Doctors Skip The Whole Insurance Thing By Charging Monthly Retainers

What if, instead of paying hundreds — or even thousands — of dollars each month for health insurance that you may not even be taking advantage of, you paid a retainer of somewhere between $39 to $79 a month to your primary care physician? Some doctors say this kind of service can work out to the benefit of both caregiver and patient.

For patients who can’t afford huge monthly premiums — or who can’t get individual insurance because of pre-existing conditions — the retainer (plus around $20 per office visit) allows them to see the doctor when they need to without breaking the bank.

For doctors, those retainers cut out the insurance companies, which means they are doing less paperwork and worrying less about whether or not some computer at the insurer decides some visit isn’t covered. All this means more time dealing with patients and less time wrapped up in red tape.

“What I’m doing allows the patient to come to the doctor and pay the doctor without a third party there to set rules and regulations for how we conduct medicine,” one doctor tells USA Today.

According to the paper, these types of retainer-based practices are operating in 18 states, with Oregon, Utah, Washington and West Virginia having specific laws governing such practices. No states specifically outlaw retainer-based physicians.

While retainers do allow people without insurance to see a doctor for regular healthcare and check-ups, those payments generally don’t cover the more expensive procedures that most insurance policies would.

“I think the issue is for patients to really understand what they’re getting,” says the director of public affairs for the Center for Studying Health System Change. “They’re getting doctor visits and some minimum level of diagnostic services. But if they get really sick, they better have insurance, or they’re going to be bankrupt. This is not insurance in any way, shape or form.”

Some physicians offer service based on monthly retainers [USA Today]

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  1. mrvw says:

    I can see this working for very healthy people. I go to the dr once a year for an annual physical and have to pay for the lab tests out of pocket anyway, this would save me money on insurance premium.

    • TBGBoodler says:

      “Very healthy people” don’t always stay that way–or realize they’re not as healthy as they think.

      My mom thought she was incredibly healthy, and she was–except for the malignant brain tumor she turned out to have. Thank goodness she didn’t eschew insurance because she was so healthy.

      • baristabrawl says:

        Aunt Edna Phenomenon. Everyone knows someone who denies the statistics, but the statistics are there for a reason or else perfectly smart college kids wouldn’t be failing the class.

  2. TuxthePenguin says:

    “They’re getting doctor visits and some minimum level of diagnostic services. But if they get really sick, they better have insurance, or they’re going to be bankrupt. This is not insurance in any way, shape or form.”

    It’d be nice if there were some form of insurance available that would cover people under such situations. You know, like a high-deductible insurance or major medical… too bad those are going away under ACA.

    • ARP says:

      I’ve seen articles saying high deductible plans are still acceptable once the mandate kicks in. What’s your source?

      • Nigerian prince looking for business partner says:

        HDHP policies will go away for two reason:

        1) They wont meet the 80/20 MLR ratios.
        2) They wont meet minimum comprehensive insurance requirements set by the DHHS.

        • jeb says:

          Are you sure?

          I have a $5,000 deductible, $7,000 maximum out-of-pocket (while in-network, which is not much of an issue with my plan, as it uses the Blue Cross Blue Shield network), and the provider (Wellmark BCBS) touts their 91.7% spending on claims. Not sure how they divy up the money, but I’m guessing that my plan won’t be affected.

          Doesn’t stop the 8-10% yearly increases, though. = Currently paying $51.65 a month, though, so I’m not complaining too loudly.

      • Bsamm09 says:

        I believe that there is an outstanding issue of whether contributions made by plan holders will be counted to meet the 60% actuarial values. The director of HHS will make this determination but has not done so AFAIK.

        I may be wrong about this so please correct if I am.

    • fortymegafonzies says:

      Even with ACA, anyone can still get a plan with up to a $2000 deductible, and many people will be eligible for even higher deductibles if they so choose.

      • Nigerian prince looking for business partner says:

        A $2,000 deductible still has very high premiums. My former policy had a $5,000 deductible and premiums were still in the $1,200/month ballpark.

        I’d much rather have a very high deductible and self-insure for that amount. Our new policy has a $10,000 deductible but we’re saving over $10,000/year in premiums with it and putting the difference (up to the legal limit) into our HSA.

        • jayphat says:

          Oh my god you were getting screwed. 4 years ago I had a high deductible plan at about $5000. My monthly premiums were about $100.

          • Nigerian prince looking for business partner says:

            Premiums seem to vary greatly between states.

            My family’s $10,000 HDHP still has a premium of around $400/month. It’s not great but way better than $1,200/month.

            • The Cybernetic Entomologist says:

              I’m paying $350 a month for a HSA-qualified HDHP with a $5000 overall deductible ($2500 for any one individual) for a family of four.

            • sponica says:

              In addition to premiums varying, I think expectations for health insurance vary. Up here in the northeast (from what I can tell) the expectation is that your employer will provide you with decent insurance. Although in NH, unless your company is self insured, that “decent” insurance is Anthem which means the copays tend to be pricier than I like.

              My employer does cost sharing for the employer portion of the health premiums, employees with higher salaries have a higher contribution and subsidize the credit given to the lower paid employee…so I actually pay half as much per month and have a better plan than at my old employer. I pay 66 dollars a month for a Point of Service Plan. If I had a family, it would be 198 a month. The tradeoff to good benefits is lower wages…

          • dolemite says:

            Where I work, the employer-provided plan is about $950 a month (for a family) and has a $3,000 deductible per person. This isn’t exactly unknown.

        • clippy2.0 says:

          that doesn’t sound right at all. If you are paying possibly 20k a year (premium + deductable) you’re not really getting any benefit from insurance. Even paying the 14.5 in just premiums, you might as well stick the money in a CD and actually collect money on it! Unless 50k hospital bills every 3 years are typical for you, in which case maybe it is a good deal!

          No, not even then

          • Nigerian prince looking for business partner says:

            Yeah, it sucks. Those premiums are also after a $300/month employer subsidy.

            Unfortunately, the national average for family premiums in group plans just broke $20,000/year for the first time. Even the policies sold on the exchange are expected to be in this ballpark for the bronze tier.

            I’m very grateful for my family’s $10,000-deductible HDHP that we switched to.

        • varro says:

          $2000 deductible here, premiums are $865/month. $35 copay, $50 specialist visit, $20/40 prescriptions.

          ACA will give me approximately $4000-5000 in tax credits, since I own my own business. Damn right I’m voting for Obama, despite me being a honky-ass cracker.

    • psm321 says:

      You’re kidding, right? The ACA actually encourages (IMO messed-up) high-deductible plans with things like the “cadillac tax”.

  3. az123 says:

    Something like this plus a catastrophic insurance plan (something with a $2-3K annual deductible) could cover a reasonably healthy person for a lower overall cost than full coverage insurance would. Of course at some point the offices doing this are going to start acting just as stupid as the insurance companies :)

  4. aja175 says:

    The key phrase there is “This is not insurance in any way, shape or form.”

    So for an additional $39-$79/mo I can continue to pay the $20 per visit that would normally be my copay plus continue to pay the insurance monthly for more serious emergencies?
    Sign me up!

    • Nasty Dan was a Nasty Man says:

      no, the idea would be to drop your current insurance premiums to levels charged for catastrophic insurance, which is cheaper and would result in a net decrease in your total layout.

    • Nigerian prince looking for business partner says:

      For it to make sense, you would have to dump your PPO and switch to a HDHP or a major medical policy.

  5. lovemypets00 - You'll need to forgive me, my social filter has cracked. says:

    This sounds like good common sense for both the patient and the doctor, so I’m afraid the insurance lobby will quash it as quickly as they can.

    I have insurance through my job, but it’s the same policy everyone else has, and I understand that as it’s probably easier for HR to have one huge policy that covers every need. Someday, if we get to the place where we have to purchase our own insurance, hopefully we’ll have the option to pick the items we want to be covered.

  6. Flyersfan says:

    There was a doctor in Lancaster PA that tried this. I don’t know how it worked out for her but for a couple grand a year, you could get an appointment for any reason. She was trying to limit the practice in this manner to about 400 patients, I think.

    My question is this – if doctors are willing to take patients on retainer for ~$950 per year because it cuts out the middleman, why aren’t they willing to promote a single payer system? Single payer would cut out a huge amount of paperwork since there is only one “insurance” company and allow them to spend more time helping patients too.

    • StarKillerX says:

      Single payer cutting out huge amounts of paperwork?

      Since medicaid and medicare require far more paperwork then any other insurance I’m not sure where you draw this conclusion from?.

      • Kate says:

        No, a single payer would mean that all health care would come from or through the government. There wouldn’t be medicare or medical anymore. It would all be one program, which would cut down the paperwork

        • StarKillerX says:

          It might cut down on the variety of forms, such that there wouldn’t be different forms for different payment sources but if you think payments from the government “single payer” would have less paperwork per patient/procedure then you’ve obviously had little if any dealing with the government.

          • Nikephoros says:

            “Paperwork” is irrelevant. It’s the cost of supporting the bureaucracy that matters. And by that measure, Medicare is significantly more efficient than private insurance.

          • NeverLetMeDown says:

            Think of it this way: right now, doctors have to (in effect) submit bills in English, German, French, and Korean. Single payer would mean that all bills would have to be submitted in Korean. While that might be the toughest of the four languages to learn (for a native English speaker), the doctor’s administrative people would only have to learn/deal with _one_ language, not four.

    • Happy Tinfoil Cat says:

      The medical professionals I have talked to would LOVE single payer healthcare. Insurance companies are milking them dry and dictating which meds they can prescribe and what procedures they can do.

      • Nigerian prince looking for business partner says:

        “…and dictating which meds they can prescribe and what procedures they can do.”

        There isn’t a health care system in the world that doesn’t use some kind of rationing, cost/benefit analysis, or Quality Adjusted Life Year calculations.

        The advantage of single payer would be a reduction in overhead and progressive premiums via taxation.

      • aerodawg says:

        The medical professional I’m married to wants nothing to do with single payer because virtually ALL the issues she has getting paid come on the gov’t medicare/medicaid side.

    • aerodawg says:

      The word of the day is “paperwork.”

      Like any other insurance system, no gov’t system is going to pay anything and everything without a pile of paperwork and justification. Medicare doesn’t. Medicaid doesn’t. And if they decide not to pay, it’s AFTER the services have been provided, letting ye olde doctor eat the costs.

      With retainer service, you bill the patient. The patient pays. If they don’t they don’t get service.

  7. tiredofit says:

    Check out Group Health in Seattle. It was founded on this model, though they do accept insurance and Medicare/Medicaid.

  8. mistyfire says:

    I live in Oregon but my local doctors office doesn’t do this. I hope they will.

  9. Tim says:

    It’s still insurance, essentially. You pay someone a regular fee, and in exchange, your costs will be lower when you need to spend money.

    Of course, what this covers is extremely limited, since it’s just that one doctor, and s/he can charge you a lot for expensive procedures.

    How is this better than insurance?

    • crispyduck13 says:

      It’s probably better for younger/healthy people who only need a yearly physical or the option to come in when they get the flu. I think the same thing could be accomplished by using one of those medical clinics I see popping up everywhere. They treat common sicknesses and I think can even do stitches, way cheaper than ER, no insurance required, no appointment required.

    • pythonspam says:

      Low cost due to limits on what services the doctor offers, liability for only normal wear and tear.
      And no deductible for services.

      Think of it as a plan for you car that gets you periodic oil changes, belt checks, tire rotations, etc, but if it breaks down, repairs are billed on a per-incident basis.

  10. catastrophegirl chooses not to fly says:

    in general, i like the idea. in practice, i’m too unhealthy.
    would that be a monthly retainer to my primary care, my endocrinologist, my neurologist…. etc?

  11. jbandsma says:

    Maybe we ought to go to the old Chinese way of medicine…you paid the doctor when you were well. You quit paying him when you got sick; that was a sign he wasn’t doing his job for you properly.

  12. chiieddy says:

    My guess is any and all labwork is not included, which is the bulk of my annual medical bills.

  13. Gorbachev says:

    This wouldn’t be a good solution for a majority of people as it won’t cover bills from hospitalization, ER or lab work.

    • KyBash says:

      You can buy insurance to cover those costs, and the combination of payments to the doctor and to the insurance company can be less than insurance which covers everything.

  14. chucklebuck says:

    My insurance plan requires a PCP referral for anything I have done. I wonder, if I was seeing a doctor who didn’t take insurance, would her referrals be accepted by my insurance plan? I don’t think I’d even be allowed to pick a non-network PCP, come to think of it.

  15. Nigerian prince looking for business partner says:

    Although, I find the idea interesting, insuring against such a small amount of money makes little sense. Dollar for dollar, consumers are better off insuring against catastrophic claims than for highly predictable and small events (unless a 3rd party is subsidizing premiums).

    If the goal is to pay a retainer, just to have a guaranteed appointment slot in an under-served area, then it might make sense. Otherwise, you’re better off getting a high deductible policy and self-insuring for the first several thousand dollars of medical bills.

  16. Alliance to Restore the Republic of the United States of America says:

    What would happen if we just outlawed health insurance companies? Once hospitals, doctors, etc realized they wouldn’t get paid by them anymore they’d lower prices to what’s affordable for the average person.

    • Bsamm09 says:

      No they wouldn’t. Even if they were forced to operate on a not-for-profit format, costs would still be high. The equipment that is used by hospitals is very expensive. Medical school is also very expensive and loan payments afterwards are more than most people’s mortgages.

      Even if you subsidized Med school so you could pay them less, it couldn’t be too much less. The time it takes for a person to get a MD and practice is very long. For surgeons, that time is even longer. Who wants to give up that much of their life to have a job that doesn’t pay the premium they now receive?

      Not to mention the support staff they have to employ are specially trained also.

      What would be better is to have people on Hdhp plans with deductibles of $2,500, $5,000 or $10,000 for example. That way people would have to actually pay money when they see their primary care doctor and not a low co-pay. Since everyone will know how much the visit costs, they will shop around for a doctor.

      If something bad happens, all you are out is the deductible. If you are worried about paying that money start at the low amount and contribute what you can to your HSA. As it builds, raise your deductible.

  17. CharlesFarley says:

    My father in law has been using a concierge general practice family physician for at least five years now. He pays a fixed amount every month and in return for an agreed upon set of services. In return, he has the Dr’s cell phone number and calls when there is an issue and a website to use to schedule a physical or other routine events.

    The doctor worked out things with a local lab whereby if you pay cash/check for the lab services, you get a steep discount and all of the lab procedures are priced out on a schedule so you know up front what the expenses could be.

    My father in law carries a catastrophic policy with a deductible around $10K.

    Oh, the doctor does make house calls. He only adds on a per mile charge if he has to travel over 20 miles.

    Everyone gets what they want.

    • Nigerian prince looking for business partner says:

      That sounds like a pretty good setup.

      He’s insured against something catastrophic happening and at the same time, has a family doctor on call. In the process, I’m sure he’s paying significantly less in total (probably multiple times less) than an equivalent PPO would cost.

  18. incident man stole my avatar says:

    Our long-time primary care doctor went into something, don’t want to plug the brand name program, where we would pay in $125 month and it would include a “Gucci” 4 hour physical and a copy of our medical records on a cd-rom. His practice would be capped at 300 people and you’re guaranteed to see a doc the same day. We bolted and have yet to find a new primary care physician that we’re happy with.

    The boss pays $45/month, another plan without the physical, for the right to see a specialist in Washington DC. He doesn’t take insurance either.

    Both of these are the direct result of Obamacare. Just going to prove that those with the money get the better care and just 2 years ago we could afford the better care. Oh well we’ll just wait for the death panel.

    • BrianneG says:

      Why doesn’t he have physicals? They are considered preventive care under the Affordable Care Act and are therefore available annually without co-pay or deductible.

      • incident man stole my avatar says:

        I think it’s just a money grab by him… the fee is just for the priviledge to be his patient and covers no medical services

  19. Outrun1986 says:

    Even if you are doing this the cost of prescription medication will likely eat you alive if you don’t have an insurance plan that covers it. Payments to these doctors wouldn’t cover lab work or any other tests or prescriptions. Prescriptions for common illnesses are cheap but there are plenty of $400 medications on the market as well. Also if you are put on an expensive medication for a long period of time or it becomes something you have to take regularly then you are going to be screwed.

  20. Press1forDialTone says:

    This is an excellent idea for pre-medicare folks who need access to a general
    physician and don’t have insurance, or have been rejected for a pre-existing
    condition, or only have insurance for catastrophic medical events.

    This idea should go viral to see what people and doctors think about it
    and folks should pressure their state medical folks to allow doctors to do
    this.

    The insurance companies will push back hard and we should push back
    HARDER.

  21. nedpwolf says:

    I can vouch for this model. For a few years, I had a personal physician that would write me prescriptions when needed, give me valued advice and provide me with some peace of mind that I could call someone “my doctor”.

    Screwed Again

    Unfortunately, he sold his practice. The group he is now with has no such option and will not take cash payments. They only bill to insurance companies.

    Healthcare for the Self-Employed

    As a self-employed Consultant/Contractor for some years, healthcare costs are a constant struggle for me. Workers in my category typically do not qualify for any type of group health-care insurance plan. For those of us that do pay for our family’s health insurance (sadly, most don’t), there is virtually no legal protection against arbitrary insurance cancellation. What happens if I get cancer? I get cancelled, that’s what.

    No Cobra.
    No group discounts.
    No protection.

    Many of us have what is referred to as “catastrophic insurance”, very high deductibles in the $5000 to $10,000 range. All normal medical expenses come directly out of my pocket.

    http://nedwolf.com/blog/2012/04/23/i-would-like-to-pay-for-my-medical-care-with-a-monthly-retainer/

  22. shibotu says:

    Yes, I know several doctors at a university who have created a mutual arrangement like this for treating their own families.

  23. Wathnix says:

    This makes no sense at all, even for extremely healthy people. Fact is no matter how healthy you are or how well you take care of yourself you can always get in an acident requiring extensive surgery. How will your doctor visit help then?

    You need real health insurance to cover catastrophic care, you will end up paying twice for the same doctor visit this way.

    • MrEvil says:

      I’m not sure of the statistics, but outside of auto and workplace accidents how likely is it you would be severely injured at home? Most folks with major medical only are concerned about the healthcare issues that can arise without an injury.

  24. phsiii says:

    This is what an HMO is — a pool of people who are tied to a doc, and for whom that doc gets a fixed amount per month, whether he sees them or not.

    Put it this way:
    With a PPO, the doctor gets paid to see you.
    With an HMO, the doctor gets paid NOT to see you.

    Pretty simple, really…so this is a self-administered (by the doc) HMO. Now, what happens when you need higher levels of care? Does the doc pay? I’m guessing “no”…so it’s *worse* than an HMO.

  25. HogwartsProfessor says:

    My doctor’s office has a thing for unemployed and low-income people where if you qualify, you only have to pay $10 for the office visit. It’s only with the doctor’s office (and I think includes the lab down the hall), so if I get sick or need them, I can still see my own physician rather than take my chances with the clinic.

    It does NOT cover ER, urgent care or hospitalization, or prescriptions. Lucky my thyroid meds are only $4 even without insurance. The only semi-risky activity besides driving that I engage in is figure skating. I plan to renew my lapsed club membership in July because 1) I may not have a job by then, and 2) USFSA has something like $5000 in coverage for members. If someone hits me driving, hopefully it will be someone with good insurance (or any insurance X_X).

    This is the best I can do right now.

  26. crazydavythe1st says:

    Sounds like capitation in an HMO…except you have much crappier coverage.

    So you’re paying $80/mo for a ~$80 discount per visit (that you could probably negotiate down if you were self paying)? I don’t think that would be worthwhile for most people.

    For $80/mo, in many cases, you can get real catastrophic coverage with an HSA option. That probably makes the most sense if you’re cash strapped.

  27. ldnyc says:

    Dr. John Muni and AMG Medical Group (http://www.amgmedicalgroup.com/) here in NYC offers a similar service. I’ve been a very happy “member” of theirs for 3 years. I’ve had services and procedures (including mole removals, x-rays, sonograms, MRIs, comprehensive lab work, general check-ups, etc) – which would have cost me tends of thousands of dollars out of pocket on my previous insurance (which, since I am a small business owner, cost me almost $700/month in premiums). I am on their “Classic” plan and pay $89/month for peace of mind and preventative or urgent care when I need it. And rather than having to see a Dr. one day in order to get referred to a specialist on another day (losing 2 days of work productivity), I have never had to make a return visit to see a specialist or get a test/lab/imagine – everything has always been done in-house while I am already there, unless I need a follow-up after a procedure. I’ve only been to the Manhattan office, so I can’t speak to how their outer-borogh offices are run, but every Dr, nurse, lab tech and receptionist I have dealt with by phone and in person has been friendly, professional and compassionate. Don’t get me wrong – I adore the Doc who was my primary care physician for many years and I wish I could afford to retain him as my personal physician forever, but neither he nor I can afford that, so rather than pay premiums to a greedy insurance company that still requires me to pay a substantial amount out of pocket on top of the premiums, and nets my Dr less money than he can support his practice with, I have chosen to go the “membership” route with AMG. By saving so much on insurance premiums I am able to actually save money in my own savings account so that if something dire and costly DOES happen and I need to be hospitalized or treated for something major that AMG can’t handle, I no longer fear going bankrupt so early in the process.

  28. jeb says:

    This is not appealing to me, at least.

    Instead of paying $39-$79/month, I pay $51.65 a month (the 19 year old male rate) for a plan that gives me three office visits a year at a $30 copay (including any urgent care that bills it as an “office visit” instead of a “hospital visit”…found that out the hard way) with any provider that accepts BCBS (which, at least around here, is everywhere, and I had zero trouble finding an urgent care place in DC that accepted it when I needed one.) ER visits are capped at $150 (why they don’t have some program that caps office visits at a slightly lower rate, I’m not sure.) Outside of that, it’s a straight $5,000 deductible, $7,000 max out-of-pocket (assuming I’m in network, which I always am.)

    It offers the best of both worlds. If I absolutely need to visit a doctor, I can visit one a couple times a year (along with an end-of-the-year physical, which they fully cover) and if something major occurs, I only have to find a way to pay $7,000 (instead of five or six digits worth of expenses.)

    I’m not sure why this isn’t offered more places; it seems like the best of both worlds for a young, healthy person while limiting some of the liability for the insurance company (thanks to the 3-visit limit, I try to either solve minor illnesses, such as the cold or flu, through the Mayo Clinic symptom checker thing or through calling the free nurse line that my insurance company has.)

  29. SloppyJoe says:

    During a short period without insurance, I went to a doctor who did not take insurance at all. He charged by the minute during the diagnosis.

    Since it was a new patient visit, it took longer. I was in and out of there WITH prescriptions dispensed from him for $53. He had a surprisingly large variety of meds on hand at ridiculously low prices. He also didn’t take a cut for lab work. He charges the amount the labs charge him.

    I now have insurance that covers rather well. If my employer didn’t pay 100% of my insurance premium, I would probably be paying less to go to this guy, even though I’m insured.

  30. ripoffnation says:

    Cutting out the middleman is always win-win for both patient and provider? A hybrid system that uses direct retainer for primary care and a 3-party system for out of the ordinary care seems attractive.