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How to Pick a 'Concierge' Health Plan
Unless you appear to be at death's door, it can be tough to get a doctor's attention for more than 10 minutes.

Concierge health care aims to change that for patients who can afford it.

Many concierge plans cost $2,000 or more out of pocket, with little to none of that amount reimbursable by insurance. The cost of other concierge plans depends on how much you use them. If you're relatively healthy, they can be a good deal.

Also known as "boutique" or "direct" health care, the model advocates a direct financial relationship between doctor and patient -- reducing the role of the insurance company in setting limits on coverage.

The idea is to give some patients better access to their primary-care physician.

Broadly speaking, doctors set up direct-care practices in three ways, according to Dr. Chris Ewin, a Houston primary-care physician and past president of the Society for Innovative Medical Practice Design.

Here's what you need to know to choose between the three models:

Fee for service

In this model, patients pay their physician directly for office visits and other services as needed. The benefit is that you typically get much more time with your physician when you have an appointment (although you won't necessarily get his cell phone number, as you will in the models below).

These visits may be covered (at least partly) by your health-insurance policy, depending on your coverage for out-of-network physicians. However, you'll have to do the insurance paperwork yourself. Your doctor will likely provide you with an itemized receipt complete with the codes insurers use for various procedures. But filing that paperwork -- and waiting for reimbursement -- is up to you.

That could be significant in a couple of ways. First, the rate at which you're reimbursed will vary depending on your coverage for out-of-network providers. Second, since appointments can be luxuriously long -- picture a 90-minute intake meeting -- your doc will charge accordingly.

Expect to pay as much as $250 or $300 for a lengthy visit. Finally, there is little to no regulation or oversight of these practices' fees. This mean it's up to you to make sure you get your money's worth.



Like the fee-for-service model, the retainer model involves patients paying cash directly to a primary-care doctor. In this model, though, you pay a flat annual fee that covers all of your primary care. That includes your office visits, as well as phone and email consultations.

You'll receive your doctor's personal email address, as well as mobile and home-phone numbers, and in many cases you'll be able to schedule same-day appointments. And you're likely to have a very short wait when you do need to be seen, since doctors using this model typically have just a few hundred patients, as opposed to the thousands of patients seen by a typical HMO doctor.

The details of a retainer arrangement are typically laid out in a contract signed by you and your physician. Since your fee isn't tied to a specific office visit or procedure, most insurers won't cover it. So you'll have to pony up the money -- typically $1,500 to $2,000 -- in cash. Furthermore, you may not use pretax dollars from a flexible spending account to pay the retainer (Ewin's group is lobbying Congress to change that rule).

Hybrid, or fee for noncovered service


Like the retainer model, the hybrid model gives you access to your doctor's personal email address and cell phone number, as well as prime appointment times, in return for a flat annual fee that you must pay in cash.

Your doctor, however, still bills your insurance company for regular office visits and tests, and accepts their limits on how much to charge. That way, you're not stuck with big out-of-pocket costs beyond the flat fee -- which should be somewhat lower than the fee you'd pay in the retainer model.

f you're considering this model, or any other concierge form of care, it's worth thinking about how you typically use the services of your primary-care doctor, and whether the extra cash you spend will be worth it.

While concierge care may sound heavenly -- a doctor who actually returns phone calls and can devote a reasonable amount of time to your care -- it isn't a solution to our health care crisis.

"Rather than creating a better system of care for everyone, this model only ensures that people who can afford it get the best care," argues David Barton Smith, a research professor at the Center for Health Equality at Drexel University's School of Public Health.

Still, Smith admits that the benefits can be hard to resist, especially for people who are trying to keep their aging parents out of a nursing home.

"Even though I'm a skeptic, my 93-year-old mother is in one of these [concierge] practices," he says. "She's got an entire encyclopedia of various types of medical problems that need a lot of thought."


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