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Concierge medical plans meet Consumer Driven Health Care, and the patient’s the winner.

When one contemplates “concierge service,” one’s thoughts most likely
turn to valet parking and maitre d’s. But that’s not always the case.

A relatively new type of medical practice has come about, called
“concierge” (or “boutique”). According to Warner, Norcross and Judd (a
Michigan-based law firm specializing in such things), there are three basic iterations of concierge medical practices (MCP’s):

In the Periodic Fee for Enhanced or Preferred Access model, the
provider collects a retainer (either once, or annually, or some such
arrangement). This grants the “member” special access to the doctor(s).
Such practices still accept “regular” insurance, and participate in PPO
networks.

The second type of MCP is called Periodic Fee for Access and Medical
Services. This model build on the previous one, and includes extra
medical services in addition to enhanced physician access. One major
difference is that this type of practice does –not-- accept
private insurance or Medicare reimbursement. Thus, the patient is
pretty much back to the old chicken-and-eggs method: cash on the
barrelhead.

Finally, there’s the Per-Visit Access Fee configuration. The newest
form of MCP, this version is a sort of hybrid of the first two: the
practice accepts private insurance, but requires the patient to pay an
additional “access fee,” which grants him more immediate and personal
access to care.

So what’s that got to do with insurance?

Well, medical insurance is really driven by covered expenses; that is,
policies pay for (or reimburse based on) services that the contract
specifies. If the policy excludes something, say, hair restoration,
it’s not going to count toward the deductible, or be reimbursed under
the co-insurance corridor.

We’ll skip the discussion about whether or not MCP’s are a good idea or
not. I’ll only mention that they don’t completely do away with the need
for some kind of underlying cat cover: if you have a heart attack,
you’re probably not going to be dropping by the concierge practice for
immediate care.

On the other hand, at least one carrier is at least addressing the MCP issue: Avalon Healthcare Inc.
specializes in HDHP’s for Florida’s citizens and employers. They’ve
recently announced that their insureds who choose a specific MCP will
have their program fees applied to their deductible. MDVIP
is a “fraternity of individual physicians, each with their own distinct
practice and approach to medicine, yet inherently linked to their roots
in prevention and wellness.” Okay: MCP, fraternity, tomato, tomahto.

In this case, MDVIP will provide a complete physical, as well as other
preventive services, for about $1,500 a year. That would be a pretty
good chunk (if not all) of one’s HDHP out-of-pocket. Most carriers
wouldn’t apply this to the deductible; apparently Avalon will. Good
deal.

Henry Stern, LUTCF is an independent insurance agent in Dayton, OH.
A licensed Continuing Education instructor for Ohio and Kentucky, he
has well over 20 years of experience in “the biz.” He blogs every
day (or so it seems) at InsureBlog.

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from InsureBlog on Sun, 01/28/2007 - 8:38am

This week, we look at Concierge Medical Plans, and how one carrier that specializes in Consumer Driven Health plans handles them.



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