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Concierge Medicine and Insurance

Concierge Medicine and Insurance: Here’s What You Need to Know

When people first hear about concierge medical practices, they generally like the idea, but often wonder about concierge medicine and insurance. Whether or not insurance covered concierge medicine is a question worth asking, but it doesn’t have a simple answer. On this page, we’ll explore some of the costs associated with care and discuss whether or not insurance companies traditionally cover them.

Each Plan is Unique, and May Have Different Benefits

Insurance companies have numerous plans, each with its own rules, stipulations, and coverage levels. Sometimes, even plans offered by the same employer will vary. For this reason, it’s impossible to speculate what any given plan will cover. At Dedication Health, we’re in-network providers for most major insurance companies. If you’d like specific details about concierge medicine and insurance, please call our office directly and we’ll find out what your plan offers.

Membership Fees: Generally Not Covered

Concierge medical practices typically have a monthly or annual fee to participate. The amounts will vary based on what the practice offers and the level of care you’ll receive. Because this is technically not a medical service, insurance companies do not generally cover the membership fee.

Annual Physicals/ Well Checks: Generally Covered

One of the most confusing things about the Affordable Care Act is how annual checkups are covered. In essence, the policy was written to ensure people could visit their physician once a year for a wellness visit at no cost. Unfortunately, insurance companies have found loopholes in the wording of the ACA, and often deny things that are regularly part of a wellness check. For more information on this, see the LA Times’ “Obamacare covers free annual physicals, right? Wrong.” At Dedication Health, we do try to cut through much of the red tape insurance companies string up and include an annual physical at no charge to our members.

Diagnostic Services: May Be Covered

Oftentimes, insurance companies cover traditional diagnostic testing at no cost to the policyholder, or they may charge a small copay. Things like mammograms, which are considered routine diagnostic tests, are covered. While other tests that aren’t performed under normal circumstances, such as an EKG, usually fall under the policy’s other guidelines.

Other Medical Services: Varies by Policy and Procedure

There are literally thousands of procedures and tests a physician’s office may perform, and each one is given its own unique code for tracking and insurance billing purposes. Because of the highly-specific nature, each one must be evaluated in its own right, and compared to the insurance policy’s guidelines. However, if the procedure or test is covered at an in-network non-concierge practice, the same rules will apply at a concierge medical practice that’s in-network too.

Concierge Medicine and Insurance

Is concierge medicine covered by insurance? It can be. Insurance companies don’t typically care whether a procedure was performed by a concierge doctor or a traditional one. They care about the code and the procedure that was done, as well as if the doctor was in-network. Many concierge medical practices don’t involve themselves with insurance at all, leaving you to bill your insurance on your own. They may or may not provide coverage if the doctor is out of network. Dedication Health wants to make access to quality care easier for people. This is why we are in network and do handle the billing for many insurance companies. However, we also make your care the primary concern and don’t let the insurance companies dictate what’s right.

Would you like to know more about concierge medicine and insurance or how concierge medicine services can improve your overall wellness? Speak with our practice manager Christine. You can get in touch by calling 847-986-6770 or complete our online form now.