Boutique Doctor Fees: Insurance Or Not?

Boutique medical practices, also known as concierge medicine, are a type of medical care where patients pay an out-of-pocket fee to become a patient of a medical professional with a small, established clientele. Boutique medical practices do not accept insurance payments and instead charge patients a retainer for the doctor's services. This model of healthcare is becoming increasingly popular as it allows doctors to simplify the healthcare process and offer improved standards of care, such as longer office visits and 24-hour service. However, it is important to note that boutique practice fees are not eligible for reimbursement with a Flexible Spending Account (FSA), Health Savings Account (HSA), or other similar accounts. While the fees for medical services received at a boutique practice are eligible, the initial expense of boutique practice fees is not covered by these accounts.

Concierge medicine is a term for healthcare practices that don't accept insurance

With concierge medicine, patients pay a cash "retainer" or membership fee for the care they receive. This is usually paid monthly, but can also be paid annually. The cost of concierge medicine varies, but members can expect to pay an average of $135 a month.

Concierge medicine has become more popular because practices that don't have to deal with medical insurance say they can save money and provide better service to their patients. For example, doctors don't have to hire people to process insurance reimbursements, billing and other services, which can be an onerous process and may hurt their financial bottom line.

Concierge doctors offer personalized care and direct access. They are often physicians who choose to form a private practice to limit the number of patients they're responsible for and to minimize the amount of paperwork associated with insurance payouts. This means they can spend more time with each patient and address medical problems that might otherwise be overlooked.

However, it's important to note that concierge medicine is not a substitute for medical insurance. Membership fees don't cover everything, and patients will still need health insurance for emergencies, hospitalizations, specialist care, and other major medical expenses.

Patients pay a cash retainer for care

Concierge medicine is a term used to describe healthcare practices that don't accept insurance. It is also known as retainer medicine or boutique medicine. Patients pay a cash "retainer" for the care they receive, and in return, they get 24/7 access and full coordination of care. This model allows doctors to engage with fewer patients. The cost of concierge medicine varies depending on location and services provided, with members paying an average of $135 a month. This amount covers all office visits and procedures, with no co-pays or deductibles.

Boutique medical practices have become popular due to the structure of the American healthcare system. Doctors are paid for diagnoses and procedures but not for the time spent with patients or coordinating their care. The cost and complexity of billing insurance companies or Medicare for reimbursement can sometimes outweigh the expense of the healthcare services themselves. As a result, some doctors have opted to embrace a simpler model, where patients pay a retainer for their services.

While patients pay a cash retainer for care, the fees for medical services received at a boutique practice are eligible for reimbursement through Flexible Spending Accounts (FSA), Health Savings Accounts (HSA), and Health Reimbursement Arrangements (HRA).

Doctors may opt for boutique fees to simplify the healthcare process

Boutique medical practices, also known as concierge medicine, are a type of medical care where patients pay an out-of-pocket fee to become a patient of a medical professional with a small, established clientele. These doctors typically no longer accept insurance payments for their services. Instead, patients pay a retainer for the doctor's services. While consumer-driven healthcare accounts do not cover the initial expense of boutique practice fees, any medical services paid for at these offices would be covered.

As a result, doctors who adopt boutique practice fees can simplify the healthcare process and offer benefits such as longer office visits and 24-hour service. However, doctors must determine what their boutique practice fees will cover. For example, some doctors will charge an annual fee for their services, while others will include all in-office care in this retainer fee.

While boutique medical practices can offer benefits such as improved accessibility and personalized care, they have also been criticized for potentially reducing access to healthcare, especially for underserved groups like low-income people and people with chronic conditions.

Boutique fees are not eligible for reimbursement with a Flexible Spending Account (FSA)

A flexible spending account (FSA) is a savings account that allows employees to set aside a portion of their regular earnings before tax to pay for health-related costs. The money in an FSA must be used by the end of the plan year, but employers can offer a grace period of up to 2.5 months, or allow employees to carry over a limited amount into the following year.

Boutique fees are not eligible for reimbursement with an FSA but the fees for medical services received at a boutique practice are eligible. This is because a boutique medical practice, also known as concierge medicine, is a type of medical care where patients pay an out-of-pocket fee to become a patient of a medical professional with a small, established clientele. In most cases, these are physicians who have decided to no longer accept insurance payments for their services.

The Internal Revenue Service (IRS) defines "medical care" as "amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body". Boutique practice fees do not fall within this definition.

However, while boutique practice fees are not eligible for reimbursement, the cost of medical services actually incurred by a concierge doctor are eligible for reimbursement with an FSA.

The cost of a doctor visit without insurance is often 2-5 times higher

A boutique medical practice, also known as concierge medicine, is a type of medical care where patients pay an out-of-pocket fee to become a patient of a medical professional with a small, established clientele. In most cases, these are physicians who have decided to no longer accept insurance payments for their services. Instead, patients pay a retainer for the doctor's services.

Boutique medical practices have become increasingly popular due to the structure of the American healthcare system. Doctors are paid to make diagnoses and perform procedures but are not paid for the time spent with patients or for coordinating their care. Additionally, doctors must employ individuals to process insurance reimbursements, billing, and other services, which can be costly and time-consuming.

By embracing boutique practice fees, doctors can simplify the healthcare process and offer improved standards of care, such as longer office visits and 24-hour services. However, under this format, doctors set their own fees, which may include annual fees, in-office visit charges, or a combination of both.

The cost of a doctor's visit without insurance

The cost of a doctor's visit without insurance varies depending on several factors, including the type of doctor, the purpose of the visit, the length of the visit, and the patient's location. On average, a doctor's visit without insurance can range from $150 to $450, but it can be significantly higher depending on the medical issue or procedure.

For example, the average physical exam for an uninsured patient costs around $397, including the initial visit, bloodwork, and other tests. The most expensive state for a doctor's visit is Alaska, with an average cash cost of $112-$172 for a basic visit. In contrast, Iowa is the least expensive state, with a range of $79-$121.

Tips for saving money on doctor's visits without insurance

• Ask for a self-pay discount: Many doctor's offices offer special rates for cash-paying or uninsured patients, although they may not advertise these rates.
• Price shop for providers: Call different medical offices in your area to inquire about their pricing. There can be significant price differences between practices and locations.
• Community health clinics: These clinics often provide free or low-cost care, including preventive services, health screenings, and vaccinations. Some offer a sliding scale based on income.
• Telehealth appointments: Telehealth appointments are usually much cheaper than in-person visits and have become more widely available in recent years.
• Compare prices online: Websites like Healthcare Blue Book provide estimated "fair prices" for healthcare services based on typical fees accepted by physicians from insurance companies.

Frequently asked questions