurance plan. For example, a provider could be paid per-month, per-patient, despite how many times the patient comes in for treatment or how many services needed. The payment varies, depending on the capitation agreement, but generally they are based on characteristics such as the age of the individual enrolled in the plan. Modifying the plan according to specific characteristics for groups of patients is one way to compensate providers for the medical care expected for similar ailments within a group.


And here from the AMA: http://www.ama-assn.org/ama/pub/adv...rm/evaluating-payment-options/capitation.page


-
 
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Pat H

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There have been several Dr's in the Hilton Head area who have gone concierge. I have not heard that they will not accept insurance though. The Dr's actually give the patients their cell #. The ones I know of were all GP's.
 

Phydeaux

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Very simple call. Fire that physician immediately.
 

bogey21

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If you can afford it, these may be good deals. No waiting for appointments, more face time with Doctor, prompt telephone consultations when you want it, etc. If you are so inclined, you can probably take the receipt from your visit, file it with your insurance company and get reimbursed for some of what you paid. I hasten to add, not my cup of tea.

George
 

am1

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If they can make it work more power to them. Wonder how much this is to do with more people then ever getting health care.

Thankfully I do not need to pay this. Sometimes the initial consultation fee is higher which is understandable.

Most doctors we use we have their cell numbers.
 

GetawaysRus

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I know that we are not supposed to be political here on TUG, and this is NOT meant to be political. This is just reality, and in many ways it is unfortunate.

The trend toward concierge medicine is brought on by the declining reimbursement to doctors and hospitals. For example, your doctor has ongoing expenses (rent, staff, computers, processing insurance paperwork, etc.), and these tend to rise from year to year.

At the same time, the insurers who foot the bill for most of our medical care (and for many patients, this means the government) are paying your doctor less and less for the service he provides. This makes it harder and harder to provide the level of service that most doctors wish to offer, and harder and harder to stay in business.

Another trend you will read about: some doctors are selling their practices to a local hospital and becoming hospital employees. That relieves the doctor of the day to day headaches of running a medical practice.
 

ronparise

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Im not sure its better than fee for service medicine, but I dont think its worse either.

getaway russ has it right, its not the doctor thats at fault for trying to make a living, its the insurance companies


I remember when my brother in law finished his internship and the decision he had to make. hospital employee or private practice
 
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Ty1on

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I know that we are not supposed to be political here on TUG, and this is NOT meant to be political. This is just reality, and in many ways it is unfortunate.

The trend toward concierge medicine is brought on by the declining reimbursement to doctors and hospitals. For example, your doctor has ongoing expenses (rent, staff, computers, processing insurance paperwork, etc.), and these tend to rise from year to year.

At the same time, the insurers who foot the bill for most of our medical care (and for many patients, this means the government) are paying your doctor less and less for the service he provides. This makes it harder and harder to provide the level of service that most doctors wish to offer, and harder and harder to stay in business.

Another trend you will read about: some doctors are selling their practices to a local hospital and becoming hospital employees. That relieves the doctor of the day to day headaches of running a medical practice.

And the hospital probably gets a lower group rate on malpractice insurance (insurers see a policy spread over a higher number of covered individuals as lower risk)

By the way I don't think there was anything political about your post. You didn't use the one buzzword that would have turned it political.
 

Beaglemom3

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Concierge practice first came on the scene about 1996 and has continued to grow.
Here is a quick history (there's more on the site http://conciergemedicinetoday.org/2013/10/04/2453/)

The History of Concierge Medicine

By cmtdpcjournal on October 4, 2013 • ( 0 )
Last Updated: Sunday, October 29, 2014
By Michael Tetreault, Editor-In-Chief, Concierge Medicine Today
Brief And Abridged History Of Concierge Medicine And The DPC Healthcare Marketplace.

•1996: •Dr. Howard Maron and Scott Hall, FACP established MD2 (pronounced MD squared) located in Seattle, Bellevue, WA and Oregon. They charged an annual retainer fee of $13,200 and $20,000 per family.

•1999: •Medical Professionalism Project-consisting of members of the internal medicine community, including representatives of ACP and the American Board of Internal Medicine, set out to draft a charter that could serve as a framework for understanding professionalism.
•Institute of Medicine releases the now famous report of medical errors, Patient safety, and professional integrity that caused further probing in physician exam rooms.

•2000: •Virginia Mason Medical Center in Seattle, WA began operating concierge medical services within its facilities and used some of the profits from the 5 physician practice to subsidize other programs and indigent care services.
•MDVIP, founded by Dr. Robert Colton and Bernard Kaminetsky, in Boca Raton, FL. A brand of Concierge Medicine practice and management firm which has set-up more than 700 concierge medical practices with offices in almost every State across the U.S. Update: In April 2014, Procter & Gamble announced the sale of MDVIP to a private equity firm, Summit Partners.
•“We recognized back in 2000 that health care was moving from personal to a more institutionalized form, and it was not what we wanted to do. We felt we needed to have time with our Patients, to have the excellence to have the time with Patients. Health care has been cutting reimbursement to doctors, which has forced doctors to see more Patients, so the time doctors have with their Patients has declined. The average time today with Patients for most doctors is only 10 minutes.” ~Dr. John Blanchard of Premier Private Physicians, Troy and Clarkston, Michigan.

•2001: •American Medical Association writes concierge physician guidelines: PRINCIPLES OF MEDICAL ETHICS.

•2002: •ACB Foundation , ABIM Foundation and the European Federation of Internal Medicine defines ethical principles and responsibilities contracts between Patient and physician, which is in a language that suggests both parties have equality, mutual interest and autonomy.
•Medicare addresses Concierge Medicine and retainer fees.
•Centers for Medicare and Medicaid, CMS, outlined its position on concierge care in a March 2002 memorandum. The memorandum states that physicians may enter into retainer agreements with their Patients as long as these agreements do not violate any Medicare requirements.
•Pinnacle Care establishes Patient care with a one-time membership fee for access to VIP service.
•The AMA counsel on medical services issued a report in June 2002 on Special Physician-Patient contracts. It concluded that retainer medicine was a very small phenomenon.

•2003: •American Society of Concierge Physicians was founded by Dr. John Blanchard. The association later changed its name to SIMPD, Society for Innovative Practice Design.
•AMA issued guidelines for boutique practices in June 2003.
•Department of Health and Human Services rules the concierge medical practices are not illegal and the federal government the OIG, Office of the Inspector General, takes a decidedly hands off approach.
•American College of Physicians writes doctors struggle to balance professionalism with the pressures of everyday practice.
•June 2003 the AMA Council on Ethical and Judicial Affairs outlines guidelines for “contracted medical services”. The AMA House of Delegates approves these guidelines.

• 2004: •GAO, General Accountability Office writes 146 concierge physicians in the U.S.
•Harvard University study finds that 55% of the respondents are dissatisfied with their health care, and 40% of that 55% agreed that the quality of care had worsened in the previous five years.

•2005: •The AOA, American Osteopathic Association adopts not to recommend and an official policy on concierge care.

• 2006: •MDVIP, a concierge physician practice management firm, reports that 130 physicians within their network treat up to 40,000 Patients worldwide.

•2007: •Concierge Medicine Today, a concierge medical news agency opens its doors to be an advocate for news pertaining to the Concierge Medicine, retainer-based, boutique, private medicine and direct care industry.
•Concierge Medicine Today, announces the formation of The Concierge Medicine Research Collective.
•The term “direct practice” was first used in legislation in Washington in 2007 that clarified these practices were not insurance companies under state law-but they do provide basic, preventive medical care.

•2008: •Boasting an estimated 35 concierge physician practices, Orange County, CA appeared to be a leading hub of Concierge Medicine.
•Concierge Physician of Orange County (CPOC)– a non-profit group of existing concierge physicians was founded.

•2009: •Concierge Medicine Today, reveals that concierge medical practices across the U.S. are thriving in a recession.
•Procter & Gamble Acquired MDVIP in 2009 – No less a respected corporation than Procter & Gamble (NYSE: PG) has staked out a major presence in Concierge Medicine. In 2007, P&G acquired a 48% stake in MDVIP, a Concierge Medicine company that was formed in 2000. Then, in December 2009, Procter & Gamble acquired 100% ownership in MDVIP for an undisclosed sum. This acquisition was reported by Dark Daily. (See “Boutique Medicine Venture Generates Marketing Intelligence for Procter & Gamble,” April 5, 2010.)

• 2010: •SIMPD reorganizes, expands its vision, and rebrands itself the American Academy of Private Physicians (AAPP).
•Concierge Medicine Today, reveals the affordability of concierge medical and private medicine practices across the U.S. stating that over 62% of the programs offered to Patients cost less than $135/mo.
•American Academy of Private Physicians (AAPP) forms first local chapter in Orange County, California called AAPP,OC (formerly CPOC)
•According to a 2010 American Academy of Family Physicians survey, three percent of respondents practice in a cash-only, direct care, concierge, boutique, or retainer medical practice.

=
 

presley

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It's an interesting thought for those who go to the doctor often. I tend to go once a year or every couple of years.
 

Patri

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If you can afford it, these may be good deals. No waiting for appointments, more face time with Doctor, prompt telephone consultations when you want it, etc.
George

This would be ideal, but I bet there is no guarantee. I really don't see how this type of medical service would be more beneficial to the patient financially. Hopefully, enough physicians stick with the traditional practices.
 

vacationhopeful

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.....
Another trend you will read about: some doctors are selling their practices to a local hospital and becoming hospital employees. That relieves the doctor of the day to day headaches of running a medical practice.

Selling/buying DONE is actually the patient lists and records .. not the practice with its the former liabilities or medical building.

My Family Practice had been in business since the early 1950s ... full waiting room, inhouse lab (samples collected type), billing office, referral person and OPEN from 7AM to 10PM M-Sat with limited Sunday hours.

Local hospital who got into a chain (another partial buying of assets) of hospitals and started NEW Family Practice centers ATTACHED to walkin emergency clinics. Need to see a doctor ... call the Family Practice side where YOUR insurance copay is $15 and wait 3 to 10 DAYS for an appointment; need to see a doctor TODAY or in the AM, come in to our urgent care (as we share your medical records & your followup can be schedule with them) but YOUR co-pay is at Emergency Room rates which my insurance company wants $100 for the co-pay.

Don't get the flu or a have a kid who gets HIGH fevers once a month in my area.
 

WinniWoman

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I am so sick of all insurance companies- health, auto, homeowners...

What would happen if everyone stopped paying for insurance- across the line...?

I work in healthcare and it is a nightmare.

Now I am reading that this year 35% of employers are going to impose a surcharge on spouses if they can get insurance through their own employers. It is just getting ridiculous!!

Just squeeze, squeeze, squeeze people until there is no more blood left. :mad:
 

FLDVCFamily

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My husband's doctor went this route about 2 years ago. The charge was also $1650/patient/year so maybe it was through the same company. This company blew up our phone for months and months trying to get us to sign up. DH dropped this doctor, as did I'm assuming most of his patients. We did have one friend sign up to stay on, but he has a number of medical issues and this may have been a good deal for him due to the need for increased access to the doc.

We haven't been able to find DH a new PCP accepting new patients yet, so he just goes to urgent care if he gets sick. So far no biggie.

I understand why a doctor would go the concierge route, but I also understand why most people (us included!) won't pay for this type of doctor.

ETA - I have to be honest here. If the kids' pediatrician went this route, I'd pay up to stay in his practice. He's the exception to the rule though. His practice is also under the umbrella of a big local hospital now though so hopefully the boutique thing isn't going to be an issue.
 
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Fern Modena

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What would happen if there was no more insurance?

  • Working class people who live from paycheck to paycheck would not be able to get to work if their cars died and they didn't live in an area with great public transit;
  • People who lose their houses in a fire wouldn't be able to rebuild;
  • People who are robbed/burgled would be unable to replace anything;
  • People without health insurance may not get vaccinations and spread diseases which are avoidable through vaccines;
  • People without health insurance who have chronic health problems which require treatment will die if they can't afford treatment.
  • Add your own items to the list...

I remember what it was like when insurance didn't pay much for office visits. Your child fell at school and was limping, and you'd let them limp for awhile as long as they weren't crying, etc.

Fern


I am so sick of all insurance companies- health, auto, homeowners...

What would happen if everyone stopped paying for insurance- across the line...?

I work in healthcare and it is a nightmare.
--- some stuff deleted---
 

am1

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I try to self insure where I can. For somethings the deck is stacked against that.

I am so sick of all insurance companies- health, auto, homeowners...

What would happen if everyone stopped paying for insurance- across the line...?

I work in healthcare and it is a nightmare.

Now I am reading that this year 35% of employers are going to impose a surcharge on spouses if they can get insurance through their own employers. It is just getting ridiculous!!

Just squeeze, squeeze, squeeze people until there is no more blood left. :mad:
 

bobpark56

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Self Insure? Often Yes, But Not for Medical Care

I try to self insure where I can. For somethings the deck is stacked against that.

I'm generally a fan of self insuring, but not where medical care is concerned. I often see physicians & hospitals billing as much as 10 times the rates that they agree to accept from insurers or Medicare. This seems to be one area where it really can pay you to pay someone with power represent you.
 

WinniWoman

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You pay and pay these premiums year after year after year. Then, when you have a claim, you have to fight to get it paid. I know insurance can be a good thing when you really need it, but that's if they actually pay out anything. All the ^&*((* that you have to go through and all the money you have to spend is just despicable IMO. And one of the reasons everything is so expensive is because insurance exists. If it didn't prices on everything would have to come down. Liability- lawsuits -is the other reason everything is so expensive and you have to have insurance.

(I know it is not today's reality, but I think about what it must have been like back in the olden days when there was no such thing as insurance. How did people do it then?)
 

isisdave

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It's kind of like joining Costco, except they promise to admit only one customer every 45 minutes. For $1650 per year each.

I can completely understand why some doctors want to do this. They can have a patient list of 400, give excellent care, occasionally get a vacation, and sleep at night not having to wonder if they gave Mrs Jones the right medicine.

The problem is, that doctor had been seeing 25 to 30 patients a day and had a list of 3000. Who is going to take care of the other 2600? They'll go to a new doctor, who will soon be overwhelmed and ... go boutique.

So, as usual, those who can pay, will, and those who can't will get screwed. And there will be many, many more doctors from around the world who come here to relieve the shortage.
 
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