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Posted By: Doc Gurley
Internist Physician
SFGate.com
June 13 2009 at 11:19 AM
Medscape [free subscription] has a great article that got (surprise!) very little mainstream media-play - about the insurance industry going after concierge doctors who offer services to the uninsured.
For those of us who don't live in the rarefied world of "concierge" anything, here's how a concierge doc works: you, as a doc, sign up people for a fixed monthly amount, then you offer them hand-held service for that monthly payment. Also part of the arrangement is a (sometimes explicit, sometimes assumed) limit on the total number of patients the doc will see - say, 600 people total [for more on this secretive and explosive healthcare topic - called panel size - check out the Doc Gurley article titled "Can't get an appointment with your doc? Here's the secret reason why..."].
The twisty world of healthcare
So what kind of hand-held service are we talking about? Besides getting all your medical visits (sometimes unlimited, sometimes with a co-pay or capped number), you usually also get 24-hour access to your doctor by some combo of cell/email, no wait for appointment times, and even, when desired, you can be accompanied to visits with specialists. Patients who choose this route are expected to own at least catastrophic health coverage, in case of hospitalization or a specialist-heavy illness like a new cancer diagnosis.
The shocker for most of us is finding out just how relatively cheap these concierge docs are - we're talking monthly basic cable numbers. Specifically, anywhere from $39 a month to around $139 a month, usually scaled based on age, with wide variations depending on the doctor's demand, reputation, and geography.
It turns out, some of these free-wheeling docs got sick and tired of waiting for Washington to solve the healthcare crisis, and decided to offer their services for the same price - even if the patient did not have catastrophic (or other) insurance coverage. In other words, for the working healthcare-coverage denied/poor.
It didn't take long for insurance companies to notice. Their ploy? To accuse these individual docs of falsely pretending to be, and act as, insurance companies, and - therefore, not complying with the massive regulations that it takes to compete as an insurance company.
Individual doctors tried contacting their state legislators, who, outraged, then tried to introduce bills in various states to make these sole-practitioner doctors exempt from insurance-industry regulations, except (and here's where I'm guessing you can predict the rest of the story...) the insurance lobby got involved at the state level and the doctor-protection bills died from that tragic legislative epidemic of ignored-to-death (West Virginia and Indiana).
These issues are creaking along at the state level - with some docs asked to charge more for the uninsured (New York, for example), others in different states being told they can't offer services to the uninsured at all because they aren't qualified to be an insurance company. So what do you think? Should these doctors be treated as unlicensed insurers? Or made exempt? If you'd like to weigh in on this issue, feel free in the comments section. Or, if you'd like to make a statement on this issue for California, consider contacting your local legislator, or the California Department of Insurance.
Got a thingie on your doohickey? Or are you pondering how to tell your doctor he's a jerk? Send your burning healthcare questions to Doc Gurley by emailing docgurleyatgmaildotcom. Doc Gurley cannot answer every question, and she cannot practice medicine through a keyboard (not even with her stethoscope pressed firmly against the monitor) but be assured - your questions will be kept strictly confidential and identifying traits are changed.
