Concierge Battle Brewing

[Welcome Industry Radar readers!]

Primary care physicians are battling to save their practices by looking at new ways to increase revenues. Some have converted to cash only services, other are peddling nutritional supplements. And a few have gone to concierge services.

Doctors who charge an annual fee to patients in exchange for customized care including house calls are drawing the ire of some health insurance companies.

Now it seems that some carriers are rebelling against the concierge docs.

But United Healthcare and Cigna both say the concierge model violates their contracts, and United Healthcare is dropping four Texas physicians because of the practice. Insurers say that doctors may charge patients for co-payments or co-insurance, but not additional fees

I tend to agree with the carriers.

MCO contracts signed by physicians prohibit the doc from balance billing for covered services. In other words, once the patient pays their portion the provider is prohibited from charging more.

To do otherwise defeats the concept of the copay (or coinsurance).

It seems this practice may be running afoul of the TX DOI as well.

Jennifer Ahrens, the Texas Department of Insurance's senior associate commissioner for life health and licensing programs, said Texas law is explicit for health maintenance organizations and preferred provider organizations. Physicians associated with HMOs or PPOs agree to discount the fees they bill insurers for specific patient services, but doctors who enter into these discounted-fee contracts can only charge patients related co-payments or co-insurance and not additional fees.

Concierge services is still a new concept so this battle may take a while to come to a head if it ever does.

Still, it is something worth noting.

(Thanks to Matt Horn for the tip on this story line).