If You Are Starting a Concierge Medical Practice that Accepts Private Insurance

When starting a concierge medical practice, one important question to ask is whether your practice will be accepting private insurance, which involves providing services to patients that are insured under private health insurance plans. However, accepting private insurance as part of your concierge practice carries legal risks. This blog covers an important consideration that providers should consider before starting a concierge medical practice that accepts private insurance. If you need assistance setting up a concierge medical practice or would like to discuss this blog post, you may contact our healthcare law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

It Is Important to Review Your Participating Provider Agreements with Health Insurance Plans to See if They Allow Their Providers to Start Concierge Medicine Practices.

Before providers opt into networks with health insurance plans, they sign participating provider agreements with them to provide certain healthcare services to insured patients. These contracts contain various conditions and obligations, and some contracts have conditions about concierge medicine. Other health insurance plans, however, do not have a stance on concierge medicine. These conditions may require providers not to include covered services as part of their concierge membership fees, which could result in double billing, or not to restrict certain services or amenities to insured patients. Failure to comply with these conditions may cause a provider to breach a participating provider contract with a health insurance plan, which could result in termination of the participating provider agreement. You should review all the contracts you have with your health insurance plans to determine whether they have any restrictions about concierge medicine and what services can be offered and charged to patients that are insured by a health insurance plan.

If you need assistance setting up a concierge medical practice that accepts private insurance or would like to discuss this blog post, you may contact our healthcare law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

 

 

*Disclaimers: Thoughts shared here do not constitute legal advice nor do they form an attorney-client relationship.  All digital presentations by our firm or its attorneys are provided as a public informational resource.  Although intended to be correct and up to date as of the date posted, we cannot guarantee the accuracy of posted information, especially as it relates to individual situations.  We do not routinely update such information.  To determine up-to-date information about the subject matter of this information and proper application to a specific situation, it is important that you consult your healthcare attorney.  Our communications of information through the Internet shall not constitute “presence,” “doing business” or the practice of law in any location, even when a specific state or its laws/rules are referenced.  Our firm maintains offices in Georgia and no other state. Our attorneys are licensed in some, but not all, states.  For each client engagement we accept, our firm undertakes best efforts to ensure we are aware of and adhere to applicable jurisdictional requirements, which may include reviewing local rules, conducting relevant research and collaborating with, or referring a matter to, a local attorney.