What Does Concierge Medicine Cover?

Whether concierge medicine is worth it depends on individual circumstances and priorities. For those seeking enhanced accessibility, personalized care, and preventive focus, and are able to afford the extra costs, concierge medicine can offer significant benefits. However, it’s important to consider the substantial cost, limited insurance coverage, and potential access limitations before making a decision. As always, it’s essential to carefully consider your individual health needs, financial situation, and priorities before making such a decision. At Northeast Primary Care, we’re committed to helping you make informed decisions about your healthcare.

For individuals, concierge medicine can be especially helpful:

• Who values convenient and accessible healthcare
• Who prioritizes preventive care and wellness.
• Who has complex medical conditions requiring ongoing monitoring and management.
• Who is willing to pay a premium for personalized and comprehensive care.

One of the core tenets of concierge medicine is the emphasis on preventive care, which aligns with our current approach to healthcare. We believe in preventing diseases before they develop, through regular check-ups, screenings, and a focus on lifestyle factors that contribute to overall health, such as nutrition and exercise.

The concierge model extends services beyond traditional primary care, including access to specialists, preventive health screenings, wellness programs, and personalized health advice, all under the care of a single physician.

Concierge medicine also offers longer, more detailed appointments. This extra time allows for thorough discussions about health concerns and the opportunity to build a stronger patient-doctor relationship, which is always our goal at Northeast Primary Care.

The personalized approach of the concierge model aligns with our commitment to knowing our patients and understanding their unique health needs and concerns. Better overall health outcomes, more precise diagnoses, and more successful treatment regimens can result from this individualized focus.

Lastly, a comprehensive annual physical examination is often part of concierge medicine. This exam is more detailed than a traditional physical and can help catch potential health issues early, further emphasizing the preventive approach we prioritize at Northeast Primary Care.

Although concierge medicine provides highly individualized treatment, it’s important to clarify that it may not be fully covered by traditional health insurance. Many insurance plans do not reimburse for concierge fees, as they are seen as supplemental to standard medical coverage. Therefore, we advise our patients to maintain their health insurance to cover services not included in the concierge fee, such as specialist visits, hospital stays, lab tests, radiology services, and prescription drugs.

However, rest assured that at Northeast Primary Care, we do accept insurance for services beyond the concierge fee. We bill the insurance company for individual medical visits, like traditional practices. The difference lies in the concierge fee that covers enhanced access and personalized care, which are not billable services to the insurance company.

The cost of concierge medicine can vary. Factors such as the physician’s practice, location, and services offered play a role. While the fees may not be covered by insurance, they could potentially offset other healthcare expenses by reducing the need for out-of-pocket costs for frequent appointments or urgent care visits.

Choosing concierge medicine is a personal decision that depends on individual circumstances and priorities. It’s crucial to consider healthcare needs and preferences, insurance coverage and premiums, potential cost savings versus benefits gained, and the availability and accessibility of alternative healthcare options.

At Northeast Primary Care, we understand that open communication with a potential concierge medicine provider about insurance coverage and associated costs is key. We encourage our patients to ask about payment options, whether insurance is accepted, and any additional out-of-pocket expenses. Despite the costs and unique insurance dynamics, many patients find the personalized care and immediate access to physicians provided by concierge medicine to be worth the investment.

Although concierge medicine comes with several benefits, it is important to understand its limitations, especially in terms of emergency care. Emergency care situations, that require immediate medical attention, are usually not covered under the concierge model. At Northeast Primary Care, we emphasize the necessity of immediate hospital care in emergency situations.

Moreover, concierge medicine typically does not cover out-of-office consultations like specialist appointments, hospitalizations, or emergency room visits. These services may still need to be billed to the patient’s health insurance. At our practice, we help our patients understand the importance of maintaining a comprehensive health insurance policy that covers these contingencies.

While concierge medicine can be beneficial for some, it is not a replacement for traditional health insurance. At Northeast Primary Care, we are committed to providing holistic, comprehensive care to our patients, ensuring that they are prepared for all types of health situations. For more information, please contact us today or book an appointment online now. We serve patients from Mineola NY, Melville NY, Westbury NY, Floral Park NY, Uniondale NY, Hicksville NY, Wyandanch NY, South Huntington NY, and the surrounding areas!