Concierge doctors ? (insurance, how much, buy)

[don6170]

My Better Half is in the market for a new MD. While I have had some very good experiences at Duke, she has had the opposite and wants to go somewhere else. She just turned 65 and has a Medicare Supplement plan, so she can go anywhere.

Has anyone tried a Concierge Doctor? Friends in Ga are very, very happy with one they have through MDVIP, but I don't know if they are active in our area. Appreciate any suggestions for where to start looking.

[wizard-xyzzy]

Take note, Medicare does not cover an ongoing concierge fee regardless of the supplement she has (even Medicare Advantage). Lastly, some concierge physicians have dropped out of Medicare altogether and this leads to a very complex situation.

[Jkgourmet]

You are incorrect that a medicare supplement (aka Medigap) plan means "she can go anywhere."

It's my understanding that coverage for concierge care is only covered if the doctor accepts Medicare. Membership fees are not covered under any Medicare plans including Medigap. Also check to see if they will bill insurance for you; if not, it's gonna be a nightmare to get yourself reimbursed IF they Medicare supplement will cover it.

A few other complications to consider:

If you need in-patient care, your concierge doctor probably doesn't have privileges at the hospital. You're starting from scratch.

If you need laboratory and other diagnostic testing (MRI's, CAT scans, etc.), the results are probably not on a shared MyChart system. Trust me, it's often a PITA to get those images onto a disk.

I'm sure there are other considerations that I haven't thought of.

I understand that Duke can be a cluster, and it may not be worth the hassle if one is quite healthy and needs only limited services. She might want to try the Wake Hospital system. We've found them much easier to work with (but lacking in some of the specialty services and physicians.) I can also say (from too much experience) that the vast majority of Duke NP's and PA's are excellent, accessible and very competent.

[don6170]

Originally Posted by Jkgourmet

You are incorrect that a medicare supplement (aka Medigap) plan means "she can go anywhere."

Yes, I over simplified it. I just meant she wasn't going to be locked into the Duke or UNC or Wake Med system.

It's my understanding that coverage for concierge care is only covered if the doctor accepts Medicare. Membership fees are not covered under any Medicare plans including Medigap.

She would obviously get an MD that took Medicare. We were already aware that the membership fee was not covered.

She spent 40+ years as an ER nurse/supervisor and knew every MD for miles around where she worked in Ga. Unfortunately, she is starting from scratch here.

[Flamingo13]

In general (always?) Doctors in concierge don't accept Medicare and for the most part, that is why they left regular practices.

[wizard-xyzzy]

My PCP accepts Medicare patients (that's good, because I'm on Medicare) and offers an optional concierge program. I didn't buy into it.

[Universe93B]

Even if your doctor accepts Medicare and has an optional concierge program, it will cost more and more for services and more fees. Like Flamingo13 said, dealing with insurance is a massive headache in this country and that’s why many doctors are looking for options where it is not involved (meaning patients pay cash).

[wizard-xyzzy]

Depending on the specialty that's involved, Medicare/Medicaid patients can comprise 50% or more of a physician's billables. Some physicians can walk away from that market segment, but most cannot.

Physicians who want to stay in Medicare have an emerging alternative that used to be called Direct Contracting and has been renamed ACO REACH (Accountable Care Organizations Realizing Equity, Access, and Community Health). It substantially reduces the administrative burden, but it's controversial. Hard to say how much traction it will get.

[panachecary]

I have been using Duke Signature Care for the past five years and my experience has been fabulous. My PCP is always available to me and I can see her at a moment's notice.

[paytonc]

One Medical says that they're a "Medicare-participating provider" but don't list specifics for the Triangle on their site.
https://www.onemedical.com/insurance...urance-finder/
As mentioned above, the concierge fee isn't covered.