Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
Can you use that pre-tax health "savings" account to pay a concierge fee?
Yes, but only if the expense is directly related to a medical service performed. Convenience, enhanced access, etc. is not considered a qualified IRS medical expense. There are various sources, but this link explains it best:
The basic answer is that the accounts can’t be used if the fee just covers preferred access or nonmedical services, said John Hickman, head of health benefits practice at law firm Alston & Bird, and other sources we consulted.
If, on the other hand, the fee includes the performance of an actual medical service (a physical, for example) and the patient has documentation to prove that, the account can be used for the portion of the membership fee that covers that service. This is generally the policy of the big flexible spending account administrators.
The above article goes on to discuss scenarios in which the concierge fee could be considered a qualified expense - and docs who charge concierge, by now, should know how to bill so that these fees are qualified.
Last edited by Ariadne22; 04-07-2016 at 04:40 PM..
Basically says you pay any concierge fee out of pocket, and all the normal rules apply re "accepting assignment" or "participating". (Assuming they take Medicare patients at all)
I use a quasi-concierge service in NY it is called One Medical Group and I love it. I pay $200 a year and it is worth every penny. My PCP is always on time, available via e-mail and nurses are available via phone 24/7. She also spends 45 minutes during my physical and 30 minutes with each appt. I will happily pay the fee for the service I get. I understand the issue doctors have with insurance companies.
The $200 hundred dollars pays for added services I couldn't get with a regular doctor like help via their app.
When I get older and may have multiple health issues I will look into a higher form of concierge service and would gladly pay if I can afford it.
I'm not sure how it works when it comes to the doctors (whether it's a franchise - whether the doctors are employed by One Medical - etc.). But it's good to hear you've had good experiences with the outfit.
Your point about the length of appointments is a good one. Before my father joined our concierge practice - his appointments were basically limited to 15 minutes. It's hard to cover a lot of ground during a 15 minute appointment - even for a younger healthier person - much less an older person with multiple issues. Robyn
Like most things, this should be market driven to lower costs. I dropped Medicare in my office a few months ago and sent out a letter to all my Medicare patients noting the change. Multiple patients left my practice to go find some other chump who "successfully" works in the Medicare cattle-call system. They hire an army of nurses so they can run 5 rooms at once, spend only a few minutes with each patient, and have the nurses do "clean up" and close out the appointments to free up the room for the remaining cattle. It's a race to the bottom. Some of my prior patients are already coming back to me when they realize the difference. I do my own H&Ps, I do my own consent forms for surgery, I remove my own sutures, and I do my own wound care and dressing changes. My patients get MY cell phone number....not a number to some call center or a nurse they never met. They get the same cell phone number my wife calls me on. I take these calls even when I am out of town. Surprisingly to all of them, I still charge barely above Medicare rates. It's not just about the money. There is a market for a higher level of care than Medicare provides for.
Wow, what a way to bash Medicare docs and make yourself sound better than them. It sounds like concierge medicine is exactly about money and your decision to abandon Medicare patients was just about money as well. And my Medicare accepting doc doesn't run a high volume practice, nor have my former ones, because they aren't just about money. That rationalization that "docs treat Medicare patients badly, so I might as well refuse to accept Medicare" is just a way to justify ditching Medicare patients.
Quote:
Originally Posted by toofache32
I have always seen many out-of-network patients in my office but Medicare is the toughest crowd because they are the most entitled which is the source of the original post here. Entitlement. Medicare patients believe they have clout because they are part of the largest "insurer" in the country. What they don't realize is that only institutional facilities can afford to treat them through additional "facility fees" that private practice docs are not eligible to bill. Therefore private docs are getting rid of government plans and making room for patients who value a higher level of more personalized care. This is why we are slowly moving towards a 2-tier health system where government patients will be treated in "clinic" settings and private patients will continue to be treated in private offices.
The allure for patients to sign up for Medicare is also it's greatest Achilles heal. There are SO many Medicare patients that the individual patients lose their leverage. There is no incentive for doctors to go out of their way to make these patients happy because there are 10 other patients waiting to take their spot.
If there is no value to a higher level of care then don't do it and go wherever your Medicare takes you. The choice is yours.
Way to bash us too. No, we don't lose our leverage. The key to getting around insurance hassles is to refuse to take no for an answer. I do agree that if the doc doesn't want to work with you, just find someone else. Fortunately there are tons of docs out there who accept Medicare, and the majority are very good. All you do is find a great doctor who doesn't tack on extra fees. I have several great doctors. Two of them take my Medicare, and one of them hasn't taken my insurance for 7 years, even before I got Medicare, but she's so good I pay a reduced cash price to see her.
I'm not sure how it works when it comes to the doctors (whether it's a franchise - whether the doctors are employed by One Medical - etc.). But it's good to hear you've had good experiences with the outfit.
Your point about the length of appointments is a good one. Before my father joined our concierge practice - his appointments were basically limited to 15 minutes. It's hard to cover a lot of ground during a 15 minute appointment - even for a younger healthier person - much less an older person with multiple issues. Robyn
Yes, You are correct it is a national outfit. I can go to any office I want in any city. Since I wrote on this thread I looked at their insurance coverage and they actually now accept medicare which is great news. Beforehand it was just private insurance. I think its a great model for people who may want individual care but can't afford the concierge price. You can also use your FSA/HSA funds to pay the membership fee so if doesn't feel like you are actually laying out the money.
I'm not sure how it works when it comes to the doctors (whether it's a franchise - whether the doctors are employed by One Medical - etc.). But it's good to hear you've had good experiences with the outfit.
One Medical has only seven locations in the states, all of which are in large cities. Another
observation is that most of the doctors who saw patients were very young, few accepted new
patients and the others were "virtual only."
One Medical has only seven locations in the states, all of which are in large cities. Another
observation is that most of the doctors who saw patients were very young, few accepted new
patients and the others were "virtual only."
It seems to have multiple locations in seven large metro areas. I don't know anything about the outfit - so can't comment based on personal knowledge. One way or the other.
When it comes to "virtual doctors" - I wouldn't be happy with that in terms of my primary care doc. But my primary care doc at Mayo sometimes gets "e-consults" from other doctors/specialists at Mayo - both locally and in Rochester - when seeing patients face to face isn't necessary to give an opinion. I think this is a very efficient way to do things. Mayo does too. Medicare disagrees and won't pay for e-consults. OTOH - Mayo believes so strongly in them that it only charges patients $50 for them. A very reasonable price IMO. Robyn
...Way to bash us too. No, we don't lose our leverage. The key to getting around insurance hassles is to refuse to take no for an answer. I do agree that if the doc doesn't want to work with you, just find someone else. Fortunately there are tons of docs out there who accept Medicare, and the majority are very good. All you do is find a great doctor who doesn't tack on extra fees. I have several great doctors. Two of them take my Medicare, and one of them hasn't taken my insurance for 7 years, even before I got Medicare, but she's so good I pay a reduced cash price to see her.
There really aren't "tons" who take Medicare patients. In your case - it's 2 out of 3 - and that is 2/3. What happens if the 2 follow the path of the 3rd?
And there are pretty big differences when to comes to various areas of practice. Because some are more highly paid by Medicare than others. It helps to have a specialty where you can do various procedures that can be done on a volume basis. But not always. When reimbursements are low and/or decreasing (which is what has happened when it comes to eye surgeons who do cataract surgery) The specialties that are low paid and/or can't do a lot of profitable procedures don't have much of an issue with doctors not taking Medicare patients. They have a much bigger issue. Not being able to attract enough (US trained/English as a first language) doctors who want to go into those specialties. Period. Try to find a rheumatologist these days - and you'll see what I mean.
And some specialties - like oncology - are changing. Many oncologists used to make good livings. Mostly as a result of administering drugs. But the reimbursement schedules for administering drugs are changing. As they change - the complexion of the specialty may change too.
FWIW - my brother is a nephrologist who coincidentally used to practice in Phoenix - where the OP lives. And if you think toofache is bashing Medicare patients - you should hear what my brother used to say when he was a young doctor. People would drive up to his office in a brand new Lexus or BMW - on their way to/from the golf course - and then refuse to pay Medicare co-pays/deductibles. It used to drive him nuts. In any event - he now works for a big pharma company. Where he makes more money and doesn't have to deal with Medicare patients ("entitled" or otherwise). And he is much happier.
Just curious - what are the 3 kinds of doctors you deal with? Which 2 will deal with insurance/Medicare - and which 1 won't? Robyn
Ok, I think I understand that. Being non-participating Medicare providers would allow those concierge practices to accept Medicare payments, plus the 20% (as applicable) from a secondary or supplemental insurance, up to the amount allowed for nonparticipating providers for a given service. The patient would be responsible for a set amount above that. And it is likely the patient would have to pay the bill first and be reimbursed by Medicare/insurance, or get lucky and possibly just have to pay their copayments if the provider directly bills Medicare/insurance. Or something like that.
Thanks for the explanations.
Just to explain more in our case. Mayo doesn't require us to participate in its concierge program to use most of its services. But we can't get a primary provider at Mayo outside the concierge program these days (once the main primary care department gets below 1/3 Medicare patients - it might reopen for Medicare patients). And - to me - our PCP is our most important doctor. The doctor who deals with our everyday stuff - and tells us if/when we need specialists and - if we do - which ones. I'm talking about the old fashioned kind of primary care doctor - the board certified internist. Whose range of knowledge is often fairly astounding.
We have other very large "medical homes/systems" here in our metro area. My opinion is 2 are probably ok for most things - and 1 isn't. But it would be like pulling teeth to get a PCP in one of those systems to refer us to Mayo. In terms of "independent" PCPs - they are rapidly disappearing. Many now are more on the order of Medicaid/diet/pill mill doctors - not any doctors I'd care to have.
In terms of billing at Mayo - we pay the concierge fee at the start of our fiscal year. Since Mayo doesn't "accept Medicare" - it bills us directly. As a courtesy - it informs both Medicare and our Medigap carrier - UHC - of its charges. We pay the Mayo bills - and get checks from Medicare and UHC. As a practical matter - our Medicare and UHC payments almost always get to us before the bill from Mayo. And we have Medigap policies that cover the "excess Medicare charges" that Mayo is allowed to bill (which has nothing to do with the concierge program). It's a bit of extra bookkeeping on our part. But we charge the Mayo bills on a credit card - and get lots of FF miles . Robyn
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
