04 Jun How Does Concierge Medicine Work with Insurance?

Concierge medicine offers personalized healthcare with benefits like extended doctor visits, direct physician access, and preventive care. it’s important to understand how concierge medicine fits into your overall financial and insurance picture. In this article, we’ll explore what’s included, what’s not, and how concierge medicine can work alongside your existing health coverage.

Is Concierge Medicine Covered by Insurance?

Most concierge medicine practices, including Concierge MD, do not accept insurance directly. While the monthly/annual membership fee is not typically reimbursable, many of the services and treatments we provide can be reimbursed by employee offered insurance plans. Reimbursement is not guaranteed.

Concierge MD can provide patients with the documentation needed for submitting reimbursement claims. Patients take the responsibility for billing the insurance company allowing Concierge MD to focus on personalized quality healthcare.

Concierge MD LA’s Insurance Policy

Concierge MD LA does not bill your insurance company directly. Here’s how Concierge MD LA works in concert with your insurance plan:

• Concierge MD provides quality, personalized healthcare service
• Patients receive itemized documentation for each visit, service, and treatment received 
• Patients submit the documentation alongside the insurance company’s claim forms for potential reimbursement
• Patients may receive financial reimbursement from their insurance company for any covered services; however, reimbursement is not guaranteed and depends on the terms of the individual’s insurance plan

Understanding what your insurance company pays for and doesn’t pay for is key.

Can I Use an HSA or FSA for Concierge Medicine?

Yes, Concierge MD accepts both HSA (Health Savings Accounts) and FSA (Financial Services Accounts). Simply enter your account number when booking your visits or services. This is often a great option for using pre-tax dollars for healthcare.

What’s Typically Covered or Reimbursed?

What can be reimbursed by an insurance provider depends greatly on your insurance plan. Plans vary by insurance provider so it is important to understand your specific coverage. In general, these are the types of services that may be reimbursable by an insurance plan:

• Preventive Care Services. This can include annual physical exams, vaccinations and screenings (e.g., blood pressure, cholesterol, diabetes).
  

• Diagnostic Testing. Lab work, imaging (e.g., X-rays, ultrasounds), EKGs or other in-office/in-home tests.
  

• Illness or Injury Visits. Evaluation and management for acute conditions (e.g., flu, infections), chronic disease management (e.g., hypertension, diabetes), if billed as part of a covered service.

• Visits to referred specialists. While the coordination with specialists may not be reimbursed, the actual visit with the specialist may be covered.

Always check with your insurance provider in advance—some services may require pre-authorization or be excluded depending on your plan.

Do I Still Need Health Insurance?

Yes.. Concierge medicine is not a replacement for insurance. Concierge medicine and insurance can work in concert to ensure you have enhanced, personalized healthcare and get reimbursed for services that are covered by your insurance plan.

Pros and Cons of Combining Concierge Medicine with Insurance

To make an informed decision about your healthcare provider choice, let’s look at some important benefits and drawbacks for combining concierge medicine with an insurance plan.

Benefits

• Financial Protection. Concierge medicine offers personalized healthcare and stronger relationships with healthcare providers while insurance provides the financial reimbursement and protection for unforeseen medical services (injury/sickness while traveling, hospital visits, for example).
• Preventive Care: Combining concierge medicine with insurance ensures that individuals can access essential preventive measures, contributing to early detection and management of potential health issues.
• Network Access: Integrating concierge medicine with insurance allows patients to leverage networks when necessary, ensuring access to a wide range of medical expertise.
• Flexibility and Choice: Patients can enjoy the personalized and attentive care provided by concierge medicine practices while having the capability to seek specialized or emergency care covered by insurance.

Drawbacks

• Additional Membership Fee: The membership subscription fee that is not covered by insurance could be a drawback for some individuals.
  
• Limited Insurance Reimbursement: Concierge medicine offers many services and conveniences not offered by traditional physicians. These may not be reimbursable by insurance.
  
• Administrative Complexities: Patients pay for concierge medicine directly and must file for coverage reimbursement which is an additional financial step.
  
• Coverage Gaps: Patients might face coverage gaps for medical needs that fall outside the scope of services.
  
• Reduced Accessibility for the Uninsured: The exclusive nature of concierge practices, coupled with insurance-related costs, may limit access for individuals who do not have insurance.

Why Patients Choose Concierge Medicine Anyway

Concierge medicine is rising in popularity nation-wide for a reason. Individuals and families want more from their healthcare providers and the benefits outweigh potential drawbacks for these reasons.

• Faster 24/7 access to healthcare
• Longer, more meaningful visits with doctors
• Convenience of at-home or at-office visits
• Faster access, longer visits, and convenience
• Personalized attention

Focus on preventative healthcare and not on administrative matters

Frequently Asked Questions

Can I Use Insurance to Pay for Concierge Medicine?

Concierge MD LA does not accept insurance. Rather we provide itemized documentation for potential reimbursement by your insurance company. Monthly/annual subscription fees are not typically reimbursable by insurance plans but medical services and medically-necessary treatments usually are. 

Can I Use my HSA or FSA to Pay for Concierge Medicine?  

Yes. HSA and FSA programs offered by your employer are an ideal way to use pre-tax dollars for your healthcare costs.

What’s the Best Way to Get Reimbursed?

Concierge MD LA will provide itemized documentation for each visit and service you receive. Using this documentation when you file a reimbursement claim with your insurance provider.

Can I Use HSA/FSA for Concierge Doctor Visits?

Yes. When you book your visit, enter your HSA or FSA account number.

Do I Need Regular Health Insurance if I Join CMD LA?

You don’t need insurance to become a Concierge MD LA member. However, most patients keep health insurance for hospital visits, surgeries, prescriptions, or emergencies. Concierge medicine complements—not replaces—your existing insurance coverage.