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Old Yesterday, 04:47 PM
 
9,334 posts, read 8,139,371 times
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Quote:
Originally Posted by Jakealope View Post
I am considering a concierge/direct care physician. Basically, you pay a monthly fee for your primary care doctor for 24/7 access to the doctor. The doctor can spend a lot more time with each patient with this type of care. Since they don't bill insurance, the doctor can determine what type of tests and care are needed rather than being dictated to by an insurance company.

I am wondering if anyone has any experiences, good or bad, with this type of doctor?
They take insurance for the most part. Only the membership fee and co-pay is out of pocket.

They just limit the number of patients. My doctor limits the number of patients to something between 400 and 500.
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Old Yesterday, 04:50 PM
 
2,635 posts, read 1,007,092 times
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My wife and I have used DPC doctors for ten years. We started because of the awful service we received from our “family care” PCP who was associated with a large hospital. The DPC practice was like night and day, personal service, actual conversations with a doctor who had time to do his job, and no insurance nonsense.

If you are in good health and only see the doc once a year then yes, the cost is probably higher than pay-per-visit at a typical PCP. Since a typical office visit costs about $200 these days, IMO paying $50 a month for a DPC membership is worth the extra expense even if you only go for the annual physical and blood work.
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Old Yesterday, 05:26 PM
 
11,189 posts, read 7,373,406 times
Reputation: 21513
Quote:
Originally Posted by jaminhealth View Post
So mike1003 are you saying you have used this type service?

Did you even read my post??????


NO, I said I know of 2 concierge practices and have 5-6 friends who use them

I also said that All have said at the end of this year, they will stop.


It was right there in MY post


It is an unnecessary extra expense


There is no real pro
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Old Today, 07:22 AM
 
542 posts, read 553,350 times
Reputation: 976
Quote:
Originally Posted by mike1003 View Post
Did you even read my post??????


NO, I said I know of 2 concierge practices and have 5-6 friends who use them

I also said that All have said at the end of this year, they will stop.


It was right there in MY post


It is an unnecessary extra expense


There is no real pro
As the OP, I am wanting to know if anyone with experience using a concierge doctor has some insight into some issues that a potential client may not have thought about. Like the dr not really being as available as advertised. Or some hidden costs outside the monthly fee.

I don't think it's reasonable to call it an unnecessary expense. It depends on your circumstances. If you have good insurance with low co-pays and a reasonable deductible and you are happy with your primary care doctor, there's probably no point in changing to a concierge doctor. The problem is, many people no longer have that. And primary care doctors, even good ones, can't always provide a high level of care for their patients due to constraints from insurance companies, and the number of patients they are required to see.

In my case, I've had the same primary care doc for many years. I like her, and I think she is a good doctor and not a "pill pusher". However, when I get sick I can't get in to see her for several days. I have to make appointments for my annual physical a year in advance. If I need to change the appointment, chances are I won't get one for another 6 months. I don't get sick that often, but I've had multiple situations over the years where I needed to get in there the same day and the staff tells me to go to a Patient First. What level of care am I going to get from an urgent care doctor who gives me a 5-10 minute evaluation, but knows nothing about me or my lifestyle and has no access to my medical records? I consider myself a pretty healthy person, but now that I'm over 55 I'm having some issues. I don't want to be sent to a specialist who doesn't coordinate with my primary care doctor. And in our current system, it's really hard to shop around for a doctor to see if you like them. If you see Dr Jones for a GI problem and you don't like him, will your insurance pay for more visits for the same problems to other doctors? Many times the answer is no. Or if you don't have insurance, you may not be able to pay for more office visits.

The concierge doctor I am considering says they limit the number of patients the doctor sees, and patients have 24/7 access to the dr. So if I get terribly ill on a Sunday, I can call my concierge doctor rather than going to an E/R or urgent care clinic. I pay a monthly fee for unlimited office visits and thorough exams. The doctor spends far more time with his patients because they don't book appointment in 15 minute blocks. The minimum appointment time is 30 minutes. The doctor is not restricted by insurance company requirements and they don't have to hire staff to work through the quagmire of the various health insurance companies and requirements of all of their patients. And if I add a year's worth of the monthly fees, it is less than most deductibles. Many people avoid going to the doctor because they haven't met their deductible. So people without insurance or who have high deductibles may be far better off paying the monthly fee and having a good primary care dr.

Basically, this type of service is how doctors used to operate before insurance companies started calling the shots. It makes a lot of sense for many people. I'm self employed and don't qualify for an ACA plan subsidy. And the ACA plans available to me have such high deductibles and high premiums, they are unaffordable. My approach to healthcare is to try to be as responsible as possible for my own health by exercising, keeping my weight down, eating healthy, not smoking, drinking little alcohol and using common sense. But as I age, I feel like it would be great to have good doctor who I can consult with and access whenever I want/need. Isn't that what a doctor is for?
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Old Today, 07:57 AM
 
9,334 posts, read 8,139,371 times
Reputation: 7797
Quote:
Originally Posted by Jakealope View Post
As the OP, I am wanting to know if anyone with experience using a concierge doctor has some insight into some issues that a potential client may not have thought about. Like the dr not really being as available as advertised. Or some hidden costs outside the monthly fee.

I don't think it's reasonable to call it an unnecessary expense. It depends on your circumstances. If you have good insurance with low co-pays and a reasonable deductible and you are happy with your primary care doctor, there's probably no point in changing to a concierge doctor. The problem is, many people no longer have that. And primary care doctors, even good ones, can't always provide a high level of care for their patients due to constraints from insurance companies, and the number of patients they are required to see.

In my case, I've had the same primary care doc for many years. I like her, and I think she is a good doctor and not a "pill pusher". However, when I get sick I can't get in to see her for several days. I have to make appointments for my annual physical a year in advance. If I need to change the appointment, chances are I won't get one for another 6 months. I don't get sick that often, but I've had multiple situations over the years where I needed to get in there the same day and the staff tells me to go to a Patient First. What level of care am I going to get from an urgent care doctor who gives me a 5-10 minute evaluation, but knows nothing about me or my lifestyle and has no access to my medical records? I consider myself a pretty healthy person, but now that I'm over 55 I'm having some issues. I don't want to be sent to a specialist who doesn't coordinate with my primary care doctor. And in our current system, it's really hard to shop around for a doctor to see if you like them. If you see Dr Jones for a GI problem and you don't like him, will your insurance pay for more visits for the same problems to other doctors? Many times the answer is no. Or if you don't have insurance, you may not be able to pay for more office visits.

The concierge doctor I am considering says they limit the number of patients the doctor sees, and patients have 24/7 access to the dr. So if I get terribly ill on a Sunday, I can call my concierge doctor rather than going to an E/R or urgent care clinic. I pay a monthly fee for unlimited office visits and thorough exams. The doctor spends far more time with his patients because they don't book appointment in 15 minute blocks. The minimum appointment time is 30 minutes. The doctor is not restricted by insurance company requirements and they don't have to hire staff to work through the quagmire of the various health insurance companies and requirements of all of their patients. And if I add a year's worth of the monthly fees, it is less than most deductibles. Many people avoid going to the doctor because they haven't met their deductible. So people without insurance or who have high deductibles may be far better off paying the monthly fee and having a good primary care dr.

Basically, this type of service is how doctors used to operate before insurance companies started calling the shots. It makes a lot of sense for many people. I'm self employed and don't qualify for an ACA plan subsidy. And the ACA plans available to me have such high deductibles and high premiums, they are unaffordable. My approach to healthcare is to try to be as responsible as possible for my own health by exercising, keeping my weight down, eating healthy, not smoking, drinking little alcohol and using common sense. But as I age, I feel like it would be great to have good doctor who I can consult with and access whenever I want/need. Isn't that what a doctor is for?
It's very hard to get timely appointments with female general practitioners. If we didn't get the three-month followup scheduled, we would get bumped another three months.

You will get scheduled more easily because there are fewer patients. I think you will see the doctor about the same amount of time as other practices unless you're going to a big family practice chain. You're being seen by a team of medical technicians, nurse practitioner, or other assistants most of the time. My last visit was for a broken hand and I got a referral to an orthopedic specialist. The doctor saw me all of 5 minutes or less. The nurse practitioner dude saw me about 5 minutes.

They still bill insurance. It you are self-pay, it will cost a lot more because you don't have preference for reimbursement rate. The co-pay is what you pay for the office visit, not the deductible.

I've been to a large practice chain and I was very dissatisfied. They make a big deal about computerization, but got a lot of information wrong even when it transferred between hospital and office. They weren't very timely with referrals.

Last edited by lchoro; Today at 08:25 AM..
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Old Today, 11:08 AM
 
Location: SW Florida
10,882 posts, read 7,951,541 times
Reputation: 16737
Quote:
Originally Posted by mike1003 View Post
Did you even read my post??????


NO, I said I know of 2 concierge practices and have 5-6 friends who use them

I also said that All have said at the end of this year, they will stop.


It was right there in MY post


It is an unnecessary extra expense


There is no real pro
Did your friends say why they've decided against staying with the concierge medical practice?

I've never used one either, but like you I have a couple friends who do. As I understand it (from from checking out the websites of a few around here, and that I've seen advertised), the touted advantage of a concierge practice seems to be the increased availability of the doctor to a patient. There's a membership fee ranging from about$1500 or a little more annually, and from what I read this gets the members unlimited access to their doctor (including the doc's cell phone number) 24/7. Some of the practices include an annual visit and perhaps some routine lab tests, and most say they will bill insurance for other services.

What I wonder is if say when a patient is admitted to the hospital (including if they admit the patient themselves) do their concierge doc oversees their nonspecialist care, and coordinates their overall care there, or is this left to the hospitalist physicians like other patients? This is the case even though the "regular" primary care docs are listed as having admitting privileges at these hospitals.

My friends have been happy enough, apparently, with their concierge docs to continue with them. I guess it could be advantageous in the event someone has medical conditions requiring a lot of oversight and whose health is unstable. Otherwise, though, with those of us who don't see the doctor that often, and are happy enough with the service we get, I'm not sure it's worth the extra cost.
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Old Today, 01:35 PM
 
11,189 posts, read 7,373,406 times
Reputation: 21513
Quote:
Originally Posted by Travelassie View Post
Did your friends say why they've decided against staying with the concierge medical practice?

That was also in my original post


Quote:
Originally Posted by mike1003 View Post

Yep, you have a doc if you need him/her. But, really why pay out of pocket for what insurance covers when you don't need it?


I know of 2 Concierge offices here in town and have 5-6 friends who use them


All have said at the end of this year, they will stop. They are paying docs up front plus still have to carry insurance in case of tests or hospitalizations. All said that they are fed up with the expense. Also said, once out of this plan, even if they cant get 24 hr access, there is still Urgent Care that is covered by insurance
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Old Today, 02:14 PM
 
8,837 posts, read 12,681,595 times
Reputation: 21158
Quote:
Originally Posted by mike1003 View Post
Did you even read my post??????


NO, I said I know of 2 concierge practices and have 5-6 friends who use the

I also said that All have said at the end of this year, they will stop.


It was right there in MY post


It is an unnecessary extra expense


There is no real pro

Of course there is/are.

The are two very important pros, imo. First, as has been stated, you have 24/7 access to your doctor. And that is literal 24/7 access as I have my doctor's cellphone number for any after hours issues/problems. Secondly, concierge doctors limit the number of patients in their practice so there is never an issue with getting an appointment to see my doctor either the same day I call or the very next day at the latest. None of this "we're booked up for the next two months." And of course, with fewer patients, the doctor can spend more time with you when you do come in to the office. Another nice little benefit (at least with my doctor's practice) is that whenever you call the office, a staff person answers the phone. There's never any "press 1 for this or press 2 for that, and the phone never goes to voicemail. That's a promise that's in the annual contract itself.

I've been with concierge practices for almost 15 years in both Maryland and in Florida. Interestingly, there were differences in how services were billed and whether they dealt with insurance companies. The concierge practice in Maryland charged a flat fee for not only access, but it also covered all of the doctor's services during the year, including visits while I was hospitalized. It also included routine annual lab work. There was no insurance involved because there were no charges other than the annual fee.

Conversely, the annual fee for my current PCP only covers "membership" in the concierge practice and is basically a fee for access to the doctor. All office visits and other services are billed to my BCBS policy and I pay my normal copayment in addition to the concierge annual fee.

Unlike your friends, I believe that the annual fee for unfettered access is money well spent. Of course, I've had a myriad of health problems over 30 years including pulmonary emboli in both lungs and numerous DVTs due to a hereditary blood disorder that makes me prone to blood clots, two autoimmune disorders, and two separate battles with cancer, including stage 4 Non-Hodgkins Lymphoma.

Now if I was a perfectly healthy individual who might only need to see a doctor once or twice a year, then of course there would be no need whatsoever to pay to belong to a concierge practice.
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