"Concierge" Medical Care � Is It Really Insurance?

As insurance payments for medical care dwindle, the concept of “concierge” or “boutique” medical practice, which has been around for more than a decade, is gaining ground. It now involves an estimated 5,000 doctors serving more than a million patients. In a boutique practice, a doctor offers a limited number of patients highly personalized services like same-day appointments and 24/7 availability in return for annual fees that can range from $500 to $15,000. At the higher end of the fee scale, the doctor drops out of all insurance plans and provides all the primary care the patient needs at no extra cost. At the lower end, the fee pays for services not covered by the patient’s insurance.

The most common argument against this type of medical practice is that it promotes a two-tier model of medical care that gives affluent patients access to better care. However, the concept has also come under fire from insurance companies, which consider boutique medical practices a form of competition. That argument gained some traction recently as regulators in Maryland held hearings to determine whether doctors in boutique practices should come under the scrutiny of the state insurance administration.

The report that came out of the hearings concluded that doctors can avoid oversight by the insurance regulators if they define and limit the services covered and peg their fees to the market value of those services. The report also suggested that doctors review their contracts with the Maryland Insurance Administration to make sure they are not in the insurance business.