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.
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. If you want a consultation by telephone or skype, some insurance and Medicaid covers it, but Medicare rarely does. It may expand in Medicare and has already spread in Veterans hospitals, including permission for any VA doctor to treat any VA patient, regardless of state licensing rules.
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.
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.
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.
A Commonwealth Fund study gives examples of what to watch for in deciding if an app is safe to use.
Some apps will call a doctor to visit you at home, 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.
Luxury Suites at Hospitals
Many hospitals offer amenity rooms, typically on a separate floor, with extra service and space for an extra $250 to $2,500 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.
utsandiego.com/uniontrib/20050904/news_1n4hospital.html (associated press)
nydailynews.com/new-york/class-ward-lenox-hill-hospital-article-1.1186213 Nurse overwork on non-luxury floor
denverpost.com/news/ci_7746964 Claims a profit
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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