VIP Medicine

[cjhepburn]

About eight months ago, a friend, went to work for a doctor who offered cash based medicine. It ended up being VIP or Concierge Medicine but at the time she was naive enough to think it was for folks without insurance, so did I.

Many of the doctors in my area are doing this now which means you have to come up with an amount ranging from $12000 to $100000 a year before the doctor will even talk to you. Tests, medications and many office procedures are billed in addition to this.

I personally find this practice nothing short of legal robbery. Patients seldom get the service they pay for and in my personal experience, the doctor may take the money and run, or file bankruptcy, leaving a lot of nice folks without medical care and money.

Does anyone know if VIP Medicine is regulated? I've not been able to get a response from the Medical Board.

[Oualawouzou]

What area are you from?

[cjhepburn]

What area are you from?
California

[Emet]

IANAD; IANAL. But I would imagine this is not an issue for the licensing board.

The Board's staff will review the following types of complaints:

the quality of care and treatment provided by a physician (e.g., negligence)
violation of drug laws, misprescribing, or over prescribing
substance abuse by a physician
sexual misconduct by a physician
dishonesty (including filing fraudulent insurance claims)
practice of medicine by an unlicensed person or persons under the supervision of a physician

http://www.medbd.ca.gov/consumer/complaint_info.html

Here's an article from a year ago about Concierge Medicine:

http://www.dailyfinance.com/story/concierge-medicine-patients-pay-up-for-a-doctors-undivided-att/19349963/

I would imagine patients have legal contracts with these physicians (but could be wrong), and a violation of the contract would be an issue of contract law... or perhaps a government consumer agency.

[ElMondoHummus]

... Patients seldom get the service they pay for and in my personal experience, the doctor may take the money and run, or file bankruptcy, leaving a lot of nice folks without medical care and money.

Is that claim based on any actual evidence that you're aware of? Or are you merely saying that it's a possibility?

[Tomtomkent]

Can I be all British and say "Pay for medicine? As well as pay taxes?"

[jhunter1163]

I work for a medical practice, so I am familiar with the concept of concierge medicine. NB: I am in the state of Connecticut; California law may differ.

What you are describing is "straight" concierge medicine; the selling point for this is access to your doctor at any time, much more personal attention, etc. etc. As I understand it, the physician is not permitted to bill any third party (insurance, worker's compensation, auto insurance personal-injury coverage) for any service rendered under such an agreement. If the patient suffers an injury with third-party responsibility, the physician is required to return any payment he/she receives to the insurer (that is, the concierge arrangement with the patient takes precedence over the third-party obligation).

Some practices offer a "hybrid" concierge medicine plan, in which the patient pays a (usually much lower) fee, but the physician is allowed to bill the patient's insurer for some services. The concierge fee pays for services that are not covered by the insurer, as well as copays and coinsurance. This plan has not been legally challenged in Connecticut, but I expect that it will be, as it is clearly a breach of the doctor's agreement with the insurer not to collect any amount from patients other than copays and coinsurance before they are incurred.

[JoelKatz]

Some practices offer a "hybrid" concierge medicine plan, in which the patient pays a (usually much lower) fee, but the physician is allowed to bill the patient's insurer for some services. The concierge fee pays for services that are not covered by the insurer, as well as copays and coinsurance. This plan has not been legally challenged in Connecticut, but I expect that it will be, as it is clearly a breach of the doctor's agreement with the insurer not to collect any amount from patients other than copays and coinsurance before they are incurred.I would think you'd be okay on that score. While amounts are collected, they are not *for* the covered services.

I would think the problem would be the opposite. A doctor's agreement with an insurance company requires them to collect the copays, as otherwise doctors could compete by agreeing to waive copayments. Charging the patient the same amount regardless of applicable, required copayments would violate the typical doctor-insurer agreement.

[jhunter1163]

About eight months ago, a friend, went to work for a doctor who offered cash based medicine. It ended up being VIP or Concierge Medicine but at the time she was naive enough to think it was for folks without insurance, so did I.

Many of the doctors in my area are doing this now which means you have to come up with an amount ranging from $12000 to $100000 a year before the doctor will even talk to you. Tests, medications and many office procedures are billed in addition to this.

I personally find this practice nothing short of legal robbery. Patients seldom get the service they pay for and in my personal experience, the doctor may take the money and run, or file bankruptcy, leaving a lot of nice folks without medical care and money.

Does anyone know if VIP Medicine is regulated? I've not been able to get a response from the Medical Board.

I would suggest contacting your local state medical association to find out which state agency regulates this. In Connecticut, it's the Department of Health. And I just want to add... a hundred thousand a year? For that money I'm going to want a room in the guy's HOUSE.