Concierge medicine Worth It????

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drawpoker
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Re: Concierge medicine Worth It????

Post by drawpoker » Fri Jul 13, 2018 5:36 pm

toofache32 wrote:
Thu Jul 12, 2018 10:34 pm

.....there will be "light refreshments". Probably cheese & crackers, assorted fruit slices, maybe cookies and punch. IOW, a really cheesey, El Cheapo spread. :x
Meanwhile, in the main dining rooms next door, people will be enjoying fresh local rockfish, or Maine lobster flown in that morning, filet mignon, escargot. :(
Seems cruel and unusual to me :P :P
So first you said it was too high class. Now you're saying it's too low class??

[/quote]

Neither.

It is the juxtaposition of this whole picture here. Comic, really. Rapidly descending into theater of the absurd.

Get it? Peanuts and crackers being handed out in the opulent surroundings of the XXX Yacht Club. To take it even a (humorous) step further, knowing the Club rules, now wonder.

Will any of the men who show up for the 6:30 pm session without a jacket be denied entry to the meeting....... :P

toofache32
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Re: Concierge medicine Worth It????

Post by toofache32 » Fri Jul 13, 2018 7:37 pm

dm200 wrote:
Fri Jul 13, 2018 11:50 am
Yes most group practices will have their partners or their doctors available for existing patients.
That has been my experience with group practices as well.
You altered my post for some reason.

toofache32
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Re: Concierge medicine Worth It????

Post by toofache32 » Fri Jul 13, 2018 7:39 pm

Fascinating how some here post with the sound of anger. If this is not for you, then simply don't buy it.

ResearchMed
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Re: Concierge medicine Worth It????

Post by ResearchMed » Fri Jul 13, 2018 7:43 pm

toofache32 wrote:
Fri Jul 13, 2018 7:37 pm
dm200 wrote:
Fri Jul 13, 2018 11:50 am
Yes most group practices will have their partners or their doctors available for existing patients.
That has been my experience with group practices as well.
You altered my post for some reason.
I'm guessing the dm200 thought you had a typo, and corrected it (rather than copying it exactly with a [sic] or such).

Meanwhile, dm200, could you try to quote and keep the name of the quoted poster?
It can get very confusing to those of us trying to follow along if there are "quotes" but the name of the person being quoted is omitted. Thanks!


RM
This signature is a placebo. You are in the control group.

toofache32
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Re: Concierge medicine Worth It????

Post by toofache32 » Fri Jul 13, 2018 8:17 pm

Thank you. It was not a typo.

drawpoker
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Re: Concierge medicine Worth It????

Post by drawpoker » Fri Jul 13, 2018 8:59 pm

ResearchMed wrote:
Fri Jul 13, 2018 7:43 pm
toofache32 wrote:
Fri Jul 13, 2018 7:37 pm
dm200 wrote:
Fri Jul 13, 2018 11:50 am
Yes most group practices will have their partners or their doctors available for existing patients.
That has been my experience with group practices as well.
You altered my post for some reason.
I'm guessing the dm200 thought you had a typo, and corrected it (rather than copying it exactly with a [sic] or such).....
Well, guess again, dm200 , toofache32 typed noctors (instead of doctors) for a reason.

https://www.urbandictionary.com/define.php?term=Noctor

ResearchMed
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Re: Concierge medicine Worth It????

Post by ResearchMed » Fri Jul 13, 2018 9:06 pm

drawpoker wrote:
Fri Jul 13, 2018 8:59 pm
ResearchMed wrote:
Fri Jul 13, 2018 7:43 pm
toofache32 wrote:
Fri Jul 13, 2018 7:37 pm
dm200 wrote:
Fri Jul 13, 2018 11:50 am
Yes most group practices will have their partners or their doctors available for existing patients.
That has been my experience with group practices as well.
You altered my post for some reason.
I'm guessing the dm200 thought you had a typo, and corrected it (rather than copying it exactly with a [sic] or such).....
Well, guess again, dm200 , toofache32 typed noctors (instead of doctors) for a reason.

https://www.urbandictionary.com/define.php?term=Noctor
Correct.

Part of my point was that IF someone is going to "correct" something, there should be a notation about that, or just use the "[sic]" which typically indicates that one is copying an error of some sort... Then what was happening would have been more clear.

(I had to look up "noctor" to make sure it was some variation of "doctor". I hadn't seen that before, either.)

RM
This signature is a placebo. You are in the control group.

drawpoker
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Re: Concierge medicine Worth It????

Post by drawpoker » Fri Jul 13, 2018 9:16 pm

Yes. About rushing to make "corrections".
Also, I think it is a good idea to try and keep a sense of humor with these weighty topics and, apparently, hot buttons for some.
For example, everyone should just be glad that they aren't labeled a "GOMER" and receive a diagnosis of "Horrendoma" delivered by a FOOBA :P :P :P

http://mentalfloss.com/article/77618/17 ... t-be-using

HIinvestor
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Re: Concierge medicine Worth It????

Post by HIinvestor » Fri Jul 13, 2018 9:35 pm

It does make sense to see what refreshments are to be served. If I were invited, I’d attend to see what I’d said and perhaps take some notes. I’d go home afterwards and ponder with other patients, check the alternatives and decide whether for ME and my family, it was worth the extra price.

I do know some folks who have paid extra for concierge. Not sure how long they will keep paying extra as they’re all pretty healthy with no chronic conditions I’m aware of. Definitely I could see it on patients who need extra visits and additional services from the MD, but otherwise, would look carefully for alternatives.

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ram
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Re: Concierge medicine Worth It????

Post by ram » Fri Jul 13, 2018 9:42 pm

https://medcitynews.com/2014/02/many-pa ... cian-care/
The article has some data about patient panel size.
Ram

drawpoker
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Re: Concierge medicine Worth It????

Post by drawpoker » Fri Jul 13, 2018 10:32 pm

ram wrote:
Fri Jul 13, 2018 9:42 pm
https://medcitynews.com/2014/02/many-pa ... cian-care/
The article has some data about patient panel size.
Thanks, ram, for the link. This is very useful info for the thread.

Am assuming when the author uses the term "retainer based" PCPs that is the same as saying "concierge service" practice. :?:

toofache32
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Re: Concierge medicine Worth It????

Post by toofache32 » Fri Jul 13, 2018 10:36 pm

Don't attorneys use retainers also?

HIinvestor
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Re: Concierge medicine Worth It????

Post by HIinvestor » Fri Jul 13, 2018 11:22 pm

Some attorneys get retainers so they will be regularly available for their clients but many attorneys charge by the hour and may give varying discounts to favored clients. Many attorneys also burnout with caseloads that are way too high to be manageable.

Some attorneys are on contingency basis and only are paid if their client recovers.

Yes, I can definitely see the tension between having enough time between the client and professional while there are enough clients to pay overhead and keep the professionals employed with a comfortable income.

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ram
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Re: Concierge medicine Worth It????

Post by ram » Sat Jul 14, 2018 6:58 pm

drawpoker wrote:
Fri Jul 13, 2018 10:32 pm
ram wrote:
Fri Jul 13, 2018 9:42 pm
https://medcitynews.com/2014/02/many-pa ... cian-care/
The article has some data about patient panel size.
Thanks, ram, for the link. This is very useful info for the thread.

Am assuming when the author uses the term "retainer based" PCPs that is the same as saying "concierge service" practice. :?:
Yes. You are correct.
Ram

ResearchMed
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Re: Concierge medicine Worth It????

Post by ResearchMed » Sat Jul 14, 2018 7:30 pm

ram wrote:
Sat Jul 14, 2018 6:58 pm
drawpoker wrote:
Fri Jul 13, 2018 10:32 pm
ram wrote:
Fri Jul 13, 2018 9:42 pm
https://medcitynews.com/2014/02/many-pa ... cian-care/
The article has some data about patient panel size.
Thanks, ram, for the link. This is very useful info for the thread.

Am assuming when the author uses the term "retainer based" PCPs that is the same as saying "concierge service" practice. :?:
Yes. You are correct.
I thought attorney retainers were more like pre-paid deposits, and they deduct the amount as work is done, so they don't have to worry about chasing after clients when a lot of work has already been done.

RM
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dm200
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Re: Concierge medicine Worth It????

Post by dm200 » Sun Jul 15, 2018 8:58 am

ResearchMed wrote:
Sat Jul 14, 2018 7:30 pm
ram wrote:
Sat Jul 14, 2018 6:58 pm
drawpoker wrote:
Fri Jul 13, 2018 10:32 pm
ram wrote:
Fri Jul 13, 2018 9:42 pm
https://medcitynews.com/2014/02/many-pa ... cian-care/
The article has some data about patient panel size.
Thanks, ram, for the link. This is very useful info for the thread.
Am assuming when the author uses the term "retainer based" PCPs that is the same as saying "concierge service" practice. :?:
Yes. You are correct.
I thought attorney retainers were more like pre-paid deposits, and they deduct the amount as work is done, so they don't have to worry about chasing after clients when a lot of work has already been done.
RM
My understanding and experience. The attorney spends/bills and does work as long as there is money - and then stops doing more work. In my experience attorneys never return anything - always "work" until the money is gone.

Isabelle77
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Re: Concierge medicine Worth It????

Post by Isabelle77 » Sun Jul 15, 2018 9:31 am

My parents’ primary care doctor switched to a concierge a few years ago. They were reluctant to join but love their doctor and they live in a somewhat remote area and he is nearby.

My mom (71) was diagnosed with a tumor on her pancreas last year. The concierge service had her at Johns Hopkins (several states away) in four days to see a specialist. I have no idea if that’s normal or not but it was pretty impressive.

anil686
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Re: Concierge medicine Worth It????

Post by anil686 » Sun Jul 15, 2018 9:40 am

Isabelle77 wrote:
Sun Jul 15, 2018 9:31 am
My parents’ primary care doctor switched to a concierge a few years ago. They were reluctant to join but love their doctor and they live in a somewhat remote area and he is nearby.

My mom (71) was diagnosed with a tumor on her pancreas last year. The concierge service had her at Johns Hopkins (several states away) in four days to see a specialist. I have no idea if that’s normal or not but it was pretty impressive.
It is not normal and that is impressive. This is something every physician could do if they had the time to do it. Several of my friends work like this with the concierge model. I do think they provide additional services you will not find at a typical PCP. The question of whether the value matches the cost is personal. It clearly exceeded the cost IMO for your mom, but if your mom was healthy - maybe your parents would have paid for 25 years of medicine and not needed to use it. What is awesome is that they did what they felt was in their best interest and their instincts were validated...

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dm200
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Re: Concierge medicine Worth It????

Post by dm200 » Sun Jul 15, 2018 10:11 am

Isabelle77 wrote:
Sun Jul 15, 2018 9:31 am
My parents’ primary care doctor switched to a concierge a few years ago. They were reluctant to join but love their doctor and they live in a somewhat remote area and he is nearby.
My mom (71) was diagnosed with a tumor on her pancreas last year. The concierge service had her at Johns Hopkins (several states away) in four days to see a specialist. I have no idea if that’s normal or not but it was pretty impressive.
I doubt there is any "normal", BUT in my plan - I would hope and expect (based on our experiences with much less serious issues) to be seen by an appropriate specialist in a day or two. BUT - almost certainly not Johns Hopkins.

ResearchMed
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Re: Concierge medicine Worth It????

Post by ResearchMed » Sun Jul 15, 2018 11:27 am

dm200 wrote:
Sun Jul 15, 2018 8:58 am
ResearchMed wrote:
Sat Jul 14, 2018 7:30 pm
ram wrote:
Sat Jul 14, 2018 6:58 pm
drawpoker wrote:
Fri Jul 13, 2018 10:32 pm
ram wrote:
Fri Jul 13, 2018 9:42 pm
https://medcitynews.com/2014/02/many-pa ... cian-care/
The article has some data about patient panel size.
Thanks, ram, for the link. This is very useful info for the thread.
Am assuming when the author uses the term "retainer based" PCPs that is the same as saying "concierge service" practice. :?:
Yes. You are correct.
I thought attorney retainers were more like pre-paid deposits, and they deduct the amount as work is done, so they don't have to worry about chasing after clients when a lot of work has already been done.
RM
My understanding and experience. The attorney spends/bills and does work as long as there is money - and then stops doing more work. In my experience attorneys never return anything - always "work" until the money is gone.
We've had legal retainer money returned if the work was done.
And we've also had a need to send more money to refresh the pot, for an ongoing situation. But we were always kept involved in the progress, both legal work and the money "usage", so we could discuss whether issue "x" should be pursued or not, for example.

But my question was more about the "concierge medicine retainer": I had assumed that a concierge physician charged a fee that was intended to sort of pay for extra time, so she/he could have fewer patients and more easily take more time with each.
If one is just "pre-paying" medical care, how does that make things different, other than the billing "schedule"?
And I didn't have the impression that there would be "unused annual fee" that might be refunded.

RM
This signature is a placebo. You are in the control group.

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ram
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Re: Concierge medicine Worth It????

Post by ram » Sun Jul 15, 2018 11:56 am

ResearchMed wrote:
Sun Jul 15, 2018 11:27 am

But my question was more about the "concierge medicine retainer": I had assumed that a concierge physician charged a fee that was intended to sort of pay for extra time, so she/he could have fewer patients and more easily take more time with each.
If one is just "pre-paying" medical care, how does that make things different, other than the billing "schedule"?
And I didn't have the impression that there would be "unused annual fee" that might be refunded.
RM
RM,
The product for sale is "physician time". You do not prepay for that time. You are buying "insurance" for that product and you pay the premium in the form of retainer fee.
Say you pay the concierge fee and your physician has a panel of 600 patients. Assume he works 2000 hours per year. That means average time allocated per patient per year is 3.33 hours. If you happen to have a serious illness in a given year and need 10 hours of his/her time you do NOT pay extra. If you were healthy and just needed some questions answered and only took 2 hours of his time in that year no fee is refunded.
At least that is how I understand the model. (I am a physician who does not practice concierge medicine)
Ram

ResearchMed
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Re: Concierge medicine Worth It????

Post by ResearchMed » Sun Jul 15, 2018 12:10 pm

ram wrote:
Sun Jul 15, 2018 11:56 am
ResearchMed wrote:
Sun Jul 15, 2018 11:27 am

But my question was more about the "concierge medicine retainer": I had assumed that a concierge physician charged a fee that was intended to sort of pay for extra time, so she/he could have fewer patients and more easily take more time with each.
If one is just "pre-paying" medical care, how does that make things different, other than the billing "schedule"?
And I didn't have the impression that there would be "unused annual fee" that might be refunded.
RM
RM,
The product for sale is "physician time". You do not prepay for that time. You are buying "insurance" for that product and you pay the premium in the form of retainer fee.
Say you pay the concierge fee and your physician has a panel of 600 patients. Assume he works 2000 hours per year. That means average time allocated per patient per year is 3.33 hours. If you happen to have a serious illness in a given year and need 10 hours of his/her time you do NOT pay extra. If you were healthy and just needed some questions answered and only took 2 hours of his time in that year no fee is refunded.
At least that is how I understand the model. (I am a physician who does not practice concierge medicine)
That's what I thought - assuming I now understand.
That is, it's *not* like a legal retainer, where the retainer is more of a deposit that gets "used up" as the work progresses. One is then either refunded any money remaining when the case is ended, or one needs to pay more as the work progresses, etc.
(I had thought I understood, until someone equated it to a legal retainer, and then I wasn't sure anymore...)

Thanks!

RM
This signature is a placebo. You are in the control group.

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dm200
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Re: Concierge medicine Worth It????

Post by dm200 » Sun Jul 15, 2018 1:17 pm

ram wrote:
Sun Jul 15, 2018 11:56 am
ResearchMed wrote:
Sun Jul 15, 2018 11:27 am
But my question was more about the "concierge medicine retainer": I had assumed that a concierge physician charged a fee that was intended to sort of pay for extra time, so she/he could have fewer patients and more easily take more time with each.
If one is just "pre-paying" medical care, how does that make things different, other than the billing "schedule"?
And I didn't have the impression that there would be "unused annual fee" that might be refunded.
RM
RM,
The product for sale is "physician time". You do not prepay for that time. You are buying "insurance" for that product and you pay the premium in the form of retainer fee.
Say you pay the concierge fee and your physician has a panel of 600 patients. Assume he works 2000 hours per year. That means average time allocated per patient per year is 3.33 hours. If you happen to have a serious illness in a given year and need 10 hours of his/her time you do NOT pay extra. If you were healthy and just needed some questions answered and only took 2 hours of his time in that year no fee is refunded.
At least that is how I understand the model. (I am a physician who does not practice concierge medicine)
My understanding as well - NO experience. Are you including regular visits (probably paid to a degree by insurance) in this 3.33 hours?

I don't know how much time Primary care Physicians take in scheduling patient visits, but my Kaiser PCP is schedule 20 minutes (all kinds - some short things some longer like annual health assessments). So, 3.33 hours would be ten office visits of 20 minutes. presumably, though many of the added things included might be a 5 minute phone call or 5 minute email or text exchange.

One would think (have not seen data) that the mix of those choosing a concierge doctor (or be willing to pay the annual fee) would tend to be those with more risk and health problems than the average patient.

I also about the patient "perception" of value vs. an "objective" valuation. My guess is that it is just as much (or more) "perception" than objective value. Then again, "perception" may translate into subjective "value".

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dm200
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Re: Concierge medicine Worth It????

Post by dm200 » Sun Jul 15, 2018 1:51 pm

I don't know all the details - but friends of ours are in a Humana MA plan. Both husband and wife are in the plan with the same PCP, but the husband sighed up with the DR concierge extra fee and the wife did not. Very confusing - I will check with them how it works.

Miriam2
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Re: Concierge medicine Worth It????

Post by Miriam2 » Sun Jul 15, 2018 4:17 pm

drawpoker wrote:
Miriam2 wrote: My doctor recently retired and his office mate is now concierge at $2,000 per year. I use my general physician once or twice a year, other doctor visits are specialists (dermatologist, etc). This means I will be paying either $1,000 or $2,000 per visit to my general physician :shock: :shock: Seems like the only way this can work is if the patient is a high doctor-use patient (perhaps with a heart condition, diabetes, etc).
Don't know what your age group is Miriam2 (I am on Medicare) but what springs to mind - just because you now see your G.P. only once or twice a year - that could change in a heartbeat (no pun intended) So that $2,000 per year could easily be broken down divisible by four, six, eight, ten, twelve To look at it realistically, right? . . .
My age group is Medicare :D and you - and other posters - have made a good point about this. Although I have only seen my GP once or twice a year, that will change - if I get older :wink: - and will need more medical care.

drawpoker wrote: Don't know just what type of concierge model your G.P. went to (?) Maybe their's is diff from the MD-Vip business model.

With MD-Vip, the docs agree to limit their practice to no more than 600 patients. The sales hook being, of course, that by restricting the practice, the doc will be able to devote more time and attention to each patient. . . . Miriam2, that $2,000 per year you quoted. How is it paid? Directly to the doc, or to a 3rd party org like MDVip?

It does make a difference. At least with the MD-Vip affiliation agreement, patient pays the vendor directly, they take their cut ($500) and send the rest on to the doc.
-- My GP's concierge model is not MDVip or any other such medical vendor or company. It is "private concierge," I'm not sure what the model would be called. The payment goes directly to the doctor. The price for my new doctor is $2,000/yr and the other doctor charges $2,500/yr. (A friend has concierge with a different doctor at $2,250/yr individual or $3,500 for a couple). We live in South Florida.

-- This concierge practice is only for their Medicare patients. My millennial kids can use them as their doctor without going concierge. They accept most insurance plans, and if not, then it would be considered out-of-network for the insurance company; the doctor would file with the insurance company the same as always.

-- My concierge payment covers the "gap" between what Medicare pays the doctor and what the doctor charges. The doctor files with Medicare and with my secondary insurance (Blue Cross) and accepts what they pay them. The doctor does not bill me for the remainder of the charges - this is covered by the concierge retainer. Thus, the retainer is a "pre-payment" for those "gap" costs.

-- Labs & tests - I'm not clear on this, but my notes say the concierge fee covers labs, echo-grams, outside labs, etc, although unusual lab tests may be different.

-- Injections - covers all injections covered by Medicare, but not vaccines not covered by Medicare (such as the new Shingles vaccine). The doctor provides references for labs & clinics that would give these uncovered vaccines and their prices. As a practical matter, I have sometimes needed vaccines that my doctor did not stock, so I'm used to going to our Department of Health for these vaccines.

-- Hospitalization - if I'm hospitalized, the doctor would be listed as the physician of choice and would coordinate care (and/or emergency room care) with the hospital. One problem is that my doctor does not have privileges at all local hospitals, but this has always been a problem for us and many people we know.

:idea: On a personal finance note - I agree with previous posters that this concierge model with the yearly retainer can be seen as "insurance" to cover most otherwise-uncovered-expenses - and that "whether the value matches the cost is personal."

HIinvestor
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Re: Concierge medicine Worth It????

Post by HIinvestor » Sun Jul 15, 2018 4:38 pm

By the way, I believe the new Shingrix vaccine (2 part series) IS covered by Medicare. My folks and H both have Medicare. I believe there may be a $30 copay per injection as I paid that on my folks behalf per person before insurer said it was covered and I should be reimbursed and pharmacy reimbursed me.

My insurer has a contract with the lab used by most in our state that there is no copay for routine blood tests, so concierge wouldn’t reduce that cost.

I believe Medicare reimbursement is similar to BCBS reimbursement in our state.

At this point, I can’t see what I’d gain from concierge as I already get the care I desire. Being able to see the doctor more than once every 6 months is really not necessary at this time. I guess if I needed care more often it would be more tempting.

toofache32
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Re: Concierge medicine Worth It????

Post by toofache32 » Sun Jul 15, 2018 6:41 pm

HIinvestor wrote:
Sun Jul 15, 2018 4:38 pm

I believe Medicare reimbursement is similar to BCBS reimbursement in our state.
This speaks more to the low BCBS reimbursement than Medicare rates, which vary by only a few percentage points nationally.

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Re: Concierge medicine Worth It????

Post by drawpoker » Sun Jul 15, 2018 7:31 pm

Miriam2 wrote:
Sun Jul 15, 2018 4:17 pm
-- My GP's concierge model is not MDVip or any other such medical vendor or company. It is "private concierge," I'm not sure what the model would be called.......payment goes directly to the doctor.... This concierge practice is only for their Medicare patients.........My concierge payment covers the "gap" between what Medicare pays the doctor and what the doctor charges......


Ah, I see, said the Blind Man. This is entirely different. The objective here is to try and close that gap between the doc's usual charges and what Medicare allows. So, with that in mind, your PCP has not entered into any agreement to limit the practice to a certain no. of patients?




-- Injections - covers all injections covered by Medicare, but not vaccines not covered by Medicare (such as the new Shingles vaccine).

To clarify here, as already another poster has gotten confused, Medicare does not cover the new Shingles vaccine under Part B benefits (part of a doctor's visit. Medicare covers shingles, tetanus and some other common ones under Part D benefits. Depending on which Part D insurer's Plan a Medicare beneficiary has chosen the co-payment amount may vary considerably. For ex, my CheapAssBare bones Part D insurance co. is quoting $90 co-pay for my 10-year tetanus booster. Forget that, Jack! Got it at the doc's office for 30 bucks. Think they are demanding something like $180-$200 for the new shingles, not sure, but whatever, I have a hunch I end up getting it (2 actually is what is called for) for a lot less in my PCP's office during an office visit.



-- Hospitalization - if I'm hospitalized, the doctor would be listed as the physician of choice and would coordinate care (and/or emergency room care) with the hospital. One problem is that my doctor does not have privileges at all local hospitals, but this has always been a problem for us and many people we know.

I would say that is a problem. How in hell would your doc get you admitted to a certain hospital you preferred and wished to go to with no privileges? (Unless you became seriously ill or injured, went to that hospital's ER, ER doctors approved admission due to your condition)



South Florida, eh? The plot thickens...... :|

HIinvestor
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Re: Concierge medicine Worth It????

Post by HIinvestor » Sun Jul 15, 2018 7:38 pm

I do realize that since both my lung and internal med docs have privileges at the same one hospital if I am ever hospitalized it will likely be at that hospital which is th e closest to our home anyway.

I agree that if your doc doesn’t have privileges at the hospital you are admitted to, I can’t see how said MD will even be added to the case, much less be supervising care.

Many places just have hospitalists in charge of care at their hospitals anyway, as it makes workflow in the hospital smoother.

Yes, sadly, our BCBS has low reimbursements but they claim that allows them to have low premiums (and I do believe the premiums are quite reasonable for the care and services I have received). Sadly fighting to get claims properly paid and having to appeal can be a pain and takes time but fortunately that doesn’t happen very often.

toofache32
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Re: Concierge medicine Worth It????

Post by toofache32 » Sun Jul 15, 2018 8:03 pm

HIinvestor wrote:
Sun Jul 15, 2018 7:38 pm
I do realize that since both my lung and internal med docs have privileges at the same one hospital if I am ever hospitalized it will likely be at that hospital which is th e closest to our home anyway.

I agree that if your doc doesn’t have privileges at the hospital you are admitted to, I can’t see how said MD will even be added to the case, much less be supervising care.

Many places just have hospitalists in charge of care at their hospitals anyway, as it makes workflow in the hospital smoother.

Yes, sadly, our BCBS has low reimbursements but they claim that allows them to have low premiums (and I do believe the premiums are quite reasonable for the care and services I have received). Sadly fighting to get claims properly paid and having to appeal can be a pain and takes time but fortunately that doesn’t happen very often.
For the most part, the days are long gone when your PCP had time (and got paid) to leave his office and drive over to the hospital to see patients. Hospitalists have taken over this role which is generally much more efficient because they live in the hospital. I'm not sure how this would work in a concierge model, but I would guess the concierge doc would call the hospitalist to update them on your diagnoses and issues.

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Re: Concierge medicine Worth It????

Post by dm200 » Mon Jul 16, 2018 9:33 am

By the way, I believe the new Shingrix vaccine (2 part series) IS covered by Medicare. My folks and H both have Medicare. I believe there may be a $30 copay per injection as I paid that on my folks behalf per person before insurer said it was covered and I should be reimbursed and pharmacy reimbursed me.
Our MA plan covers all vaccinations/inoculations at no charge/copay - including the new shingles vaccine. Because of their supply,, however, they are not offering it to everyone yet - I got mine last month (1st of 2) but my wife is in the next priority category

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Re: Concierge medicine Worth It????

Post by dm200 » Mon Jul 16, 2018 9:35 am

For the most part, the days are long gone when your PCP had time (and got paid) to leave his office and drive over to the hospital to see patients. Hospitalists have taken over this role which is generally much more efficient because they live in the hospital. I'm not sure how this would work in a concierge model, but I would guess the concierge doc would call the hospitalist to update them on your diagnoses and issues.
Yes - in the "old days" your "GP" would often do hospital "rounds" every day (usually in the mornings) and see patients in his/her office in the afternoons.

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Re: Concierge medicine Worth It????

Post by ResearchMed » Mon Jul 16, 2018 9:38 am

dm200 wrote:
Mon Jul 16, 2018 9:35 am
For the most part, the days are long gone when your PCP had time (and got paid) to leave his office and drive over to the hospital to see patients. Hospitalists have taken over this role which is generally much more efficient because they live in the hospital. I'm not sure how this would work in a concierge model, but I would guess the concierge doc would call the hospitalist to update them on your diagnoses and issues.
Yes - in the "old days" your "GP" would often do hospital "rounds" every day (usually in the mornings) and see patients in his/her office in the afternoons.
And in the "Old old days", the "family doctor" would also stop by your house, and see the patient in bed if they were very sick.
However, I think some of those "events" back then would now be handled by a hospital admission, many of them appropriate.

RM
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Re: Concierge medicine Worth It????

Post by dm200 » Mon Jul 16, 2018 9:45 am

And in the "Old old days", the "family doctor" would also stop by your house, and see the patient in bed if they were very sick.
However, I think some of those "events" back then would now be handled by a hospital admission, many of them appropriate.
Been there. Our doctors then were husband and wife (BOTH GPs) - and they each made regular "housecalls" - whether I was sick or my grandmother had a stroke -

Our current health plan has "virtual housecalls" - using a smart phone - two way audio and visual. My wife used that on a Sunday afternoon when she was concerned about a surgical incision problem. No charge either :)

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Re: Concierge medicine Worth It????

Post by dm200 » Mon Jul 16, 2018 12:54 pm

Miriam2 wrote:
Sun Jul 15, 2018 4:17 pm


My age group is Medicare :D and you - and other posters - have made a good point about this. Although I have only seen my GP once or twice a year, that will change - if I get older :wink: - and will need more medical care.

Is this Original Medicare? if so, with Medigap or not? Or is it a Medicare Advantage Plan?

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Re: Concierge medicine Worth It????

Post by Miriam2 » Tue Jul 17, 2018 12:17 am

dm200 wrote:
Miriam2 wrote: My age group is Medicare :D and you - and other posters - have made a good point about this. Although I have only seen my GP once or twice a year, that will change - if I get older :wink: - and will need more medical care.
Is this Original Medicare? if so, with Medigap or not? Or is it a Medicare Advantage Plan?
I have regular plain old Original Medicare, relatively new to it. No Medigap, no Medicare Advantage Plan.

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Re: Concierge medicine Worth It????

Post by HIinvestor » Tue Jul 17, 2018 2:46 am

The risk of having no MediGap and no Medicare Advantage plan is there is NO cap for your out of pocket medical expenses with regular Medicare A&B. Having a MediGsp or Medicare Advantage plan would cap your out of pocket. 20% of a huge medical bill is still a huge $$$$$.

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Re: Concierge medicine Worth It????

Post by drawpoker » Tue Jul 17, 2018 8:14 am

HIinvestor wrote:
Tue Jul 17, 2018 2:46 am
The risk of having no MediGap and no Medicare Advantage plan is there is NO cap for your out of pocket medical expenses with regular Medicare A&B. Having a MediGsp or Medicare Advantage plan would cap your out of pocket. 20% of a huge medical bill is still a huge $$$$$.
Good God, the 20% is only a part of it. Without any Medigap insurance, if she has to go into the hospital, she's looking at $1,340 out of pocket (2018 Part A deductible) right off the bat. Not per year deductible, that's per benefit period deductible. 2 or 3 hospitalizations within same year, yikes.
She must be a very wealthy person who is self-insuring. :?:

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Re: Concierge medicine Worth It????

Post by queso » Tue Jul 17, 2018 8:35 am

I'm not a doc, but my wife is a concierge patient so I thought I could help clear up how the financial side works. It's a fee. She pays $2100 per year out of pocket just to be a patient of the concierge practice. That does not include any medical services. She does get a fancy parking permit so she can park right in front of the medical building though. All visits are submitted to her insurance and she pays copays. The explanation of benefits statements, additional invoices for charges outside what the insurance company allows for procedures, etc. all come to us just like a regular non-concierge doc.

What she does get for her $2100 is:
- aforementioned fancy parking permit
- an extensive review and physical exam when the joined (I want to say it was almost a whole day at the hospital - tons of tests)
- 24/7 physician access via email, phone and text
- "aggressive referrals" like the previous poster mentioned. If she needs to go somewhere else she will be sent somewhere very good and very quickly.

There is a discount (only $1900!) if I join as well and children are $900 each. I've thought about it, but I don't have as many health issues as she does and I am pretty happy with my primary care doc of 15 years. When he retires I may rethink it, but I'm a lot more frugal than she is so it is a harder sell for me.

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Re: Concierge medicine Worth It????

Post by dm200 » Tue Jul 17, 2018 10:11 am

HIinvestor wrote:
Tue Jul 17, 2018 2:46 am
The risk of having no MediGap and no Medicare Advantage plan is there is NO cap for your out of pocket medical expenses with regular Medicare A&B. Having a MediGsp or Medicare Advantage plan would cap your out of pocket. 20% of a huge medical bill is still a huge $$$$$.
Yes - seems to me a risk of unlimited expenses without either Medigap (Original Medicare) or an MA or MC plan.

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Re: Concierge medicine Worth It????

Post by dm200 » Tue Jul 17, 2018 10:26 am

queso wrote:
Tue Jul 17, 2018 8:35 am
I'm not a doc, but my wife is a concierge patient so I thought I could help clear up how the financial side works. It's a fee. She pays $2100 per year out of pocket just to be a patient of the concierge practice. That does not include any medical services. She does get a fancy parking permit so she can park right in front of the medical building though. All visits are submitted to her insurance and she pays copays. The explanation of benefits statements, additional invoices for charges outside what the insurance company allows for procedures, etc. all come to us just like a regular non-concierge doc.
What she does get for her $2100 is:
- aforementioned fancy parking permit
- an extensive review and physical exam when the joined (I want to say it was almost a whole day at the hospital - tons of tests)
- 24/7 physician access via email, phone and text
- "aggressive referrals" like the previous poster mentioned. If she needs to go somewhere else she will be sent somewhere very good and very quickly.
There is a discount (only $1900!) if I join as well and children are $900 each. I've thought about it, but I don't have as many health issues as she does and I am pretty happy with my primary care doc of 15 years. When he retires I may rethink it, but I'm a lot more frugal than she is so it is a harder sell for me.
- My wife and I are on Medicare - in a Kaiser plan. Parking is free - at the facilities - but nothing fancy.
- We get whatever tests are needed/recommended an an annual health assessment
- Telephone nurse advice 24x7
- Urgent care facility 24x7
- email with physicians
- appts/referrals to specialists done very quickly (sometimes hours) -

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Re: Concierge medicine Worth It????

Post by queso » Tue Jul 17, 2018 10:33 am

dm200 wrote:
Tue Jul 17, 2018 10:26 am
queso wrote:
Tue Jul 17, 2018 8:35 am
I'm not a doc, but my wife is a concierge patient so I thought I could help clear up how the financial side works. It's a fee. She pays $2100 per year out of pocket just to be a patient of the concierge practice. That does not include any medical services. She does get a fancy parking permit so she can park right in front of the medical building though. All visits are submitted to her insurance and she pays copays. The explanation of benefits statements, additional invoices for charges outside what the insurance company allows for procedures, etc. all come to us just like a regular non-concierge doc.
What she does get for her $2100 is:
- aforementioned fancy parking permit
- an extensive review and physical exam when the joined (I want to say it was almost a whole day at the hospital - tons of tests)
- 24/7 physician access via email, phone and text
- "aggressive referrals" like the previous poster mentioned. If she needs to go somewhere else she will be sent somewhere very good and very quickly.
There is a discount (only $1900!) if I join as well and children are $900 each. I've thought about it, but I don't have as many health issues as she does and I am pretty happy with my primary care doc of 15 years. When he retires I may rethink it, but I'm a lot more frugal than she is so it is a harder sell for me.
- My wife and I are on Medicare - in a Kaiser plan. Parking is free - at the facilities - but nothing fancy.
- We get whatever tests are needed/recommended an an annual health assessment
- Telephone nurse advice 24x7
- Urgent care facility 24x7
- email with physicians
- appts/referrals to specialists done very quickly (sometimes hours) -
Nice! We both have CareFirst BCBS. I don't have anything like what she has with concierge. I can see my primary care doc during office hours - usually the same day if I need to. For anything urgent there is an unaffiliated urgent care near my house and an ER a bit further away. I have no access to anybody by phone/email/SMS.

Sounds like you have a pretty good thing going with Kaiser.

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Re: Concierge medicine Worth It????

Post by dm200 » Tue Jul 17, 2018 11:03 am

Nice! We both have CareFirst BCBS. I don't have anything like what she has with concierge. I can see my primary care doc during office hours - usually the same day if I need to. For anything urgent there is an unaffiliated urgent care near my house and an ER a bit further away. I have no access to anybody by phone/email/SMS.
Sounds like you have a pretty good thing going with Kaiser.
Sure do :)

What you describe is what DW and I had before returning to Kaiser 7 years ago.

In addition, for primary care I always see a Physician (almost always my PCP unless she is on vacation, etc.) and never a nurse, physicians assistant or nurse practitioner. About half of what I need with my PCP I can do with email or telephone appt - no charge/copays. We have never felt that our kaiser physicians delayed referrals, appts, etc. In fact, in a few cases, I thought they were somewhat overly "concerned" - panicked I was having a heart attack and sent me to stay overnight monitoring my heart - false alarm - just a virus.

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Re: Concierge medicine Worth It????

Post by dm200 » Tue Jul 17, 2018 12:49 pm

No personal experience with Original Medicare - but it seems to me that Physicians with patients on Original medicare might give a heads up to any such patients who do not have a Medigap policy of the potential high risks of costs.

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Re: Concierge medicine Worth It????

Post by Miriam2 » Tue Jul 17, 2018 2:43 pm

HIinvestor wrote: The risk of having no MediGap and no Medicare Advantage plan is there is NO cap for your out of pocket medical expenses with regular Medicare A&B. Having a MediGsp or Medicare Advantage plan would cap your out of pocket. 20% of a huge medical bill is still a huge $$$$$.
drawpoker wrote: . . . the 20% is only a part of it. Without any Medigap insurance, if she has to go into the hospital, she's looking at $1,340 out of pocket (2018 Part A deductible) right off the bat. Not per year deductible, that's per benefit period deductible. 2 or 3 hospitalizations within same year, yikes.
She must be a very wealthy person who is self-insuring. :?:
Haha I wish!
I have retiree secondary insurance from my employer through Blue Cross that covers the extra 20% and also covers all prescription drugs. Thus, I don't need a separate Medigap or Medicare Advantage insurance or Part D for drugs.

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Re: Concierge medicine Worth It????

Post by dm200 » Tue Jul 17, 2018 2:58 pm

Miriam2 wrote:
Tue Jul 17, 2018 2:43 pm
HIinvestor wrote: The risk of having no MediGap and no Medicare Advantage plan is there is NO cap for your out of pocket medical expenses with regular Medicare A&B. Having a MediGsp or Medicare Advantage plan would cap your out of pocket. 20% of a huge medical bill is still a huge $$$$$.
drawpoker wrote: . . . the 20% is only a part of it. Without any Medigap insurance, if she has to go into the hospital, she's looking at $1,340 out of pocket (2018 Part A deductible) right off the bat. Not per year deductible, that's per benefit period deductible. 2 or 3 hospitalizations within same year, yikes.
She must be a very wealthy person who is self-insuring. :?:
Haha I wish!
I have retiree secondary insurance from my employer through Blue Cross that covers the extra 20% and also covers all prescription drugs. Thus, I don't need a separate Medigap or Medicare Advantage insurance or Part D for drugs.
You are very fortunate!

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Re: Concierge medicine Worth It????

Post by HIinvestor » Tue Jul 17, 2018 9:05 pm

We are fortunate that H’s former employer provides us a lifetime BCBS family plan (or during open season we could switch to a different plan), where we pay a portion of the premiums and employer pays a portion. This is what H has to go with his A+B plans. Works perfectly for us. Some of his former coworkers didn’t buy B, but we are risk adverse, so we bought it after H retired. We sleep well at night with the combo we have.

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Re: Concierge medicine Worth It????

Post by toofache32 » Tue Jul 17, 2018 10:02 pm

dm200 wrote:
Tue Jul 17, 2018 12:49 pm
No personal experience with Original Medicare - but it seems to me that Physicians with patients on Original medicare might give a heads up to any such patients who do not have a Medigap policy of the potential high risks of costs.
Hmmm interesting you think physicians know about these things, and that we even pay attention to what plans our patients are on. There are others in the office to answer questions about financing/insurance. I'm a physician and I have no idea what you're talking about. I am not a Medicare provider. I would think this would be between the patient and Medicare.

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Re: Concierge medicine Worth It????

Post by dm200 » Wed Jul 18, 2018 10:29 am

toofache32 wrote:
Tue Jul 17, 2018 10:02 pm
dm200 wrote:
Tue Jul 17, 2018 12:49 pm
No personal experience with Original Medicare - but it seems to me that Physicians with patients on Original medicare might give a heads up to any such patients who do not have a Medigap policy of the potential high risks of costs.
Hmmm interesting you think physicians know about these things, and that we even pay attention to what plans our patients are on. There are others in the office to answer questions about financing/insurance. I'm a physician and I have no idea what you're talking about. I am not a Medicare provider. I would think this would be between the patient and Medicare.
By "Physicians" - I mean the offices (all staff). Physicians (offices) that accept Original Medicare certainly know what patients are on Original Medicare - or they would not get paid. As well, these would know what such Original Medicare patients have medigap.

I also believe that the Physician(s) who own the practice set the tone and attitude(s) of the entire staff towards all aspect of the practice - whether medical or financial.

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Re: Concierge medicine Worth It????

Post by HIinvestor » Wed Jul 18, 2018 12:35 pm

I think the doc’s billing staff just knew they were having problems getting paid when H was signed up for A + his BCBS. For some reason they kept trying to process his claims thru Medicare B, which H didn’t have and it kept getting rejected so we’d have to keep telling them to please just process it they his insurance like always. It did eventually get paid after several phone calls.

I’m quite sure the MD had no idea but I was frustrated his office kept making the same mistake despite repeated phone calls.

I can’t see why anyone can think the MD can know or even care about the insurance/Medicare coverage of each of the several thousand patients they see—way too much. It’s up to patients to figure this all out, calling their state Dept of health SHIP program, independent medical insurance agent, etc.

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