salaries of concierge docs to very wealthy people

[The White Coat Investor]

The CEO of my wife's company is fond of saying, "Don't say you don't have a price. Everyone has a price. Just make sure you set your price really high."

I'd like to think I wouldn't compromise my ethics for $10M a year, but honestly I probably would. It's really easy to justify things to yourself for $10M a year.

I disagree. The more you make the more you have and the less you need more and thus the MORE you can stick up for what you believe in. It's the docs with nothing in savings and $300K in student loans who really need to keep that $150K a year job that are bending over backwards to keep employers happy. I think financially successful docs can be and usually are better docs.

[Larry Ragman]

I disagree. The more you make the more you have and the less you need more and thus the MORE you can stick up for what you believe in. It's the docs with nothing in savings and $300K in student loans who really need to keep that $150K a year job that are bending over backwards to keep employers happy. I think financially successful docs can be and usually are better docs.

This is the beautiful truth of FI. Not just RE, but freedom and security.

[Tim]

“My comment on "think they are more important than they really are" was based on sounded like these patients contact their concierge doctor during evenings, etc.”

This. For someone that can afford it, the primary reason for paying for a concierge physician is availability when they want it, not necessarily on a whim, but by their schedule not first opening is four weeks at 10am. Nights and weekends might be what they want, need and are willing to pay for it.
I don’t think anyone expects 24/7 coverage. 24 or 48 hour turn around is reasonable and emergencies need to be defined. Importance is not a factor, it is money pays for a smaller patient load and availability by their schedule.

[Kennyt7]

How is it legal to accept fees outside of what Medicare pays if you are a participating provider; and insurance companies as well

[StateOfMyHead]

How is it legal to accept fees outside of what Medicare pays if you are a participating provider; and insurance companies as well

My understanding is you have to totally opt out of Medicare or not take their patients or risk having to pay back any fees collected at an out of network practice which is problematic if you want to retain hospital privileges. The others are all location dependent, again just my understanding so hopefully someone will correct me if I'm mistaken.

[AR]

My understanding is you have to totally opt out of Medicare or not take their patients or risk having to pay back any fees collected at an out of network practice which is problematic if you want to retain hospital privileges. The others are all location dependent, again just my understanding so hopefully someone will correct me if I'm mistaken.

This is my understanding too, but it seems a little surprising that some sort of creative lawyering hasn't created some sort of unorthodox business structure that can circumvent this. Maybe the lawmakers actually enacted something robust.

[StateOfMyHead]

This is my understanding too, but it seems a little surprising that some sort of creative lawyering hasn't created some sort of unorthodox business structure that can circumvent this. Maybe the lawmakers actually enacted something robust.

I also don't understand why Medicare wouldn't be happy people were paying for their own out of network services. Saves them money right?

[jfoxcpacfp]

I also don't understand why Medicare wouldn't be happy people were paying for their own out of network services. Saves them money right?

That’s not the way the government works, last time I checked.

[AR]

I also don't understand why Medicare wouldn't be happy people were paying for their own out of network services. Saves them money right?

What they don't want is providers charging Medicare the full rate and then charging the patient an extra amount on top of that for necessary medical care. That seems like it would be in the interests of people who have Medicare. And it's not like Medicare patients can't purchase certain additional services. For example they could see an ophthalmologist to deal with a medical eye problem and then pay out of pocket for a blepharoplasty or some botox. That's totally kosher.

The problem here is access to a doc is a bit different than a cosmetic procedure. But I am quite interested in how they codified that distinction. It seems hard to do it in such a way that can't be circumvented.

[StateOfMyHead]

What they don't want is providers charging Medicare the full rate and then charging the patient an extra amount on top of that for necessary medical care. That seems like it would be in the interests of people who have Medicare. And it's not like Medicare patients can't purchase certain additional services. For example they could see an ophthalmologist to deal with a medical eye problem and then pay out of pocket for a blepharoplasty or some botox. That's totally kosher.

The problem here is access to a doc is a bit different than a cosmetic procedure. But I am quite interested in how they codified that distinction. It seems hard to do it in such a way that can't be circumvented.

Ah makes sense. I was thinking about out of network boutique practices that don’t bill insurance at all but the doc might still round at hospital or see patients in a health clinic part time and therefore don’t want to opt out of Medicare.

[Tim]

Ah makes sense. I was thinking about out of network boutique practices that don’t bill insurance at all but the doc might still round at hospital or see patients in a health clinic part time and therefore don’t want to opt out of Medicare.

The model speculating is having two practices, one Medicare and one not.
Different question than is a procedure is covered Medicare or cash.

“Whether you are in-network or out-of-network, in Medicare, you must file a claim for all active care/treatment or if the patient requests that one be filed. Therefore, since you must file a claim, a cash-only practice is not possible if you are seeing Medicare patients.”
I think the physician is the key.

[Kennyt7]

????-Do Concierge docs who charge 2k/yr to be with them, BILL MEDICARE AND PRIVATE INSURANCE. I have to assume so as those concierge fees won't be sufficient by themself. As a retired dentist if you participate with insurance or medicaid you can only bill the pt copay. With Medicaid no copays

[jfoxcpacfp]

The model speculating is having two practices, one Medicare and one not.
Different question than is a procedure is covered Medicare or cash.

“Whether you are in-network or out-of-network, in Medicare, you must file a claim for all active care/treatment or if the patient requests that one be filed. Therefore, since you must file a claim, a cash-only practice is not possible if you are seeing Medicare patients.”
I think the physician is the key.

wow - so, in general, nobody over age 64 can legally use a cash-only practice? Never would have guessed that, but prob s/n/b surprised. (Of course, I realize that there are exceptions and some people over 64 have not yet signed up for Medicare).

[Tim]

Antares or someone with a cash practice can chime in.

wow - so, in general, nobody over age 64 can legally use a cash-only practice? Never would have guessed that, but prob s/n/b surprised. (Of course, I realize that there are exceptions and some people over 64 have not yet signed up for Medicare).

“if the patient requests that one be filed. ”
Wiggle room. Get a waiver first? I am sure one could contract out, cash in advance…..
Maybe, clear as mud.

[StateOfMyHead]

wow - so, in general, nobody over age 64 can legally use a cash-only practice? Never would have guessed that, but prob s/n/b surprised. (Of course, I realize that there are exceptions and some people over 64 have not yet signed up for Medicare).

If the physician has opted out of Medicare which is not location dependent then patients are able to go to a boutique practice and pay cash. I try to remember some participants who respond to medical questions here aren't actually in the field.