I had the same thing happen to me. I was really disappointed as I liked my doctor very much, but I just couldn't afford to go in that direction considering what I already pay for insurance. I try to get as much done through my OB/GYN as possible. Otherwise, I go to a group practice that I found. I don't like it much because you never know which doctor will see you and they're super busy, but at least it's covered under my insurance.

My endocrinologist/primary care of 20 yrs has done the same (3 yrs ago), similar reasons. As a small business owner, I pay the whole cost for the still needed insurance policy (emergencies, hospitals, possible surgery) and can't really afford to take on more per month....my medical and dental policies now without adding more are $931/mo. And that's just for me alone.

What I've done is made an appointment with her once a year only and paid cash for the appointment - $195. That has worked for now, I haven't been sick :) No point in trying to be reimbursed, my insurance has a separate $3000 deductible for her type practice, then will only pay half after that (when I have an 80/20 policy). They do pay for my lab work, and will pay for the DEXA (bone density scan) she has asked me to do at a different facility.

Not a good circumstance for those of us without a lot of extra income. My brother has had that type contract with his doctor for the last 5 years and loves it...but his income supports it too where mine (and I suspect many) does not. I don't know what the answer is, I sympathize with doctors being fed up with insurance trying to dictate their treatment, drug choices for their patients, but moving out of our reach can't be the best resolution either.

Haven't heard of that before, but imagine it probably is going to be the way some drs. go to avoid the mess of national healthcare.

We've been with our GP for many years now (over 20). He's gone through periods where he's decided not to take insurance--but we've always been able to pay him, then submit the bills to our insurance so we've stayed with him. At the moment, he's back to taking our insurance, so that's nice. One of the things we like about him is the fact that it's a very small practice, he's the main dr. and we can almost always get in to see him. It's important to us to have that kind of relationship with our dr.

The main reason I wanted to answer, though, was to recommend that you not wait to get your records. It can take time for the practice to get them together for you, and probably will be expensive, if you've been there that long (many practices charge per page for copying or putting on a disk). You don't want to have an issue in the meantime, and not have your records if you need go to another physician. Good luck finding a practice that suits you.

It sounded pretty good until I got to the part where your insurance won't accept his referrals.

I hadn't heard of this either.

Wondering???? Is it possible to carry "hospital" insurance? What happens if (for example) one needed to be hospitalized for pneumonia or surgery?I suppose that medicare would take care of those items if one were over 65, and the "private MD" part would be in addition to it. Would "private MD", have hospital privileges? That would work for me, in some ways; as I really like my current MD and fear that he will be retiring too soon. I did have a Chiropractor who had a program like this...it worked for me and hospitalization was never a concern.

Lily...we took my mother off her retiree insurance (yup, Aetna) because of those referrals. Put her on Medicare with a Medigap policy that gave her access to board certified doctors, with no referrals - and, it was less expensive, too.

Most of the concierge docs work with a counterpart so that the counterpart can handle the admission, the concierge doc can then either handle things as a consultant or they have privileges. The docs that are tired of having to work 10-12 hour days to see the formulary appointed number of patients that their healthcare system demands. They don't want to treat their patients like a number, they want to be "Dr. Welby" and are going back to that.

The desire for some folks to want personalized, unlimited attention is becoming more and more evident.. Others are willing to settle for a Wal-Mart type of service and go to a clinic where they may never see the same physician twice. Most of us probably fall somewhere in between. My endo just dropped his membership in the AMA, he's fed up with the bureaucracy and the big business of medicine.

The desire for one on one service is what pushed me to to close the public business and open my concierge travel business. People will pay as long as I deliver on my promises. Most folks thought I was nuts, but it's working.

My husband has Medicare (primary) and New York State Employee insurance (secondary). Our primary physician of 30 years first stopped taking the State Insurance, then stopped dealing with Medicare. He said the paperwork was just too much. Plus he's around 70 and getting a little tired looking, tho his care is always top-notch. He didn't offer any all-inclusive options, but now charges $300 for a simple office visit. Hubby switched to another doctor who seems just as knowledgeable, but she accepts Medicare and the co-pay is a lot less, around $35. The old doctor is still in practice, but has taken on two young partners. I heard he is nearly retired, but goes into the office a couple days a week.

My Dh pays a concierge fee. He is busy and it makes sense for him to be able to get quick appointments and a doctor that has time to call/email when DH needs to know something asap. I never join because I'm a SAHM, with kids in school now, so I have time to go to daytime appointments.

Another way to widen the gap....

that sort of sounds like my dd's peds dr. she's a one woman office! no secretary, no nurse, just her...but her refferals must be covered as dd had to take dgd in with a broken wrist...

With 600 patients, how can he guarantee 24/7 availability to every patient?

Thank you all for your stories. This doctor will be the only one in the practice and will only have a nurse, and I would guess a receptionist. He's already gone from the old practice and has 100 people enrolled in the new one. When he vacations, if he's out of the country, there will be a substitute doctor. But if he's in the country ,he'll take calls or emails. I think it will be a great hardship for the people with families who were patients. A couple would cost $3400 and two kids would be another $3000.(kids are $1500) Who has that kind of money today? My husband is looking for a new doctor, and our old doc has given him some names. I rarely see him and had blood work , tests, mammo, pap, and dexa scan done before he left ,so that gives me time. I hadn't seen him since last December. I already knew his email address and phone number because of his friend ship with my daughter. It's difficult finding a doctor you can establish a rapport with. I'll miss him but wish him well. And if I could get my insurance company to at least cover his referrals, I might just sign up.

Did your insurance company tell you why they wouldn't accept his referrals? That seems odd to me - I've never had that problem with insurance as long as the referrals were in-network.

I just moved to CA from Boston and I really miss my old medical team. I could get anything from general appointments to dermatology to OB/GYN and specialists to xrays to bloodwork to MRI's and ultrasounds all in the same building without dealing with referrals. I hope to find something similar in California.

Years ago we had a primary care MD who never dealt with Medicare or ANY insurance. He'd give us the information on services he performed. We had to file claims to be reimbursed as the insurance saw fit (not his whole bill).

Seems to me this scheme lets the doctor bypass the insurance maze and collect whatever his patients will pay *without* going 'boutique' and without denying his patients the right to collect whatever they can from insurance. Any private practice MD can limit his caseload if he wishes. He can even do it gradually, by refusing to take new patients.

I'm not crazy about a single practitioner practice. We use a group practice, although we primarily see 'our' designated MD. There are about ten MD's and two nurse-practitioners, plus the usual RN and LPN and office staffers. They have on-site X-Ray and Lab. No complaints. I have never waited more than a few hours to have a message replied to and can be 'seen' within a day or two for non-urgent problems. (Anything really pressing is seen to even faster; truly URGENT or outside of office hours...I go to an ER.)

This is certainly better than the MD who 'fired' us as patients around 2000. (Was it something I said about his staff being unable to take a message accurately?) He was a good MD; had one partner. Their front office staffers were near-illiterate. I had resorted to MAILING prescription refill requests (and keeping copies because they could still get it wrong).

I have a great insurance company,Geisinger HMO. They are rated number one on PA and 8th in the country in this issue of Consumer Reports. But they're an an HMO and I was told I need a PPO??? I knew the minute I heard boutique, concierge that this would not be covered by insurance, but I never thought it wouldn't cover referrals. I only have two choices Geisinger or Aetna. BTW..I think his yearly fee is really $2000 a year, the discount given to those who followed him from his other practice.

With HMO insurance, you can only go to their doctors. That's why you have to have a primary doctor, who decides if he/she can treat you themselves, or allows you(via a referral) to go to a specialist that is on the HMO's list. Primary doctors are discouraged from referring to specialists by the insurance co.

Lily, if you are over 65, you are far, far better off with standard Medicare and a Medicare supplemental policy. Cheaper, and they pay for the better doctors.

"...his yearly fee will be $1700 the first year. This insures 24/7 access to him, 10 office visits a year,phone/ email consultations, a 2 hour physical once a year, same or next day appointments..."

"I rarely see him and had blood work , tests, mammo, pap, and dexa scan done before he left ,so that gives me time. I hadn't seen him since last December."

So you see him once, maybe twice, a year and you want to pay $1,700 for that?

The $1,700 annual fee includes 10 office visits and one 2-hour physical. How much time does he allow for those 10 office visits? An hour each? Only 30 minutes?

I don't know how long the other office visits are, but he usually spent 20-30 minutes with me. I was lucky not to need to see him in almost a year, but that could change in a heartbeat as we all know. When my husband fell off the roof almost a year ago, I called daughter and she called our doctor who rang us up right away . He talked to DD, me and my husband. An hour later he called back, asked to talk to Husband and then said to me that he didn't like the way he sounded..take him to the hospital. He called ahead to get us thru a wait in the ER. Turns out H had a punctured lung and broken back. That's the kind of attention his patients will receive now. .But you're right Lindsey. Is it worth $1700 a year? He wrote on my blood work report..Good luck and whatever you decide, we'll still be friends..Nice guy. He says he wants to be just like he remembers his family doctor was.

When I was a kid, our family had a doctor who treated everyone in the family, all ages, made housecalls, would prescribe meds over the phone. And we had NO insurance. We just paid as we went. I remember as a teen he did a chest Xray in his office and it cost $30, which I thought was an awful lot! How times have changed!

I remember those days well. We didn't make appointments but sat in the office and waited our turn. Doctor would hand out pills in a little white envelop. If we were too sick, he'd come to the house. Five dollars for an office visit. It seems like 100 years ago. Times have certainly changed.

Wow.. so according to my figures, he'll be making over a million a year just doing office visits and consults? That seems high for so little work. Will you need to pay separately for blood work, xrays, and in office procedures (burning off warts, cutting off ingrown toenails, etc).

I'm not understanding what you are getting for so much money. I would think a good nurse practictioner or your neighborhood clinic could offer as much for a lot lower. What expertise are you paying for if you are, as it sounds, generally healthy?

Will he have priviledges at local hospitals to see you if you get ill and end up there?

I'm all for doctors doing right for their customers... but this doesn't seem like a doctor caring about his patients as much as it seems like a plan to make the big bucks. Kind of got to wonder, friend or not, if that's the kind of person you want treating you. I know people have gone off on vets here for doing the same type of thing.

I once went out of my plan and paid extra for a treatment I needed that generally wasn't fully covered and that a known doctor excelled in. I paid for a specific expertise I needed but here what are you paying for... getting taken advantage of by a doctor friend?

Also, I would be a little leary that possibly he was kicked out of your insurance plan for some reason... check into that just in case. He could have numerous suits filed against him and was more or less forced to go out on his own. I'm sure insurance companies aren't easy to deal with, but there may be two sides to the story.

Carla35 asked, "Will he have priviledges at local hospitals to see you if you get ill and end up there?"

My guess is that, no, he won't have hospital privileges since Lily says that her insurance won't cover his fees. Hospitals won't want to risk having a lot of "uninsured" patients. Even if they have insurance, if the insurance won't cover costs of this doctor's services, and won't pay for his referrals, they are essentially the same as uninsured, as far as the hospital is concerned. And that means the hospital would be stuck with a bill that won't get paid. They won't do that willingly.

Another thing to consider is that yearly fee. You pay the fee up front, and what you "don't use" you don't get back. So you could be paying $1,700 and go to him once, and it would cost you $1,700 for that one office visit.

Ok...so let's just guess a normal person's medical year...

So, in January you get a bad sore thorat and fever. He has you come in. He looks at you, tells a few jokes, and runs an in-office strep test (is that covered) --he then sends the stuff away to off site lab to get a more accurate strep test (will that be covered?). He decides afterall that you have strep and prescribes an antibiotic (I'm guessing you have to pay for that too). Ok, so then spring comes along and you start getting the sneezes... you go to see him... it's bad, so he refers you to an allergist (will that referal work for you?). Next comes the Summer, when you fall in the store wearing those fancy flip flops... yes, you sprained your ankle. He agrees to see you quickly, takes a look at the swollen thing, and tells you to alternate soaking it in hot then cold (or whatever the proper treatment for a sprain is), stay off it for a while and take some advil. Finally Fall comes.. flu shot time (I guess you'll have to pay for these too) and his expertise to keep track of the fact that you got the flu shot. Then winter..Worse case scenario, Christmas time comes and you get so stressed out you have a heart attack, end up in the hopsital and...where is your doctor?...Do they even call him? Will they be able to get easy access to your records? I'm thinking you will be assigned a staff doctor for your needs and questions... So what exactly do you hope to get out of staying with this doctor? The fact that he will call you...most doctors even if they rotate do answer calls 24 hours a day. And clinics are everywhere if you want to swing by for a quick consult of something that doesn't need hospital attention.

Just wondering..how often do you even visit a doctor every year?

Wnen I was a teenager my mother and I were both very ill with something like the flu. She telephoned the family doctor at his home. He came to our house that morning before going to his office.

He checked us, told us to stay in bed, telephoned the pharmacy to deliver meds, lectured the younger sisters about behaving and staying quite, and inquired if there was sufficeint food.

I think his bill was $10. It was $5 for an office visit.

We did not have insurance, probably did not even know about insurance. Some things really were better in the "old days."

You're right. Somethings were better in the old days. I brought the matter up to doc that I had not seen him since last December and wasn't scheduled till this Dec. I changed it to the end of August when I heard of the plan. I told him it would have been a very expensive office visit..$1700. He does not have hospital privileges. Most don't around here. The attending is your hospital doc and your family practice one keeps in touch. Before he left I received a letter from Geisinger saying that doc is no longer my PCP because he is not in their system any longer. We have a huge manual listing doctors we are eligble to see under their plan. A few he recommended were not in the plan. They referred me to another doctor at that practice. In ten years I have never seen anyone but him but I rarely go. I tend to treat myself. .A few months ago I had a UTI and drank a lot of cranberry juice but it didn't go away. So I called, and he didn't need to see me but called in a script. >>He says it's not the money. He wants to spend more time person to person than dealing with insurance companies. He has a family and he said he works more hours than he ever did. The practice will suffer, because he is the star. My husband has a cardiologist, dermatologist, urologist and others. I have no one now. He was my ob/gyn . I guess it's time to do some searching for a new doctor.

A Doctor who doesn't have hospital privileges, and is probably not board certified in any area....is a doctor I would run away from.

If you can afford it, get out of that HMO insurance and into a good one. You said it was retirees insurance - get into Medicare and a good Medicare Supplement.

I pay no co-pays, and have my pick any doctor - no referrals. All for very little cost.

I think it just sounds like too much money. My family of 4 would never pay $6400+ just for office visits. Knock on wood we normally just have annuals and a few visits here and there for sniffles!

I have a chiropracter friend that eventually sold his sucessful practice because he was so sick of dealing with the insurance crap. He really liked his job and the patients but said NO MORE!!

I really don't think this doctor is as patient-friendly as you may believe. There are ways to go out on your own and not deal with insurance companies. Why doesn't he just charge you a hundred or two per appointment? The way he is charging is catering to the weathly, not the sick or his long term established patients.

And the fact that he didn't recommend a new doctor to you that is in your plan is kind of unprofessional. He should have made a point to figure out and refer you to someone that you could use especially since you have been a patient of his for so long.

Plus, you rarely see this guy, yet he wrote a scrip for a persistent UTI? Weird.

I'm sure our doctor had enough on his mind without going thru Geisinger's inch thick manual finding what doctors are on our plan. Some he recommended are, others aren't. He said this is the wave of the future and even though I had never heard of boutique doctors, since then I've found there are about five practices around here. About the UTI..it wasn't serious but persistent, and I didn't need to take up valuable time , pee in a cup to know what it was. I have had a few over the years. Took the cipro and it was gone in two days. I didn't want to risk it traveling to my kidney. It was very mild but could turn not so good.

Doctor has sent to all old patients a letter and brochure describing his new service. He has reams of letters from locals who are well known..presidents of colleges, industry..praising him. I might add this is a wealthy area, and he has country club connections too. Out of my league.

I've heard of this for quite a while but don't have this myself. This concept of capitation has been around a long time and is coming back again but it's usually your ins company or HMO paying the doc a fixed fee per patient.

I don't blame these guys for doing this because the insurance requirements - and Medicare is among the most onerous - are extreme. Add to that all the other government regulatory intervention including HIPAA and meaningful use requirements that came out of the ARRA stimulus package. Healthcare providers are now spending so much time and money trying to comply with all these requirements that there is little time left to care for patients not to mention keeping abreast of all the new information needed to provide the best care possible.

I'd say get used to it because it's only going to get worse. People want all the best healthcare available and want it at little to no cost to them. There is a price to be paid and sometimes it's different than what you expected.

"He says it's not the money. He wants to spend more time person to person than dealing with insurance companies."

In the 1970s I worked for OB/GYNs and I often helped out with the insurance billing. The key to getting paid is to use the right diagnosis code for the services that were provided. It's not that difficult.

If the doctor wants to spend more time with his patients, he can control that, too. It's called, "tell the staff to schedule fewer patients per day; and quit taking new patients for a while."

Billing in the 70's was drastically simpler than today. Guess what the federal government is instituting - a complete revamping of the diagnostic codes used for submitting claims.

Right now there are 18,000 codes.

Soon there will be 140,000.

The federal government in their infinite wisdom has announced the 10th revision of the International Classification of Diseases

There are codes for being struck by a chicken, injured by a crochet needle, walking into a lamp post, there are 14 for injuries sustained by spacecraft.

Guess what this is going to do to the cost of medicine.

The new computer systems, which automatically share information with the patients' other doctors, automatically connects to your pharmacy to order a new prescription, and yes, looks up codes, plus many other "labor-saving" items ....all this will SAVE time and the cost of medicine.

When you see your doctor, he/she can look up all your "paperwork, x-rays scans, test results - on their laptop in the office. No rooting thru filing cabinets and papers.

All my Drs have implemented the new systems, and love it.

Is my tentative evaluation that "boutique" usually equates with "expensive" ...

... somewhat faulty, do you figure?

ole joyful

I have no other doctors, but his old practice went electronic two years ago. It should be much more efficient. The nurse brings the laptop in and records BP and pulse, and then doctor enters all his data on his laptop. That's why transferring records should be simple I would think. He gave a link to do it if you want to send your records to his new boutique practice. So will a click of a mouse send my records to a new practice when I find one? It's very hard to doctor shop.Any good ones aren't taking new patients. In fact his old practice isn't. I' have anxiety about suddenly needing a doctor and not having one I even know. The two doctors at my practice now I never caught a glimpse of. They're getting a new female doctor but this will be her first practice so I don't want someone that young.I have a cat scratch on my leg that I'm praying won't get infected so I don't have to deal with someone I never saw.

Ahh yes - ICD-10 - classification of diseases and conditions will be much more granular - including being burned due to water skis on fire. No kidding - there are multiple ICD-10 codes for that along with the other ridiculous items mentioned above. Though ICD-10 is used world wide, we in the US of course have to make our own bigger and more ridiculous version of it.

And electronic medical records that allow your providers to find information about you without rooting through paper files - wonderful! I can even look up my own records online which I think is fantastic. However all that is expensive both to purchase and maintain.

All that and more prevents your family physician from electively choosing to schedule fewer patients per day because fewer patients per day = less revenue. Less revenue means you can't afford to pay for all this stuff.

That's so sad that your doctor left you in a situation like this. I hope your leg doesn't get infected but I'm sure even a clinic could treat it if it does. And don't worry, generally, most doctors and medical staff can handle stuff like that.

Sometimes new doctors are the most enthusiastic and have studied and know the newest medical information so don't rule a newbie out. I hope this situation doesn't produce enough anxiety for you that you'll have to treat that too :-)

Sadly, I don't think doctors or the medical field realize how their decisions can effect their patients, or maybe they do and just don't care.

I have a problem now where in January my pharmacy won't be taking my insurance for my prescriptions. Of course, they have given me many months notice that it will happen... but I too have to shop around for a new pharmacist.

EMRs - Electronic Medical Records.

With the exception of many of the younger physicians I have yet to met a physician who honestly likes it. My DH now comes home after a long day at work and spends an additional 2 hours reading all the EMR's that are in his inbox. The cost to his practice to implement this system was over $250,000. Training was not only expensive but time consuming. The software is proprietary and when DH began his office conversion there was only one software program available to medical oncologists. Needless to say this was very expensive. Plus the cost of new hardware for the oncology nurses, techs and physicians.

What really bothers him is that it interferes with his patient time. He allots 50 minutes for a new cancer patient. Now he spends the first 15 to 20 minutes asking the questions listed in his software program and typing in the answer. The program won't let him skip a question. Most of his patients dislike it too because they feel the doctor is too busy looking at his laptop rather than looking at them. It's not a good way to begin such an important relationship.

In time it should improve. It will facilitate the transfer of important data - but as practices convert it's quite painful. My best friend's DH is simply going to retire when the conversion becomes mandatory. He's a solo family practitioner in a fairly poor urban neighborhood and he doesn't have the extra money nor the desire to switch to EMRs.