Is Concierge Medicine Legal?

While concierge medicine caters primarily to those who can afford care of this kind, concierge medical practices are rising, and annual fees are becoming more affordable. And while there are some legal issues to consider, there is no reason concierge models of care cannot be legally, ethically, and medically sound.

What is Concierge Medicine?

Concierge medicine involves patients paying an annual or monthly fee for their medical care, in much the same way as you might pay a law firm a retainer so you can always see your lawyer, you can pay your care provider a fee that you can always see your doctor. Concierge medicine can provide a customized health plan that deals with physical and mental health with greater patient engagement. Concierge doctors can provide annual physicals and on-demand care, usually with shorter wait times.

Concierge medicine has seen a significant rise in popularity since the enactment of the affordable care act in 2010. The care act was designed to extend health care to millions of Americans who didn’t have access to medical care by expanding access to health insurance.

One of the impacts of more people having access to primary care is that it becomes more challenging to get an appointment at your primary care practice or see your usual primary care physician. With more pressure on appointments, a physician practice wishing to maintain or improve patient experiences may look to concierge medicine as a way of preserving care delivery and reducing the number of patients cared for, more in line with older care models where patients would have an ongoing relationship with their family physician.

Does Insurance Cover Concierge Medicine?

One of the potential issues related to concierge medicine is whether or not your insurance plan will cover your medical costs. One of the reasons that concierge medical care is on the rise is that it is easier to see a doctor in concierge practices than to get an appointment with traditional primary care physicians. One of the reasons for this is that you have already paid upfront rather than waiting for your insurance company to authorize payment.

Generally, medical insurance will not cover your monthly fee, so this will need to be paid directly. Still, depending on your care plan, most concierge doctors and practices will accept and bill Medicare or private insurance for additional treatment and services.

However, it is worth being aware that doctors can opt out of Medicare. This is one of the legal issues related to concierge medicine, as opting out of Medicare coverage can make things easier for practice managers.

The US Department of Health and Human Services (HSS) has determined that concierge medicine is legal, provided that agreements do not violate Medicare requirements. A Medicare patient must be given a tailored patient contract that does not include any services Medicare covers. This means if Medicare patients pay a fee, this must not have a charge for any direct primary care services that Medicare covers. This can cause legal issues for a medical practice as it can be hard to determine where to draw the line.

Is Concierge Medicine Ethical?

Although there are several issues to consider with concierge medicine, there is no reason why this style of medical care should not be ethical.

One of the issues with concierge medicine is the question of whether or not this style of clinical practice is creating a tiered health system. Ethics would come into play if abandonment occurred due to a patient’s inability to pay. However, this type of managed care also gives patients more choices and has a higher focus on preventative medicine. This type of care practice provides more managed care and can reduce pressure on hospitals and emergency rooms, thus benefitting the hospital and health system as well as individuals.

Why are Doctors Going to Concierge Medicine?

With changes in health laws and increased pressure on primary care physicians, more and more seem to be moving towards offering concierge care whereby patients pay a retainer fee in advance for their care.

New business models, including concierge care, can improve the patient experience as physicians can spend more time with fewer patients. At the same time, patient payment plans increase revenue for physicians, physician assistants, and medical centers, allowing them to provide better service.

Switching to concierge medicine gives doctors more time with patients and allows them to provide a more bespoke clinical practice; they can offer house calls to patients that require them, provide a regular physical exam to help prevent illness, and can reduce their dealings with insurance companies and the administration costs that this entails.

Is a Concierge Doctor Worth the Cost?

With prices becoming increasingly affordable, more and more people can afford concierge medicine and all the benefits that come with it.

Knowing that you always have access to a doctor and that the cost of your day-to-day care is already covered can give you great peace of mind. Not to mention that regular physician visits will help prevent many illnesses from occurring in the first place.

Working with a doctor to create a personalized and holistic treatment plan at TMS Health and Wellness is the first step toward improving your mental and physical health and starting your journey to recovery.[/vc_column_text][/vc_column][/vc_row]