What Does Concierge Medicine Cover? What You Need To Know

There are many issues when it comes to our existing healthcare system. From long appointment wait times to only having mere minutes to discuss your health with the doctor, the traditional model falls short on meeting patient needs all too often.

There’s also the hassles related to insurance coverage. Whether it’s determining if an upcoming procedure is covered or if a provider or specialist is in-network or out-of-network, these concerns often get in the way of care.

While concierge medicine takes away the issues of long waits and unsatisfactory care, there may still be some concerns over coverage. Below, we’ll go over what you need to know about this up-and-coming healthcare model and answer questions like, “What does concierge medicine cover” and more.

Concierge Medicine: How It Works

With traditional primary care, doctors must see a considerable number of patients a day to meet sufficient insurance reimbursement rates. In a typical eight-to-ten-hour workday, this means patients have to be squeezed into short appointment slots.

Concierge medicine works very differently. Benefiting both patients and physicians, this model focuses on an enriched patient-physician relationship and elevated level of care in exchange for a membership fee. Concierge patients gain direct access to their doctors, can schedule same-day appointments and receive more one-on-one face time. There is also a stronger emphasis on personalized preventive care and long-term wellness.

Such valuable conveniences and constructive relationships are only feasible because of the fee-based payment structure. Whether paid monthly, quarterly or annually, these membership fees cover access to numerous services and amenities, even some Medicare doesn’t cover.

Physicians also benefit from this arrangement since they can focus more on patient care, rather than dealing with administrative burdens. Furthermore, receiving direct reimbursement as opposed to low rates from insurance is a better reflection on the value of doctors’ time and services.

Each Practice Varies

Concierge doctors are no different than primary care doctors; what differs is the environment in which they practice. At their core, all concierge practices follow the same business model: to charge a reasonable fee in return for enhanced medical care. That being said, practices look different from one another in terms of services offered, degree of access to physicians and other such amenities.

The Coverage You Can Expect With Concierge Care

It’s important to understand membership fees are paid 100% by the patient. A contract or agreement is signed with the practice or doctor group detailing what is covered and what is not. However, state laws, regulations and consumer protections may apply in concierge care as these doctors must still follow all Medicare rules.

Generally, patients can expect to receive an in-depth annual physical as well as same day or next day appointments for any onsetting issues or sudden acute care needs. The practice may also provide an annual hearing screening and similar assessments conducted with state-of-the-art testing equipment.

There may also be “VIP” services available depending on the practice. This model is at times referred to as boutique medicine because patients might pay a higher fee for access to medical care while traveling outside of the country, weight management, customized medical research, in-home appointments and many more specialty conveniences.

Changing Healthcare One Practice At a Time

Physicians and practices across the United States are making the switch to this patient-focused alternative. At Specialdocs Consultants, we specialize in helping these providers convert to concierge medicine through ongoing support. It is our mission to do all we can to assist physicians and their patients as they transition to this mutually beneficial and higher-quality model of care.

To learn more about concierge medicine, please see our page of frequently asked questions.

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