The role of insurance in concierge care

One of the big questions concierge physicians are asked is, “Do I still need insurance?”

The answer is yes. I bill commercial insurance and Medicare for office visits and medical procedures.

My concierge practice does not take the place of general health insurance. It is a family medicine practice, not a health insurance program. You are advised to continue your PPO, Medicare or other insurance program as well as your FSA or HSA plan. Neither the fee nor the amenities take the place of general health insurance coverage.

Plus, it is important to remember that illnesses can be unpredictable. Should you need to be hospitalized or visit an emergency room, you want to ensure you are covered by insurance.

Will you be a provider on my insurance plan or for Medicare?

I intend to remain an in-network provider for many major PPO insurance plans and will bill your insurance directly for professional services that are covered by those plans. (Professional services are not covered by your annual fee.) If the terms of your insurance plan require a co-pay, I am obligated to request payment at the time of service. Even if I am not a provider for your insurance plan, I will attempt to refer you to in-network physicians for any necessary consultations and to in-network facilities for diagnostic tests and hospitalizations as medically indicated. Those services will likely be covered by your insurance plan.

My office will file your claims with Medicare as well as with your supplemental insurer on your behalf, as required by law. Office visit fees that are not reimbursed by insurance will be the responsibility of the patient.

Will my private insurance or Medicare reimburse my annual fee?

No. The annual fee is not covered by private insurance or by Medicare.