6 Problems with Concierge Medicine (+ Overriding Benefits)
written by
Veronica Max, APRN, FNP-C
While concierge medicine has its problems, its benefits surpass those of traditional practices.
Most people could benefit from a concierge healthcare service as opposed to the traditional model. But concierge models do have challenges, which means they are not a fit for everyone. Here’s what the problems are and how to decide if it's a good fit for you.
Problem 1. Finding a Concierge Doctor In Your Area
Finding the right primary care doctor can be hard. Finding the right concierge doctor can be even harder. It can take a few tries. Even if you like the perks of the concierge practice (access, convenience, personalized care), you might not connect with the first provider you choose.
While they are gaining popularity, concierge practices are still limited in number. Since concierge doctors try to have fewer patients to provide better care, this can also mean it’s hard to find practices that have room to take on more patients.
The good news is that concierge medical practices are typically experts in virtual care. Free from the limitations of insurance reimbursement, concierge doctors were early adopters of telehealth and related technologies. This means that you can expand your concierge search outside of your immediate geographic region.
Problem 2. Finding a Concierge Service with Room for More Patients
It’s not uncommon to contact a concierge practice only to discover they’re not accepting new patients and have a waitlist.
Concierge healthcare practices tend to have limited memberships by design.
Opting out of insurance means concierge physicians no longer need to see the high volume of patients dictated by insurance companies. Instead, they can provide high-quality, personalized care, which requires them to have a limited number of patients.
For example, UltraPersonal Healthcare tops out at roughly 600 patients per provider, which ensures every patient gets a high level of care and service.
Problem 3. Determining What Insurance Does and Does Not Cover
Insurance is far from transparent. Determining what they will and won’t cover can be tedious. If you have ever tried calling an insurance company, you know what it's like: time spent on hold, numerous transfers, dropped calls, no straight answers, and hard-to-understand overseas representatives are the rule, not the exception.
This is by design. They’re hoping you’ll give up, letting them off the hook for the bill in question and padding their bottom line (and executive salaries).
This is why concierge doctors don’t take insurance.
While the benefits vary by practice, many concierge doctors offer unlimited visits with NO copay.
Most procedures done in the office are covered by your membership fee, meaning there is no need for prior approvals from your insurance company (who are they to tell you what you can and cannot spend your healthcare dollars on anyway?!).
This doesn’t mean your catastrophic coverage (whether that be traditional insurance or a health share) is of no use altogether. If you have an FSA or HSA, you can use these pre-tax dollars to pay for your membership fees and/or specialty testing.
You can also still use your insurance for things outside of the concierge practice if you want. This could include routine bloodwork, medications, imaging and specialty visits.
However, many consumers are not aware that it is often cheaper to go the self-pay route rather than using insurance. If you choose self-pay, you also get the benefit of transparency.
Take labwork as an example. In the case of UltraPersonal Healthcare, we have accounts with all of the major national labs, granting us exceptional rates that we pass on to our members. Comprehensive bloodwork that costs $150 through us would cost as much as $1800 if insurance does not deem the labs we order as “medically necessary” (this is a real example by the way!)
Problem 4. Learning to Trust Your Concierge Doctor
Trust is essential for a productive doctor-patient relationship. The quality of care you receive is highly dependent upon the information you relay to your doctor. If you don’t feel comfortable discussing your health concerns and symptoms — especially when they are of a sensitive nature — this can negatively impact the care you receive.
While healthcare providers (especially nurses and nurse practitioners) are generally highly trusted individuals, it’s important to evaluate whether or not your provider has earned your trust.
● Does your doctor listen?
● Do they share all of the available treatment options, including their risks and benefits with you?
● Do they defer to you to decide what’s best for you and/or your child without shaming, fear-mongering, or judgment?
● Do they seem to have your best interests at heart?
● What does your intuition say?
Depending on your personality and background, it may take some time to develop a trusting and open relationship with your concierge doctor.
Building relationships (and trust) takes time, and concierge doctors have time to spend with you. Doctors working in traditional insurance based models do not.
Instead, the time that used to be spent with patients is now spent on a computer, documenting why the insurance company should pay the doctor.
Problem 5. Using Your Membership Often Enough to Justify It
“I’m healthy and I never go to the doctor. Why do I need to pay a monthly or annual membership fee?”
That is a common question asked of concierge medical practices.
Many people worry about being able to justify paying for concierge services. This usually comes from the belief that they’re only paying for sick care.
But in a good concierge medical practice you are paying not just for care when you are sick, but you are paying for access to HEALTHcare. In essence, you have the chance to optimize your health, not just treat sickness.
For example, at UltraPersonal Healthcare, we’re skilled not just in primary care, but in functional medicine, health optimization, and longevity medicine. This means we don’t just see you when you’re sick, we also see you when you’re healthy and provide education and guidance on staying healthy, and optimizing your wellness.
If you want to lose weight, we can help. If you want to get stronger, we can help. If you want to feel better, be more active in the bedroom, or improve really any sort of physical or even emotional aspect of your life, chances are we can help you get there, as can any high quality concierge medical practice.
Problem 6. Changing Your Mindset Around Healthcare
Getting healthcare via the traditional, insurance-based system can be painful.
You've probably experienced the frustration of waiting for weeks or even months to see a physician, only to find yourself languishing in a waiting room for hours to see a doctor who may or may not remember you.
According to a recent survey of physicians, Americans wait about 24 days to see a new doctor, a 30 percent increase since 2014.
And once they get there, would-be patients can expect to cool their heels for an average of about 18 minutes.
It’s no wonder that you avoid accessing the healthcare that you pay for (via insurance premiums).
Concierge medicine removes these barriers and friction, making both sickcare and healthcare easy to access.
Think about the difference:
First, you also don’t get charged a co-pay to see the doctor. Visits are included in your membership.
Second, when you’re sick, you don't wait to seek care or make an appointment. With a concierge membership, you can text or call your doctor at the onset of your illness. You may get a text back with instructions for treatment at home or you might be directed to come into the office for a same-day exam and additional testing.
Additionally, because of the monthly membership, your concierge doctor is incentivized to keep you healthy and out of their office.
When you’re well, you will be working proactively with your concierge doctor to optimize your wellness to prevent getting sick at all, and/or reducing the downtime when you do.
This goes back to #5--if you change your mindset around healthcare, you can use your membership more and be healthier and happier.
Pros of Concierge Healthcare
With the downsides out of the way, let’s talk about the benefits of concierge medicine! We’re a little biased of course, but based on years of treating thousands of patients, here is what they consistently tell us the benefits to them are.
More Access and Flexibility
Concierge medicine offers more access to your primary care physician.
This access means same-day appointments or next-day appointments and around-the-clock availability. It also equates to house calls and when appropriate, virtual care options (telephone, text, video visit).
This level of access and flexibility eliminates the need for many urgent care and emergency room visits, it also saves you on your most important asset—time!
More Time with Your Doctor
Since concierge practices service fewer patients than traditional primary care practices, you will have more time with your doctor. This attention results in relaxed appointments where you can discuss whatever you need to, without feeling rushed.
Care Coordination
With concierge medical care, your healthcare team is your advocate, and will help you navigate the healthcare system outside of their doctor’s office.
This can look like coordinating specialist appointments, finding the most cost-effective solution for medications and imaging, or making sure everyone on your healthcare team (outside of their office) is on the same page and communicating. The result is more effective, better quality care.
Personalized Care for Less
The traditional “health” system is built upon algorithmic medicine. While this has resulted in some benefit for managing disease outcomes, it is poorly suited for promoting wellness. It does not take into account the unique background and environment of individuals, which is critical when it comes to disease prevention and health optimization.
This level of care doesn’t have to break the bank either. An entire year of healthcare with UltraPersonal Healthcare costs less than 2 visits with most functional medicine or longevity medicine providers.
You may also be able to use your HSA or FSA dollars to pay for the monthly fee.
Health Optimization Instead of Sick Care
When the patient replaces the health insurance company as the consumer in healthcare, incentives change. Your doctor is driven to get the best outcomes for YOU, not your insurance company or a hospital system. This shifts the focus from disease management to health optimization.
This focus on health optimization requires an entirely different set of paradigms and tools than those utilized in the traditional sickcare system.
You’ll find that concierge doctors tend to incorporate functional medicine–a proactive approach to healthcare that emphasizes the importance of understanding the underlying causes of disease and addressing them through a combination of conventional and alternative therapies.
This could include advanced testing, such as micronutrient tests, comprehensive stool analysis, genetic testing, hair tissue mineral analysis, and telomere evaluation. It could also include “prescriptions” for a ketogenic diet, intermittent fasting, sunshine, and/or blue light blocking glasses at night.
Is Concierge Medicine Worth It?
Are concierge medical services worth it? That depends.
Are you getting the access you need and the quality of care and experience you want via the traditional system?
If yes, there’s no need to disrupt what’s already working well for you.
If not, keep reading.
Many people think that if they have traditional health insurance, all of their healthcare expenses are covered. That's just not true. Did you know that 200,000 families go bankrupt every year due to healthcare bills--even though they have health insurance?
There are two reasons for this:
High deductibles that families can’t afford to meet,
Denied claims (some health insurance companies deny as high as 50% of claims submitted).
You may be surprised to discover that concierge medicine isn’t just for the rich and famous; it’s for almost everyone.
You should use concierge medicine IF:
○ You want relaxed, unhurried appointments.
○ You want to be able to see your doctor the SAME day you need them.
○ You want to get care from the comfort of your home.
○ You want personalized care from a doctor who knows you and your unique history
○ You want to get healthy and optimize your wellness instead of just managing disease
○ You want access to cutting edge functional medicine and health optimization (and all the specialty testing that entails)
Membership in a concierge practice does not eliminate the need for catastrophic healthcare coverage, however, traditional health insurance isn’t your only option.
There are some new and innovative healthshare services available (like Crowd Health), which pair very nicely with concierge care. In fact, it is very likely that you can get more comprehensive, better healthcare coverage (concierge membership + healthshare) for LESS than a traditional health insurance plan.
Final Thoughts
Concierge medicine isn’t for everyone, but it is a good fit for more people than you realize.
It requires a mindset shift about what healthcare is, how it’s delivered, and how you pay for it.
If you’re done being a number and want a healthcare provider that is incentivized to keep you healthy and happy, check out UltraPersonal Healthcare.