Maryland Insurance Administration Releases Guide To Ensure ‘Concierge’ Practices Are Not Acting as Insurance Providers
The Baltimore Sun on Wednesday examined findings from a recent Maryland Insurance Administration report regarding physicians who do not accept insurance and operate "boutique" or "concierge" practices. MIA released the report in January after concerns about some physicians charging patients an annual or flat fee for services rather than accept insurance. The report found two types of so-called "retainer" practices: the "annual evaluation model," under which the physician provides the patient with one annual physical exam for an annual fee, and the "bundled fee-for-services model," under which the doctor offers unlimited office visits.
According to the report, as long as the fee charged by physicians does not exceed the market value of the services, the annual evaluation model would not be considered insurance and the physician would not be subject to state regulation. The bundled fee-for-services model could be considered a form of insurance without certain limitations, such as defining the services to be provided in a contract, establishing the annual fee using the market value of the physical and limiting the services provided, according to the report.
The report recommends that physicians and medical practices considering adopting a retainer practice model consult with MIA first, and encouraged those already using the methods to "contact the MIA to share their written agreements to be sure these retainer practices are not inadvertently engaging in the business of insurance" (Dixon, Baltimore Sun, 2/11).
The report is available online (.pdf).
