Do Concierge Doctors Accept Insurance?

Many concierge medical offices, like Coastal Concierge Internal Medicine, accept commercial insurance plans and government programs like Medicare Part B. Visits are billed in the traditional manner and you are responsible for any co-pays. However, each concierge practice is unique and their services vary, as does what is included in the membership cost. Some practices only offer care for a yearly, quarterly or monthly membership fee and don’t accept health insurance, but keep in mind that insurance is still needed for emergencies and hospitalizations.

Medical Insurances Accepted at Coastal Concierge Internal Medicine (CCIM)

Currently, most commercial insurance companies do not allow concierge practices to participate inside their provider network. This means that Coastal Concierge Internal Medicine is presently an out-of-network provider and does not accept assignment from insurance companies other than Medicare Part B.  

As part of the CCIM concierge membership, the practice will submit claims as an out-of-network provider to all commercial health insurance plans.  Since out-of-network benefits and deductibles vary between insurance plans, patients may be financially responsible for services (such as office visits and in-office procedures, etc.), insurance deductibles or other fees not included with the Concierge Membership.  

While CCIM services may not be covered by your commercial insurance plan, ancillary services such as bloodwork, prescriptions, lab work, imaging, emergency room visits, specialists and hospitalizations should fall in-network.

If you have any further questions for the CCIM staff about services and insurance coverage, please contact us.

Does My Healthcare Plan Cover Concierge Membership Fees?

Your concierge fee is what provides unlimited time with your physician and healthcare explicitly tailored to your needs. Concierge medicine can work with your current health insurance plan. You are responsible for paying the concierge fee out of pocket, but services like screenings, lab work, specified treatments, surgeries and emergency services are covered by your insurance.

Not all policies are the same; therefore, we highly recommend checking with your insurance company before committing to a concierge healthcare program.

Out-of-Network Medical Care

As an added benefit to your concierge membership, doctor’s offices like CCIM will submit claims to your insurance company as a non-participating partner. Non-participating means the provider you are seeing is not “in-network” with plans from companies like Cigna, BlueCross BlueShield, Humana, United Healthcare and more.

Claims submitted to your commercial insurance company typically count towards the out-of-network deductible provided your policy has one. Seeing an out-of-network doctor tends to cost a bit more out-of-pocket. This factor should be considered when determining if this healthcare model is suitable for you. Often, our patients feel that the benefits of personalized care, a concierge team, an enhanced doctor-patient relationship and 24/7 access to our medical staff seriously outweigh the additional expense.

Benefits to Using a Non-Participating Provider

Seeing a non-participating provider may not seem like a favorable scenario, but it works as a patient. At CCIM or any concierge medical practice, the care your physician provides is not limited by restrictive insurance mandates. As a concierge patient, this means your insurance company has no say in how long treatment should be and they can’t put time limits on face-to-face visits which last longer than traditional appointments. Extended appointments allow your doctor to build a relationship with you and coordinate proper care. Dr. McKenzie spends many hours conferencing with your specialists, reviewing your medical records, and remaining up to date on both common chronic conditions and rare diseases. Being under the care of a concierge doctor is exceptionally beneficial if you have a complex medical history or are under the supervision of numerous specialists.

I Have Medicare, Can I See a Concierge Doctor?

We can’t tell you how other concierge practices operate or what plans they accept, but at CCIM, we accept Medicare Part B assignment and secondary insurance policies.  What this means for Medicare patients is that in addition to the standard Medicare Annual Deductible ($233 in 2022), the patient is also financially responsible for the CCIM Annual Concierge Retainer. 

Patients with an HSA or FSA

Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) have grown in popularity because it allows you to set aside pre-tax money for medical expenses. CCIM does accept payment towards the CCIM Annual Concierge Retainer from both types of health savings accounts. Unfortunately, not all HSA or FSA providers consider concierge membership an allowable expense. If you have one of these accounts and would like to be a CCIM patient, we recommend checking with the provider to confirm whether or not they cooperate with concierge practices.

Why Paying a Concierge Medicine Retainer Makes Good Health Sense

At CCIM, we understand that this healthcare model is quite different than the conventional healthcare you’re accustomed to receiving. We believe that concierge medicine fills in the gaps left by traditional medical care. Our physicians have the freedom to be proactive regarding your health, rather than just reactive. You’ll receive comprehensive health care, which is both thorough and preventative because we aren’t restricted by insurance regulations. 

Retainer-based medical care often leads to better health outcomes such as faster diagnoses, improved long-term care and prevention of future health issues. Not only will we bill your current insurance on your behalf, but we’ll also work with you (and your loved ones) to create a comprehensive health plan that goes above and beyond the care allotted by insurance providers.  You will be seen by the doctor herself and not a midlevel provider that many traditional offices so they can continue to see a large volume of patients.

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