Concierge Medicine: Your Questions Answered

In the October 2012 issue, we investigated whether it was worth spending $1,500 or more a year on a physician who truly pays attention to you. Here, everything you need to know about what it would cost, what's included and how to find a concierge doctor that's right for you

by Cathryn Jakobson Ramin
woman doctor and patient image

What will it cost me?

·         The retainers that concierge docs charge annually range from about $1100 to $2100, although some doctors in mega-bucks neighborhoods charge much more.

·         Note that there are also direct-pay docs who accept fees on a month-to-month basis, but they do not provide all of the amenities described in the next column.

What is usually included?

·         The annual comprehensive wellness physical, including a blood panel and in some practices, multiple screenings and tests.

·         24/7 access to physician by cell phone, email and text.  

·         Same-day office visits, with little or no waiting

·         Care from your own physician if you get sick when you’re out of town.

·         Plenty of time to talk over routine concerns during office visits

·         Easily accessed and meticulously maintained electronic medical records, sometimes available to you on line, always ready to be sent to specialists or the ER.

·         Facilitated referrals to specialists, meaning that your doctor will contact other doctors for you, arrange your appointments, discuss your case in detail with the specialist, and follow up with you about your visit to the specialist.

·         Assistance you're your physician in obtaining pre-authorization and pinpointing the best specialist in network with your health care provider.

·         Focus on preventive medicine, rather than reactive medicine

·         In some practices, but definitely not all, a concierge doc will also care for your post-pediatrician-age child, up to age 26, included in your retainer fee.  

·         Some docs offer online services such as medical information, prescription refills, secure online e-mail with one's personal physician, online lab results and access to digital x-ray reports and images

What is not included in the concierge retainer?

·         The co-payment for office visits, except for the annual comprehensive physical.  (Usually, your co-payment is listed on the plastic insurance card you keep in your wallet. My co-payment, for instance, for my individual Anthem PPO Saver plan is $30 per office visit.)

·         Lab tests, scans and screenings conducted in facilities outside the concierge practice.

·         Appointments with specialists

·         Procedures, surgery and hospitalization, including visits to the emergency room.

How can signing on with concierge doctor save me money?

·         You may be able to switch to a high-deductible health insurance policy, thus reducing your monthly payments. (See: "What kind of health insurance plans work with concierge medicine?," below, for more on this.)

·         By making fewer referrals to specialists for problems that a primary care doctor is completely capable of treating. Among the physicians you may not need to see: Allergists for hay fever, dermatologists for rashes, ENTs for sinus infections.

·         By ordering fewer scans, tests and procedures, including ultrasounds, CT scans, X-rays, MRIs and biopsies. This means having fewer bills to pay, until you meet your deductible and out of pocket maximum. Another benefit: You may avoid a high-dose radiation procedure, such as a CT scan.

·         Because the concierge doc will coordinate all your care, there is less possibility that tests will be duplicated if you are seeing more than one specialist.

·         You may avoid unnecessary trips to the emergency room at your local hospital, since you can call your concierge doc for advice and consultation at any time.

·         Easy access to your physician may mean that you seek fewer sessions with alternative medicine practitioners.

·         Because your physician is available to consult with your pharmacist, you will have better control of prescription costs. For instance, you might be able, for instance, to split a higher-potency tablet in half rather than paying for double the number of pills.  Other worthwhile conversations include discussion of potential drug interactions, or the possibility of switching to a generic drug instead of paying the premium for the brand name. You save by getting drug selections and dosages right the first time, and not having to muster an additional prescription drug co-pay. Some doctors have arrangements with pharmacies that result in discounted prescriptions medications.

·         Being able to see your doctor right away may result in fewer days when you have to call in sick to work – because you hope to get in to see your doctor.

·         No sitting around waiting rooms may mean less exposure to flu germs.

How do I find a concierge doctor?

·         Although some concierge docs operate independently, most work with consulting firms that also provide management services to their practices.  They are happy to provide you with referrals in your area.

       Here are several:

·         MDVIP,a subsidiary of Procter & Gamble, is the largest of such firms, and provides an excellent doctor search function on its website.

·         Concierge Choice Physicians

·         Specialdocs 

What kind of health insurance plans work with concierge medicine?

·         Concierge physicians are doctors in private practice. The way their practices are structured, in addition to your retainer, they expect to collect your insurance co-pay.  They also expect you to carry a health insurance policy covering, at the very least, catastrophic situations.

·         In most cases, to use a concierge docs services, you need to belong to either a PPO or a corporate health insurance plan that allows you to choose your doctor. (HMOs don’t work in conjunction with concierge practices.) And, the concierge doc you choose must be a participating provider within the plan’s physician network.

·         Whether you are self-employed, like me, and have an individual policy – typically a PPO you pay for monthly -- or work for a corporation that picks up some percentage of your health insurance, you are responsible for the co-pay for all office visits to your retainer-based doc, except the annual comprehensive wellness exam.

·         Concierge docs provide immediate and comprehensive consultation, and can often treat routine ailments without referral to a specialist. Patients who sign on with concierge docs often find that they can select a high-deductible policy – what is known as catastrophic medical insurance – thus reducing monthly payments. Making this choice means that you have financial protection, in case of catastrophic expenses resulting from hospitalization, specialists and medications.

·         A high-deductible policy is a good choice ONLY if you have access to sufficient funds to cover the deductible and the maximum out-of-pocket for office visits, prescriptions and hospitalizations

Learn more about concierge medicine here, as published in theOctober 2012 issue

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Photo courtesy of wavebreakmedia/

First Published Tue, 2012-09-18 13:06

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