What Is Concierge Medicine?

Medical Care by a Provider Who Doesn't Accept Health Insurance

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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 seeking care from concierge practices pay a cash "retainer" for the care they receive.

Concierge medicine is becoming more popular because practices that do not have to deal with medical insurance and reimbursements say they can save money and provide better service to their patients. 

This article goes over concierge medicine, how it works, and why it is becoming popular.

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What Is Concierge Medicine?

Concierge medicine is a membership model of healthcare that provides personalized primary healthcare to patients who pay an up-front cash retainer. Concierge practices don't accept health insurance.

Under the current system of healthcare in the United States, providers are paid for diagnoses and procedures, usually through health insurance. They are not paid for the time they spend with a patient, nor are they paid to coordinate the care of that patient.

The cost of billing insurance companies or Medicare to get reimbursed for services can be complex and time-consuming. Offices hire billing services or employ a team of people to process insurance reimbursements, sometimes making the expense of reimbursement more costly than the actual healthcare services.

Some healthcare providers, especially in primary care, feel they can't provide high-quality services under this model. These providers have changed their practices so they no longer work with insurance at all, or they pursue reimbursements on a very limited basis.

Instead, they charge patients on an annual or monthly basis for 24/7 access and full coordination of care. This lets them engage with fewer patients, who pay them in cash for that access. This model is similar to past models that existed before the advent of health insurance.

In some of those models, patients still require insurance or Medicare. If they need the help of a specialist or specific tests, they can use their insurance for those services. However, the concierge provider's fees are all payable in cash.

How a healthcare provider gets paid does not speak to the quality of their abilities and services. Do not choose a healthcare provider simply for access. Rather, make sure you have reviewed their qualifications and ability to take care of you in the manner you need for your health, not for your wallet. 

Concierge Doctor vs. Regular Doctor?

Concierge practitioners have the same education, training, and licensing requirements as physicians in traditional practices do. Many are primary healthcare providers who have chosen to downsize their practices.

Choosing a concierge doctor over a regular doctor is not usually a question of comparing credentials, though as with any search for a physician, it is always a good idea to understand a healthcare provider's background and specialties before you schedule an appointment. This is especially important in a membership practice since you will pay in advance for the services you receive.

Cost of Concierge Medicine

The cost of concierge medicine varies considerably depending on where the practice is located and what services it provides. Generally speaking, members can expect to pay an average of $135 a month, though some practices charge less or more than what is typical. This amount covers all office visits and procedures. Patients generally do not have to pay co-pays or deductibles.

Because a concierge practice typically only provides primary care or another specific type of care, concierge patients usually keep their health insurance in case they are hospitalized or need to see a specialist. Any medical procedure that can't be provided by the concierge doctor will need to be obtained elsewhere either through insurance or out-of-pocket. Some patients choose a higher-deductible plan to help cover these expenses.

Monthly fees for concirege medicine may be higher for practices that specialize in one area of medicine or for healthcare providers who have more than one board certification.

Benefits of Concierge Medicine

Concierge medicine may be a good choice if you are generally healthy and expect to need only basic medical services from year to year. It is also a good choice if you have a condition that requires regular visits to a primary care provider, and you do not expect to need a referral to a specialist.

People also choose concierge medicine because of the more personal service these healthcare providers can give you. Because they see fewer patients, a concierge healthcare provider will be able to spend more time with you on an individual basis.

Drawbacks of Concierge Medicine

Concierge medicine is the subject of debate and criticism. Some industry experts are concerned that because these practices serve fewer patients and charge fees that are out of reach for many, their existence contributes to reduced access to healthcare, especially for underserved groups like low-income people and people with chronic conditions.

Some studies have found that concierge physicians serve fewer people of color and have fewer patients with long-term healthcare needs such as people with diabetes. 

For people who use concierge medicine, one potential drawback is the expense of medical conditions that can not be treated by their concierge doctor. Patients who choose a higher deductible health insurance plan or who don't carry health insurance will be subject to high healthcare expenses in the event of a catastrophic accident or a health condition that requires specialist care. 

In the big picture, many questions remain unanswered about why only the patients who can afford this form of care should be allowed to have it. Some question how ethical it might be for a doctor to refuse to treat a segment of society that can't afford service.

 Summary

Concierge medicine is a model of healthcare where patients pay a monthly membership in exchange for healthcare services. This type of healthcare provider doesn't accept insurance and typically serves a much smaller number of patients. This lets them provide more personalized individual service.

Concierge medicine has been criticized because the smaller patient groups and higher costs may limit access for some people. People who choose concierge medicine may also have to pay higher healthcare costs overall, since they may still need to be referred to a specialist for certain health conditions their concierge doctor doesn't treat.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Dalen JE, Alpert JS. Concierge medicine is here and growing!!Am J Med. 2017;130(8):880‐881. doi:10.1016/j.amjmed.2017.03.031

  2. Paul DP 3rd, Skiba M. Concierge medicine: a viable business model for (some) physicians of the future?Health Care Manag (Frederick). 2016;35(1):3‐8. doi:10.1097/HCM.0000000000000088

  3. Doherty R; Medical Practice and Quality Committee of the American College of Physicians. Assessing the patient care implications of “concierge” and other direct patient contracting practices: A policy position paper from the American College of Physicians. Ann Intern Med. 2015;163(12):949-52. doi:10.7326/M15-0366

Additional Reading

By Trisha Torrey
 Trisha Torrey is a patient empowerment and advocacy consultant. She has written several books about patient advocacy and how to best navigate the healthcare system.