Boutique MD’s

[softailrider]

My primary care doctor, who I do not particularly care for personally, but who I think is a really good practitioner, has a new “health and wellness” program he’s starting. If you want to continue to see him it’s going to cost an additional 1650.00 per year starting 2019. This is above what he charges your medical insurance. From what I have heard, there are a lot of doctors who are doing similar type things. I have decided to pay it for now, as I don’t feel like finding a new MD at this point. However, I have some concerns:
1) How do I know he’s not going to continue to see the patients who don’t pay the extra fee.
2) I have [[ thanks to my wife) a so-called Cadillac health care plan, why am I paying the same extra charge as someone who is on Medicare or who has lesser coverage?
3) What about his elderly patients on a fixed income or those who cannot afford the extra charges - it strikes me as not fair on a few levels.
Some real smart people on this forum, interested to hear what people think about this.

[Richard]

I’m am not real smart but what do you meen with the health and wellness program? Separate from everything else he does?Kinda quasi public private?

Down here there have been little medi clinics and dental places popping up that are quite cheap and have payment programs,if you do not have insurance,you can use them in an emergency also but they are staffed by a couple of doctors per clinic.

[Honky Tonk]

I'm not one of the real smart people on the forum, but don't even concern yourself, softailrider. Like the TV tells you "The USA has the best health care system in the world". Now, I'm going to go tell my manager, if he wants me to continue working for him, it's going to cost him an additional $1650 a year, for my new holistic approach to my job. I'll let you know how that works out.

[Pam]

Sounds like greed/price gouging to me. But what do I know, I voted for Bernie who wants "Medicare for all".

[Bong-Man]

I think it's time to shop around for a new Doctor. I've certainly heard of health insurance programs having Health & Wellness programs [[weight loss & smoking cessation as ex.). If completed or adhered to, they usually give you a discount on your premium or prescriptions. I've never heard of any Doctor asking for payment upfront for such a program. If you have caddy insurance from your spouse, I wouldn't be afraid to call them up and ask some questions about your Doctor's request for money in advance. At the least, you would both want to know if this fee would be applied to your annual deductible. Also if the advanced payment would save any charges down the road on routine exams and such. Don't pay a dime until you know the details in writing.

[softailrider]

All of my co-pays and deductibles still apply fully and are not reduced in any way. This 1650.00 yearly charge [[ he accepts 412.50 quarterly) is an additional charge to see him. This is not something he invented, there are a lot of MD’s implementing similar type programs.

As I previously stated, personally I am not crazy about the guy, I find him to be brusque among other traits, However, he is an excellent doctor.

Do I think it’s a money grab? Of course I do. I already paid for the first quarter, I may or may not continue after that, I probably will though, I’m not a huge fan of change.

[Honky Tonk]

All of my co-pays and deductibles still apply fully and are not reduced in any way. This 1650.00 yearly charge [[ he accepts 412.50 quarterly) is an additional charge to see him. This is not something he invented, there are a lot of MD’s implementing similar type programs.

Well that's humanitarian.

[Jimaz]

A few months ago I heard a story on WWJ reporting that some doctors are becoming so frustrated with insurance companies that they're offering patients a subscription service instead. The patients pay the doctor a regular fee whether or not they need their services then when they do need their services, they pay nothing extra.

It basically cuts the insurance out of the loop except in some rare and extreme situations. Imagine the savings in paperwork!

I imagine there are a lot of predatory businesses that should be cut out of the loop. Then they could earn an honest living instead.

[Meddle]

Do I think it’s a money grab? Of course I do. I already paid for the first quarter, I may or may not continue after that, I probably will though, I’m not a huge fan of change.

Which is how they get away with it.

[Honky Tonk]

A few months ago I heard a story on WWJ reporting that some doctors are becoming so frustrated with insurance companies that they're offering patients a subscription service instead. The patients pay the doctor a regular fee whether or not they need their services then when they do need their services, they pay nothing extra.

It basically cuts the insurance out of the loop except in some rare and extreme situations. Imagine the savings in paperwork!

I imagine there are a lot of predatory businesses that should be cut out of the loop. Then they could earn an honest living instead.

That's fine and I wouldn't be opposed to trying a system like that, except people who couldn't pay those fees would be SOL when it came to healthcare. What's going on in STR's case, if I'm reading this correctly, is his doctor is charging an additional fee for something STR might not use, and if he doesn't pay it he can go find someone else. Your statement implies these doctors are somehow being shafted by the AMA system. Other then a few doctors that choose to work in low income or war torn areas, [[and I have nothing but the highest respect for those people) I don't know too many people in the medical business, doctors included, that can't make ends meet.

[Jimaz]

... What's going on in STR's case, if I'm reading this correctly, is his doctor is charging an additional fee for something STR might not use, and if he doesn't pay it he can go find someone else.

My post was meant to be only tangentially related to softailrider's situation in the sense that adaptations are indeed happening due to our unstable healthcare system.

Your statement implies these doctors are somehow being shafted by the AMA system.

I didn't mean to imply that. I do know that doctors are frustrated by insurance bureaucracy though. Doctors want to treat patients, not fill out forms.

Other then a few doctors that choose to work in low income or war torn areas, [[and I have nothing but the highest respect for those people) I don't know too many people in the medical business, doctors included, that can't make ends meet.

Yes. I think that's why they're able to usurp the role of insurance companies in this way.

I think it's just a way that some doctors are firing a shot across the bow of predatory insurance companies. It's as if they're saying "I know you're exploiting my patients. You're annoying me too. I can afford replace you."

And now back to your regularly scheduled thread.

[oladub]

Maybe the Doctor's pricey retainer fee is a way of weeding out unprofitable Medicare patients from his practice. A lot of doctors are quitting. Maybe this is your doctor's way of making his life a little easier.

Plastic surgery and Lasix eye surgery are usually not paid for with insurance and coincidentally said to be getting cheaper. Cash only medical care offers some huge savings for middle class people. Although seeming to be on the other end of the spectrum, Canadian provincial single payer plans incorporate some of the same money saving strategies as cash only doctors. They both pay x amount for specified surgeries. Maybe one day a Democratic state will adopt a Canadian single payer plan and quit paying bureaucrats, lawyers, and insurance companies if politicians can wean themselves off of money from those lobbies.

[Richard]

An interesting read about hospitals,doctors and fees here.

http://www.medicaleconomics.com/blog...-pays/page/0/1

[Johnnny5]

At $1695 per year my guess is that your doctor is switching over to flat annual fee program as Jimaz described it. It's often times called direct primary care and typically covers a list of standard services with extra fees for specialized services or tests. More doctors are doing this as they can avoid dealing with insurance companies, billing costs and non-paying patients. It guarantees them a steady income, and often times lessens their patient load.

Since you have excellent insurance you may be best off looking for a different primary care doc, but I'd suggest doing so well in advance. Nowadays it's tough to find one with reasonable ratings that is accepting new patients and accepts your insurance.

[JBMcB]

At $1695 per year my guess is that your doctor is switching over to flat annual fee program as Jimaz described it. It's often times called direct primary care and typically covers a list of standard services with extra fees for specialized services or tests. More doctors are doing this as they can avoid dealing with insurance companies, billing costs and non-paying patients. It guarantees them a steady income, and often times lessens their patient load.

There were a few areas in Oregon, IIRC, that were trying out this system before Obamacare basically put the kibosh on it. The idea is you pay a flat rate directly to your doctor, then take out catastrophic insurance basically to cover large medical expenses which, for most people, are rare. If you need something done fast, like setting a broken arm, then someone else at the doctor's practice can help if your doctor isn't available.

Overall it saves a lot of money. Some estimates put insurance billing as the top cost of any doctor's practice. It's why the cost breakdown to your insurance company is sometimes 10x the actual cost - to buffer the cost of paperwork and, sometimes, to defer expenses that Medicaid/Medicare won't pay for.

[Meddle]

^^ But that doesn't appear to be what the OP is talking about. They state it's a separate charge over and above all care, not that any of it will be used to offset care costs. Almost like a membership fee or tuition of some kind. 'Pay for the privilege of seeing me, but also pay for all care and treatment'.

[LongGone06]

In Florida, where I now live, I pay substantially higher premiums for the same levels of medical and dental coverage I had in Michigan. However, many dentists in this area refuse to take insurance, regardless of your plan. You are expected to pay for the services directly. Similarly, a number of doctors have gone to "concierge medicine," in which they maintain a small number of patients and offer them 24/7 access to personalized care for a fee. Let me be clear, I do not begrudge anyone who has the resources to afford this type of care; but, it is somewhat frustrating to those of us who rely on insurance to be limited in our choice of dentists and physicians.

[Richard]

^ My mother had a private doctor for years,it caused her untimely death because a hospital will not override a private doctors diagnosis even if it is wrong.

There was the story about the Michigan doctor telling everybody and treating them for cancer that they did not have.

I guess the moral is no matter how much you trust your doctor it may be best to get a second opinion.

I hear that a lot though when it comes to Medicaid and Medicare,slim pickings in doctors and what they actually cover,which is not right.

It does sound like a retainer fee of sorts,like attorneys charge.

I posted before but when I needed anti inflammatory pills they told me $235 for the prescription,I told them I was paying cash,it became $6.

[Honky Tonk]

I needed anti inflammatory pills...

I suggest doubling your dosage.

[Zacha341]

^^^ Tumeric works great as an anti-inflammatory.

[Richard]

I suggest doubling your dosage.

Well,I was waiting on the blue light special and I heard,psst psst,when I turned around it was some Canadian guy in a trench coat.

My first clue should have been when it is 95 degrees out why is somebody even wearing a trench coat,any rate,he opened up his coat and it was reminiscent of a New York street seller with fake Rolex’s,but this was a colorful display of prescription drugs.

He said,what ails you eh ?

I told him and he hooked me right up,but would not take my Canadian change,it was cheap and when I took them they did kinda taste like chicklets gum,they did not work very well so I proably should have stuck with the $200 ones.

Strange enough in Kissimmee there was like 10 Canadian pharmacies that opened up overnight it seems that sold prescriptions cheap,they lasted like 30 days and were all shut down.