As the ecosystem of American health care continues to evolve, membership-based models such as concierge medicine are beginning to gain traction among patients and physicians alike. For patients who are willing to invest in a worthwhile healthcare experience, concierge medicine is a great investment. This new and improved healthcare alternative offers direct access to health providers as well as personalized, 24/7 care.
The bigger question in patients’ minds is, “How does a membership-based health care model work with my existing insurance?”. This blog post aims to answer that question and gives insight into how both healthcare models interact with each other.
Membership-based models, such as concierge medicine, create a direct relationship between doctor and patient. In concierge medicine, there are no middlemen. All transactions are made between doctor and patient alone. Although concierge practices do not accept insurance to cover membership fees, there are many instances where a patient’s existing health insurance complements the benefits offered by a concierge medicine practice.
Contrary to popular belief, health insurance and concierge medicine can successfully coexist and even complement each other. A patient’s existing health insurance can cover procedures, prescriptions, and other health services included in their plan. This way, concierge medicine providers can focus on being there for patients whenever they need – that includes 24/7 last-minute check-ups and even family appointments.
Medicare, Medicaid, PPOs, HMOs, and high-deductible health plans also affect how benefits are carried out in concierge memberships. For example, PPOs allow flexibility in terms of choosing providers without referrals, complementing concierge care models well.
Insurance claims in concierge settings are much like traditional primary care practices. Standard procedures, such as laboratory tests, specialist visits, and even medication, are billed to the insurance provider. On the other hand, copays, deductibles, as well as concierge membership fees are considered out-of-pocket expenses and are still shouldered by the patient.
Merging membership-based models, like concierge medicine, with traditional health insurance has pros and cons. Combining a concierge medicine membership and an insurance plan is like having the best of both worlds. An insurance plan covers standard health expenses, while a concierge subscription offers the level of care and attention patients deserve.
The only disadvantage to having both is the incurred health costs. Although health insurance covers certain medical expenses, it generally does not cover concierge membership fees. High health expenses have been a challenge to many patients when it comes to receiving proper health care. This results in patients resorting to only one healthcare model, sometimes even neither.
Both healthcare models have benefits. Concierge medicine, which focuses on authentic doctor-patient connections and 24/7, unrestricted access, complements the inclusions of any typical insurance plan. Current challenges in the healthcare ecosystem, such as accessibility, cost, and insurance coverage, require patients to have a variety of options.
Although healthcare models can indeed compete with one another, the presence of each model allows the healthcare landscape to cater to varying needs and budgets. This ensures that patients receive the equitable and high-quality medical attention that they deserve. When patients understand the value different healthcare settings bring, this gives patients power over their own healthcare choices. It allows them to weigh out personalized care and financial matters as they deem fit.
This blog offers an objective view of how concierge medicine combines with traditional insurance plans for patients who are interested in becoming more knowledgeable about the different medical options available to them.
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