Major telehealth companies include American Well, Doctor on Demand, and MDLive. If you want a consultation by telephone or skype, the rules and insurance coverage are constantly changing, so ask. Veterans hospitals have permission for any VA doctor to treat any VA patient, regardless of state licensing rules. Insurance and Medicaid may cover telehealth. Medicare has decided to do so too from 2019 on. A telehealth association has a 2019 report.

​All states now allow doctors to see patients by telehealth even from the first appointment, if they have the right license, but distant doctors refer too rarely to other local specialists, since they don't know them, so patients need to ask.

"Affordable teletherapy, such as Open Path Psychotherapy Collective, National Alliance on Mental Illness (NAMI) HelpLine or apps like Talkspace or Betterhelp. Your state may offer options too (New York state has a Covid-19 Emotional Support Helpline)."

A Commonwealth Fund study gives examples of what to watch for in deciding if an app is safe to use. FDA has some legal guidance on apps and an overview.

Some apps will call a doctor to give you a home visit, or you can use lists here to find doctors who visit homes and assisted living, and call them directly to build a relationship with the same doctor over time.

There are many health apps (some say over 100,000, others say over 1,000) competing to offer personalized service.  A commercial site with practicing doctors on its staff reviews many apps. The reviews are often specific and helpful. They also include articles written by or for advertisers. Each reviewer must tell the editors about potential conflicts of interest, and the editors decide what to reveal to the public.

Some computer systems go through your symptoms and tell you possible diagnoses. 19 systems ranged from 5% to 50% "right" on a 2014 test of 45 vignettes (sets of symptoms, 18 computer systems and one paper system), published in 2015. "Right" means the single diagnosis which the authors of the vignettes expected. No one checked if the other diagnoses offered were also fully consistent with the symptoms given, or perhaps even more consistent.

A long list of other systems use the same algorithms and would have had the same results. Many nurse help telephone lines use the same algorithms and would have about the same results, except when accuracy is changed by the nurses' own judgment.

When the systems were asked for the 3 most likely diagnoses, they included the "right" diagnosis as one of these 3 from 29% to 71% of the time, depending on system. Researchers at Harvard and 3 Boston Hospitals did the test. In 2016 they tested 234 doctors, who identified the "right" diagnosis 72% of the time and got it in their top 3 possibilities 84% of the time. Researchers did not report the range of accuracy from doctor to doctor, as they did for computer systems, but success did not vary much by level of training (intern, resident, attending doctor).

A study found poor quality in dermatology consultations based on sending photos through the internet. A RAND study of claims said that pharyngitis patients went out to get strep tests after 3% of Teladoc consults, compared to getting them (usually in the same visit) after 50% of office visits. RAND said bronchitis patients got (inappropriate) antibiotics after 83% of Teladoc consults, compared to 72% of office visits. Since the study was based on claims, it is not clear how many patients were told to get a strep test or antibiotic, and did not bother to go out and do so. 

​Amazon and Google are expected to expand into health care.

Referral sites generally give you no choice of provider, and you know which one they selected only after paying the referral fee. If you have time to search the Specialists tab above, you can find the experience and cost of different providers and negotiate directly.

Referral services may give local or distant referrals.

ZendyHealth refers you to a local provider based on how much you want to pay ($49 referral fee). They cover only a few procedures, primarily imaging, tests, counseling, dental extractions or implants, cosmetic procedures. For these and other procedures they also refer you for a free consultation. More details are on the Costs page.

PinnacleCare charges $650 to set up a consultation with a specialist and transfer medical records. 

GrandRounds.com (formerly ConsultingMD.com) refers patients to local or distant doctors for initial care or second opinions and transfers medical records to them. They charge $200 to arrange an initial office visit with a local doctor in the "top" 3% or 10% of local doctors, or $7,500 for a remote expert opinion from a doctor in the "top" 0.1%. They also charge $7,500 for "STAT," an emergency telephone consult with the best doctor they can find at short notice.

• The first time you use their services they need time to collect your health records from your doctors and hospitals, and (with your permission) provide them to the doctors they refer you to. They do not say whether your health records are encrypted while stored in their offices. 
• They offer their telephone consult ("STAT") 24/7, but don't say how many hours it may take to find a relevant expert. They're ambiguous whether the expert talks to the patient/family or the treating doctor. If you cite both those links to them, you can insist they talk to both.
• The emergency STAT service is expensive, and is based on the idea that Grand Rounds has pre-identified doctors willing to consult by phone, which you would have trouble finding in an emergency. Dr. Kussin recommends that when you know what health conditions you have, make an annual appointment with a top specialist for a checkup, so you can call him/her as an existing patient in any emergency (p.206).
• The non-emergency $7,500 expert opinion seems aimed at big spenders. They warn you that the expert will not have "information that would be obtained by examining you in person and observing your physical condition." Without spending that much you can identify the top national experts in the Specialists tab above, and in your $20 subscription to UpToDate from Wolters Kluwer, call for an appointment, and go see them in person. 
• Their $200 fee to recommend and set up a local office visit is reasonable. You pay them to research doctors and transfer records instead of doing it yourself. You and your insurance will still have to pay for the visit itself. 
• A problem with Grand Rounds is that the terms of service require you to pay their legal bills for any problems which arise: "You agree to indemnify, defend and hold the Company and its directors, officers, employees, agents and contractors harmless from and against any and all claims, damages, losses, costs (including without limitation reasonable attorneys’ fees) or other expenses that arise directly or indirectly out of or from (i) your breach of any provision of these Terms, or (ii) your activities in connection with this Site." They don't provide any examples, but perhaps this would protect them if they misuse your information.
• Grand Rounds does not reveal its algorithm to identify top doctors, but says it includes: "Institution (is the physician associated with a top-quality one?), Training (where did the physician study?), Research (does the physician publish in his or her area of study?), Reputation (what do the physician’s peers think?)" Another page adds, "procedure volumes; and clinical outcomes." Another page says that the doctors' "success rates are well above national averages and that they follow state-of-the-art care practices." They say these top 10% doctors have "15% lower hospital readmission rates. 30% – 40% lower mortality rates, 20% – 25% lower complication rates, but again no information on how these differences were found, over what time frame, comparability of patients, etc. They describe their service as doing some of the same analysis this website describes, on procedure volumes, doctors rating other doctors, and researchers. They simplify the process, while hiding the details. 

PinnacleCare and Private Health Management help wealthy clients navigate the health-care system, for $16,000 per year or more, plus the cost of care. 

Between 1% and 6% of doctors refuse insurance and/or charge concierge subscriptions starting at $600 per adult per year and $120 per child, or more typically $1,500 per adult. 10% of Texas doctors do not take insurance, and instead charge for each office visit, starting at $50 per visit.

​Industry sources include Concierge Medicine Today, Direct Primary Care Journal, and Direct Primary Care Coalition.

​​PinnacleCare and Private Health Management help wealthy clients navigate the health-care system, for $16,000 per year or more, plus the cost of care. 

A 2016 survey found 76% of hospitals have  programs to get donations  from grateful patients (p.14), usually involving screening patients online to find those with wealth:

• 82% of these hospitals ask doctors and nurses to identify hospital patients with enough gratitude and money to donate (p.15), though these staff are not trained to do this, and have varying comfort with it. 34% of the hospitals track the doctors' referrals (p.11). 21% send solicitation letters signed by doctors (p.16) 69% plan to increase "focus on physician/clinical staff engagement in patient referrals" (p.19).
• 57% screen inpatients for wealth by sending their identities to data brokers; all but 3% of the rest screen later; 44% flag VIPs and donors in their electronic health records; 13% also screen people with outpatient appointments (p.15). 
• A quarter gave care coordination services and medical concierge services to patients they identified as potential significant donors or who joined a formal donor program; 43% gave non-clinical benefits, like a parking pass (p.16).
• Over 40% had hospital executives and fundraisers visit the patients in their hospital rooms (p.16), to build a relationship with the patient, not to ask for money initially. Patients would not necessarily know the hospital had screened them online to identify their wealth.
• To find rich people, they have to send all patients' IDs to the data brokers, revealing that all these people (rich and poor alike) have been patients in that hospital system. Data brokers know what the illnesses are by the patients' search and web-browsing histories, and maybe their prescription histories.
  

​Many hospitals offer amenity rooms, typically on a separate floor, with extra service and space for an extra $250 to $5,100 per night. They often say the medical care is the same, but facilities for doctors and nurses are also presumably less crowded and more comfortable on these floors, so care could be better. If someone knows of a list, or effective way to search for them, please email it.

Below is a list compiled from news reports, sorted by city. Dates are given, since prices may have risen and services changed. Costs shown are for luxury rooms, in addition to regular room charge. Click list to see sources.

The following list shows the sources above, and some others, especially on other countries:
2019 www.enherts-tr.nhs.uk/patients-visitors/our-services/maternity/amenity-rooms/  £195 per day
2018 economist.com/britain/2018/04/26/delivering-a-prince-in-britain-costs-less-than-the-average-american-birth £5,670 per 24 hours
2016 capitalandmain.com/healthcare-versus-wealthcare-uncovering-ucla-vip-medical-program-0913 $12,000/year
2016 forbesmiddleeast.com/the-luxury-hospital-a-new-niche
2016 bu.edu/research/articles/luxury-hospital-rooms/ Boston Univ. School of Hospitality Administration says many patients willing to spend $100s more for better hospital rooms
2014 money.cnn.com/2014/10/02/luxury/luxury-hospital-suites/ $250-$5,100
2014 therichest.com/luxury/the-10-most-luxurious-hospital-rooms-in-the-world incl. Washington Hospital Ctr, Mt. Sinai, Cedars-Sinai
2014 youtu.be/z6dmAs2H_DI CBS says luxury leads to lower readmission and 1/3 the cost for some procedures
2012 nytimes.com/2012/01/22/nyregion/chefs-butlers-and-marble-baths-not-your-average-hospital-room.html "no people in training — only the best of the best."
2012 articles.sun-sentinel.com/2012-02-26/health/fl-hk-hospital-luxury-suite-20120226_1_hospitals-offer-south-florida-hospital-community-hospitals $150-$800/night
2012 nydailynews.com/new-york/class-ward-lenox-hill-hospital-article-1.1186213 $850-$2,400/night. Nurse overwork on non-luxury floor.
2007 denverpost.com/news/ci_7746964  "bring revenue into the hospital, that foster relationships" $250-$1,000/night "society that is naturally stratified by income," said Uwe Reinhardt, a health economist at Princeton University in New Jersey.
2006 forbes.com/2006/12/11/luxury-hospitals-health-forbeslife-cx_avd_1212hospital_slide.html
2005 utsandiego.com/uniontrib/20050904/news_1n4hospital.html  (associated press)
2003 forbes.com/2003/07/08/cx_ns_0708healthintro.html#3afbcd9d4153 "for every Big Shot who checks into a high-end unit there's a regular Joe who splurged for his comfort."
nd parents.com/pregnancy/giving-birth/labor-and-delivery/labor-and-delivery-most-luxurious-birthing-suites
nd dujour.com/lifestyle/luxury-hospital-accommodations/  They comment, "unclear whether hospitals are actually turning a profit from this enterprise. What they are doing, however, is cultivating future donors"
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