By Martine G. Brousse
"The Medical Bill Whisperer... and insurance stuff too"
Patient Advocate, Certified Mediator
June 12, 2023
Have you noticed the trend? the ads? the number of friends and acquaintances raving about easy, no-hassle access to a clinician?
It's called Concierge Medicine and it is a growing alternative to the US healthcare system, a seductive alternative to the usual hell-thcare maze of high bills, insurance denials and frustrated consumers.
1. What is Concierge Medicine ?
Concierge practices offer unlimited and easy access to excellent medical care, outside of insurance boundaries, to a limited number of "exclusive:" patients for a monthly or yearly membership fee. Some plans may also require a visit co-pay.
Concierge Medicine started a few years back, as a solution to delays in accessing care, difficulty finding the right physician in narrow and stringent insurance networks, weariness at fighting insurers, and rushed office visits.
"More efficient, cost-saving, quality of care, personalized service, 24/7 access to your physician, attentive customer care, extended visit time, emphasis on prevention and lifestyle improvement, insurance-free setting" are just a few benefits that concierge medicine providers advertise.
2. Why is it more and more popular?
For the medical practice, keeping office visits short and seeing a maximum of patients in a day is what pays the bills. To stay in business, quantity prevails over quality.
Physicians, burnt out by stress, frustrated by crushing administrative demands, practice a medicine that has lost its caring and healing aspects in the name of financial survival.
With doctors' schedules full, a lack of physicians or specialists in some areas, and short visit time, patients are often discouraged to seek preventive care, discuss benign concerns or seek nutritional advice. Although these are a free benefit with most policies, time wasted in the waiting room, parking costs and frustration are often not worth the efforts... until too late. Once a chronic condition or uncontrolled symptoms develop, changing habits is harder to accomplish and a full recovery difficult, distant and much more costly.
While the idea of signing up as an "exclusive patient" may seem elitist and expensive, more and more patients are looking more closely at the advantage/cost perspective, and finding it to be to their advantage.
3. The advantages
Guaranteed personalized up-to-date medical care
Limited number of "exclusive" patients
Direct access to a physician, usually 24/7
On-demand, no-wait, same-day appointments
Longer visit time
Extensive screenings and preventive measures
Supportive customer service
HSA/HRA funds can be used to cover some costs
Depending on the usual number of visits, calls or emails a year, the overall cost may break down to a smaller figure per encounter than you might think.
Concierge Physicians regain a sense of service and a more balanced lifestyle while making a more significant and direct impact on the well-being of patients.
The cost: several thousand dollars a year, at least
Expensive if you rarely seek medical care; membership is due whether you use it or not
You are very sick, require specialized treatments such as chemotherapy or dialysis, or need emergency care
Your commercial insurance may not reimburse these services, and certainly not the membership fee
Medicare and/or Medicaid do not cover these services or membership fees
Outside tests, labs, imaging services may be denied or paid lower by your insurance as they were ordered by a non-contracted provider. Those costs may quickly add up, and are usually not covered under the membership.
Pro or Con?
Concierge medicine is not free but it can be a worthwhile option for some seeking convenience, hassle-free immediate access to care, longer talks with a clinician, personalized service, an emphasis on prevention ... as long as you are not too sick.
While Concierge Medicine is not for all, and offers no "Walmart" version, there is no denying its growing appeal to both clinicians and patients.
Until the US system is reformed to provide excellence of care, rapid access at an affordable price to patients, while keeping reimbursement rates attractive to medical providers, Concierge Medicine is likely to expand its share of the healthcare market.
Martine Brousse, the "medical bill whisperer" is a Patient Advocate and Certified Mediator located in CA and the founder of AdvimedPro, which she founded after 20 years as a billing manager.
@martine brousse 2023