How Concierge Medicine Works
From the first phone call to the first bill: what actually happens when you join a membership practice, and where your insurance still does the work.
3 min readBy Concierge Med Near Me
Step 1: Finding and contacting a practice
Most people find concierge practices in one of three ways: their current physician announces a switch to a membership model, a friend recommends a practice, or they search for one nearby. Our guide on how to find a concierge doctor covers the search itself.
Many practices offer a short introductory conversation before you commit. Use it. It is your chance to learn how the practice operates and to ask for a copy of the membership agreement.
Step 2: The membership agreement
Joining means signing a contract. This document matters more than anything on the practice's website, because it is what the practice is actually obligated to do.
A complete agreement should tell you:
- The fee, how often it is billed, and how it can change
- What is included, ideally as a list of services
- What is not included and will be billed separately
- How the practice handles insurance, including Medicare
- How to cancel, the notice required, and whether unused fees are refunded
- What happens if the physician leaves or the practice closes
The American Medical Association's ethics opinion on retainer practices says physicians should present contract terms clearly and make sure patients understand that they are free to decline. If a practice is reluctant to share the agreement before you pay, treat that as information.
Varies by practice. There is no standard concierge contract. Ask for the agreement in advance and read the cancellation section first.
Step 3: Your first visit
Practices often begin with a longer intake visit to review your history, medications, and goals. Some include an extended annual wellness exam in the membership.
If you are on Medicare, the details of that exam matter. Under Medicare's rules, a membership fee cannot include additional charges for items or services that Medicare usually covers. See concierge medicine and Medicare.
Step 4: Everyday access
This is where a membership practice is meant to feel different. Because each physician looks after fewer patients, practices commonly describe:
- Shorter waits for appointments
- Longer visits
- A direct line to the physician or a small team
- Phone and video visits for simple issues
How much of this you get depends on the practice. Useful questions are specific ones: How many patients does each physician have? What is the usual wait for a routine visit? Who answers at 9 p.m. on a Saturday?
How much smaller are the panels?
Good current data is scarce. In a federal GAO survey using 2004 data, concierge physicians reported an average of 491 patients each, down from 2,716 before they converted, and they saw about 10 patients a day instead of 26. Practices today vary, so ask each one directly.
Step 5: How billing works
Billing is the part people most often misunderstand. In many concierge practices there are two separate streams.
| Charge | Paid to | What it is for |
|---|---|---|
| Membership fee | The practice | Being a member, plus whatever the agreement lists |
| Office visits | The practice, through your insurance where it bills | Medical services your plan covers, with your usual cost sharing |
| Labs, imaging, prescriptions | Labs, facilities, pharmacies | Billed separately, through insurance or at cash prices |
The GAO survey found that about three-fourths of concierge physicians billed patients' insurance for covered services. Others, particularly direct primary care practices, do not bill insurance at all and include visits in the fee.
Neither approach is better in itself. What matters is that you know which one a practice uses, because it changes what you will pay over a year. Our membership cost worksheet can help you add it up.
Step 6: When you need care outside the practice
A primary care membership does not change how the rest of the system works.
- Specialists bill your insurance or you directly. Your physician may help choose and coordinate.
- Emergency and hospital care are billed by the hospital and its clinicians.
- Prescriptions are filled at a pharmacy under your drug coverage.
This is why nearly everyone who joins a concierge practice keeps health insurance. See does insurance cover concierge medicine?
Step 7: Renewing or leaving
Memberships usually renew automatically. Before each renewal, it is reasonable to ask yourself whether you used the access you paid for. Our guide to deciding whether concierge medicine is worth it offers a simple way to think that through.
If you leave, the AMA's guidance says the practice should help transfer your care. Request your records, confirm any refund in writing, and line up a new primary care clinician before your membership ends.
Frequently asked questions
Can I use my regular insurance at a concierge practice?
Often, yes. Many concierge practices bill insurance for covered office visits, and your plan's copays and deductible apply. Some practices do not bill insurance at all. Ask each practice which approach it uses and whether it is in your plan's network.
What happens if my doctor is on vacation?
It depends on the practice. Some have partner physicians or a covering clinician; solo practices may arrange outside coverage. Ask who covers, whether that person can see your records, and how you reach them.
Can I leave a concierge practice if it is not working out?
Yes, but the terms are set by your agreement. Look for the notice period, whether prepaid fees are refunded pro rata, and how to obtain your medical records.
Will the concierge doctor take care of me in the hospital?
Practices differ. Some physicians visit or coordinate with the hospital team; many hospitals use their own inpatient physicians. Hospital charges are billed separately from the membership in any case.
Sources
- Medicare.gov. Concierge care.
- U.S. Government Accountability Office. Physician Services: Concierge Care Characteristics and Considerations for Medicare (GAO-05-929) (2005).
- American Medical Association. Code of Medical Ethics Opinion 11.2.5: Retainer Practices.
- American Academy of Family Physicians. Direct Primary Care Model for Family Physicians.
We link to primary and authoritative sources where we can. Rules and figures change, so check the linked source for the current version. See our editorial standards.
This article is general education, not medical, legal, tax, or insurance advice. Concierge and direct primary care arrangements vary by practice and by state. Confirm the specifics with the practice, your health plan, or a qualified professional before you decide. Read our medical disclaimer.
