What is concierge medicine?

Does Concierge Medicine Make Doctors and Patients Happier?

A concierge medical practice charge patients a yearly fee in order for patients to belong to a medical practice.  Sometimes these are also known as retainer based medical practice, similar to having a lawyer on retainer.

Typical fees may range from $1,500 to $1,800 a year. Fees and care levels do vary though. Some practices may only charge a $500 fee while others may charge $5,000. Sometimes this type of practice is also known by other names like boutique or retainer-based medicine.

Right now, only a few thousand doctors belong to membership based practices, but the number is increasing. All sorts of medical practices, from dentists to pediatricians, may adopt this business model. However, in response to lower Medicare payments and tighter restrictions, there have been more Medicare doctors who have begun to impose a yearly membership fee on their patients.

Advantages of Retainer-Based Medicine

Doctors defend this practice by saying they can see fewer patients and deliver higher quality medical care. Lower payments, by health programs like Medicare and private insurance companies, have encouraged more practices to adopt this business model. Instead of rushing through appointments in order to generate revenue, the membership fees allow medical service providers to reduce the number of patients they see. This allows them to spend more time with each patient.

Most of the medical practices also argue that their membership fees are modest. Middle class people can afford the fees if they see their health care as a priority.

Controversy over Membership Medical Practices

Critics claims this promotes a 2 tiered medical system, and that it aggravates problems for doctors who do not charge a membership fee. People can afford the fee may get faster service and more time with a medical professional. Those who cannot afford the fee may find they are waiting longer for less service.

For example, a medical practice with a lot of Medicare patients may impose a concierge fee. This office will still accept this government health insurance, but only for patients who pay the yearly fee. While these patients can still get their medical services covered by Medicare, they cannot get the membership fee covered.

Note that I used Medicare as an example. You could make a similar comparison with other health insurance plans too. I do not know of any medical plans that will cover the membership fee.

What happens? Patients who can afford, and see the value of, the yearly fee will remain. They may be very pleased because they will not have to wait as long for appointments and can actually talk to the doctor on the phone between visits. When they do visit the doctor, they may find that the doctor can spend more time with them.

Doctors can concentrate on delivering better quality medical care too. They get to spend more time with each patient, and they find that this type of practice is less exhausting and more rewarding.

Here’s the problem. Many people do not have the extra income to pay for a membership, and they will need to seek another doctor. Senior citizens are making do on fixed incomes. Almost 50 million Americans do not even have health insurance!

The membership practice gets to increase revenue with fewer patients. Other doctors that still accept patients without an extra fee, could see their practices becoming a lot busier. These doctors may not want to abandon patients who cannot afford the fee, but find that they are struggling to keep their practices afloat because of lower insurance payments and higher expenses.

Will Concierge Medicine Hurt Health Reform Efforts?

Right now, membership medical practices are still a small minority, though the concept is becoming more popular with doctors and some patients who do not mind paying more for extra care.

Actually, the increase in these practices is more of a symptom of a problem than the actual problem. Some hybrid or very efficient membership practices provide very good benefits with a very modest fee (like $25.00 a month). The practices make use of nurse practitioners and physician’s assistants to see patients with routine complaints and reserve doctors for more complex issues. Others have a membership program with a higher service level, but still accept non-membership patients.

Health reform needs to address the issues that are making concierge services more popular.

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1. What are Reasonable and Customary Charges?
2. Medicare at 55 – The Latest Health Reform Rewind
3. Maternity Health Insurance

Be Wary Of Health Reform Health Plans!

I was working in front of the TV today, and was amazed to see a health plan advertisemet that started with a clip of President Obama announcing the passage of the health reform bill. Then the announcer cut in to promise  a guaranteed acceptance health plan for about $3 a day. That announcer never actually suggested this plan has anything to do with health reform, which it does not, but the suggestion was there.

 I do not have to call them to know that is is not health insurance, and that it has nothing to do with government health insurance. It is a health discount plan.

These plans have a “network” that may seem a lot like a PPO network for actual major medical insurance. But that’s where the plan starts and ends. It does not ever cover you for anything. The reason I have decided to write about this is because a lot of people have been duped by these, and I am here to tell you that their salesmen will not do anything to disabuse you of any misconceptions about what this plan is.

I actually called one for a lawyer friend of mine who was attracted by the promise of a $99 monthly bill for a health plan. The customer service representative refused to answer one simple question. I asked him, “Is this health insurance?” Instead he kept going back through his sales speech until he finally got angry with me.

Now why would a sales person get angry when I asked  them if the plan is health insurance if they nothing to hide.

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1. Obama’s Health Care Reform Plan Outline
2. Health Care Reform Update – Politics, Politics, Politics!
3. Health Reform and Health Insurance Uninsurables (Declines)

How To Find Maternity Health Insurance

People who are looking for some sort of maternity health insurance generally fall into two categories. They are planning for a future pregnancy, and they are concerned about the cost of having a healthy baby. Or they are already pregnant, and wonder how they can get some help with doctor’s visits and hospital costs. Some of these people may have some coverage, but it does not cover pregnancy very well, or they may have no health insurance at all.

Are You Planning a Baby?

Group major medical insurance, from an employer, usually covers pregancy. A typical answer is for one spouse to have a job that provides this. I understand that it is not always an option. Some employers do not provide these benefits, and some people are self employed, contract workers, small business owners, or unemployed. Getting another job, with good group medical insurance, is not always an option, especially these days.

Individual Health Insurance With Maternity Benefits

I have only seen one private individual insurer, Assurant, that offers a maternity option, and that is with a fairly high deductible. That option is a rider (option) to some of their policies. You have to select it at an extra cost.  Note that there could be others, particularly regional plans, I am not aware of. That is why I always suggest that people start their search with online quotes for their own zip code.

Look For Maternity Health Insurance Quotes!

In any case, complications of pregnancy, should be covered by any medical plan. But people also want coverage for normal expenses associated with having a baby. Services like doctor’s visits, routine tests, and a normal delivery, are not covered by most family or individual health insurance plans. 

Health Reform and Pregnancy. And even though US health reform is scheduled to put a stop to this, we have even seen cases of top health insurers denying coverage to newborns with health conditions because of pre-existing conditions. In the future, 2014, health reform should mean that insurers cannot deny adults with pre-existing conditions, but that is still a few years off. I am also not clear that means that, even if they accept pregnant women, they will provide full benefits.

Charity, State, and Federal Options:

You may not like the idea of relying on public or charity support. But the important thing is for people to do everything they can to have a healthy baby and healthy parents. This really does more good in the long run. With that in mind let’s look at some options.

 Every state has some sort of high risk health insurance pool, but not everybody qualifies for it. In many cases, premiums are expensive and deductibles are fairly high.  Now the CHIPS program is the federal and state public health insurance option for children from low to moderate income children does also cover pregnant women. This is a viable option for many families. And the newborn children should also be covered as soon as they are born. You could look for information on CHIPS, Medicaid, and High Risk Health Pools in your state.

You may also have a county health care system and low cost clinics in your area. Some non-profit groups provide financial assistance too. PPARX.org is the Partnership for Prescription Assistance, but the website also has searches for area medical services like this.

Money, But No Health Insurance

Prepaid Services with Doctors and Hospitals: If your family has a higher income, but just lacks maternity health insurance, you can probably work out a payment plan with doctors and hospitals. I have seen several obstetrician’s websites with information about these services. If you already have an obstetrician, ask them. If you do not have a doctor yet, call area hospitals or search the internet.

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1. Health Insurance Reform – Why Wal-Mart Wants it
2. COBRA Health Plans After Leaving a Job
3. Be Wary of “Obama” or Health Reform Health Plan Ads

Will Millions More Americans be Without Health Insurance Now?

Well, here’s another financial crisis to follow the first one. Millions of Americans lost their jobs with the largest unemployment spike in most of our adult lives. Lots of those people lost their health benefits too, but some where able to take advantage of a $25 billion dollar COBRA subsidy which defrayed 65% of the costs of the federal medical plan extension. But that plan is due to expire, and millions more may face the loss of medical benefits.

Learn more about Unemployment Health Insurance Options.

These subsidies are not trivial either, but are though to average about $722 a family. And Congress does not seem ready to extend the benefit either. They are very busy with the current US health care debate. The average premium for COBRA has also been calculated to consumer a large percentage of state unemployment benefit checks. The plan was implemented to help more families keep their group coverage until they found a new job.

Unemployment hasn’t been dipping yet. Though of course, the same type of people who were slow to tell us we were in a recession also seem quick to tell us it is over!  Hopefully the silver lining in this growing problem will be quick action implementing some sort of health reform that we Americans can live with. And that choice of a word, live, was not an accident!

Related posts:

1. COBRA Health Insurance Extensions Stimulus Help
2. COBRA Health Plans After Leaving a Job
3. US Stimulus Plan To Help Some Unemployed With Health Insurance

Will Medicare Change Much in 2010?

Some beneficiaries will not notice a big change while others may be affected. That is because the documented differences between 2009 and 2010 will only affect certain members, and not all of them.

Online Medicare Health Plan Information Sources

Of course, you have a couple of ways to find more information online. The US government keeps medicare.gov as a very good resource for consumers and agents all across the USA. You can also use a Medicare health plan quote form to find the plans and professionals in your local area.

Changes to Medicare Supplements

You probably have heard about all of the different levels of Medigap or Medicare Supplement health insurance plans. They have letters, like Plan A, B, C, etc. This should not be cofused with Part A, Part B, which are the parts of original Medicare that most seniors and many disabled people use as their public health option.

Some plans will no longer be marketed to new business, though apparently existing members can keep them. And two new plans (Plan M and Plan N) are being introduced. These are both similar to Plan F, but either require copays or high deductible payments, and so they should have lower premiums.

All Medicare Supplement plans will include hospice care, but some preventative and home recovery benefits are scheduled to be removed.

It is important for Medigap members to understand these changes so they know how their health care will be affected.  If any of the affected people are unhappy with these changes, it is also important to be able to explore options.

Medicare Part B Premiums

Almost all beneficiaries do pay a premium for Part B. This will not change for most people who already had this sum deducted from their social security checks. New Medicare beneficiaries, and those with a high income, may see a 15% increase.  I am sure that the fact that this premium will not increase in 2010 will be welcome news new social security recipients who learned they will not get a raise this year.

Get More Help Understanding Your Health Benefits

As we wrote above, Medicare.gov is a good resource. For a simpler summary you may want to refer to this article – Compare Medicare Health Plans.

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2. Medicare Supplements or Medicare Advantage Plans?
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Arghh! Just when I thought there was real hope for US health care reform, I see that progress is being bogged down by politics. I have not given up hope, but I am getting impatient with Congress and business as usual. Maybe real change was on the horizon, but it still looks as if we have a way to go before we can brag that we have really evolved beyond partison bickering.

Who Wants to Kill Health Reform?

Republicans are bragging that the demise of health care reform may be Obama’s Waterloo. His Waterloo? It will be everybody’s Waterloo, so I can hardly see where this situation should involve any gloating.

Critics of US health care reform keep bringing up Canada. And then there are those TV ads with horror stories from our neighbors up north. And yet the vast majority of Canadians are satisfied with their system, but who is talking about Canada anyway? Really!

Look at US health insurance programs like Medicare Health Insurance. Just try to pry that benefit from the hands of American seniors. I think we need to examine our own US way of delivering health care to Americans. Let the Canadians worry about themselves.

Right now, millions of Americans, including children, lack a health insurance plan. Many of these citizens are working, or the kids or working parents. Many have tried to apply for individual health insurance, but they cannot get accepted because of pre-existing conditions or a huge cost.

We need to stop whining, annd get started.  Learn more about the government’s plan  here: Health Reform.

Individual Health Insurance Quotes

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Surprised that Wal-Mart wants an Employer Mandated Health Plan?

Wal-mart became sort of infamous for the less-than-generous health insurance plans that were provided to most of the store workers. Apparently these health plans would cover small bills, like doctor’s visits, keeping some percentage of employees happy. But the plans had limits, like mini-meds or specified benefit plans, that would max out if anybody needed to be covered for large health issues like hospital stays or cancer treatment.

So why does the famous Uncle Scrooge want the government to come in and mandate a required minimum amount of health insurance now? Well, apparently the megaloMarts health care costs are still higher than many of their competitiors. A mandated minimum may still come in under Wal-mart’s current cost, but over the cost of some of their major competitors like Target.

Also, a public option may be attractive, depending upon how the plan turns out. If Wal-mart could spend its coverage money on the public plan it may be better than the private sector alternative.

It is something to think about……

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Are You Confused About the US Stimulus Package and COBRA Extensions?

As you probably know, COBRA is a federal law that forces some employers to keep terminated empoloyees in their group health insurance for several months. However, the employers do not have to keep paying the portion of the premium they pay for active employees. So the cost of health insurance can skyrocket just when a family loses a source of income.

The US stimulus bill addressed this by extending help paying the premiums to some terminated employees. There is some confusion, which I want to address.

Contact Your Ex Employer About the Stimulus

Contact your former employer, not the government, to take advantage of the COBRA subsidy. If you were laid off since September 1, 2008, and are already receiving COBRA coverage, then you’ll pay 35% of the COBRA health-insurance premiums, and your former employer will pay the remaining 65%. The government will then reimburse your former employer for the subsidy through a payroll tax credit.

If you were laid off on September 1, 2008, or later but didn’t sign up for COBRA coverage, you’ll get a second chance to elect COBRA and benefit from the subsidy. You should receive a notice from your former employer soon, or contact your former employer to find out about the steps for signing up.

The US COBRA Stimulus Payments are Limited

Federal law requires most companies with 20 or more employees to let former employees keep group health-insurance coverage for up to 18 months after they leave their jobs. But the 65% COBRA subsidy lasts for only nine months. After that, the premiums will jump back to the full price – and the average employer health-insurance plan costs $12,680 per year for family coverage, according to the Kaiser Family Foundation.

COBRA vs. Individual Health Insurance

If you have health issues, COBRA may still be your best bet despite the hefty price tag. But many people can find a better deal by buying their own health insurance. You can get price quotes for individual health insurance policies, or find a local health-insurance agent at the National Association of Health Underwriters Web site. Check out your options at least one month before your COBRA subsidy expires so you’ll have plenty of time to find out how much an individual policy would cost.

The subsidy ends if you find a job and your new employer offers health-care coverage or you become eligible for Medicare. And COBRA does not apply if the company stops offering health coverage to current employees or shuts down entirely.

More On Unemployment Health Insurance Options!

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1. US Stimulus Plan To Help Some Unemployed With Health Insurance
2. COBRA Subsidy Over? Millions May Lose Health Insurance!
3. COBRA Health Plans After Leaving a Job

So What Does Reasonable and Customary Mean?

Many health insurance policies specify that they will pay claims based upon something called reasonable and customary charges. This means that insurers claim they will allow a normal charge for a specific service, by a specific type of medical provider, taking the geographic area into account. So we might expect a national insurance company to charge more in New York City than they would in a small midwestern town. However, this health insurer practice has come under scrutiny recently.

How Do Insurers Calculate Reasonable and Customary Charges?

Insurers won’t release any information on how these charges are calculated, and many critics (including doctors) believe that the payout limits are far too low. In fact, we are starting to hear a lot more about cases brought against insurers for this practice, especially in large metro areas where charges are higher.

Network providers in an HMO or PPO agree to follow the health insurance customer guidelines when the bill their patients. However, if a patient needs to seek out of network care, or if they do not have a network type health insurance company, then that patient is responsible.

For network health insurance policy members, it seems as if the reasonable solution would be to make sure that medical care comes from a network provider. However this is not always possible in an emergency.

Look for the best individual health insurance plans here!

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COBRA benefits help some unemployed people keep their group health insurance. As we have discussed, this extension usually comes at a high price which shocks many terminated employees. Since the employer does not have to carry any portion of the premium any longer, the ex-employee will have to pay the whole amount.

Financial Stimulus Promises Help With COBRA Payments

The US senator who chairs the finance committee says that the new stimulus bill will include some help for newly unemployed people who cannot afford to extend their COBRA group health benefit. Mass. is the only US state who already does this by financing 80% of the bill for unemployed people for a period that can last for 12 months. State unemployment benefits, on average, are barely enough to cover most people’s COBRA bills, much less help them pay for anything else, including a mortgage, utility bills, or food.

But what about ex-employees who are not eligable for COBRA because they worked for a company who does not have to offer the extension. What about the millions of Americans who do not get health benefits from their job, and cannot afford, or qualify for, a private health plan? Well, we hope change is coming.

In the meantime, if you need private health insurance: Best Indvidual Health Insurance Quotes

If you need help because you lost your job, look at some options if you have no health insurance.

Related posts:

1. COBRA Health Insurance Extensions Stimulus Help
2. Obama’s Health Care Reform Plan Outline
3. COBRA Subsidy Over? Millions May Lose Health Insurance!