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Sunday, March 21, 2010

$79 per month for what?

Today in the NYT was a story:


A Health Care Plan So Cheap, They Made Him Raise the Price

I.
Membership Benefits:
(A) Included Benefits: All AMG Members in good standing shall be entitled to unlimited regular preventive checkups for adults and/or well baby checkups for $79.00 per member per month for Classic Plan and for $119.00 per member per month for Premium Plan. Preventive checkups may include all treatment, testing and care identified on Appendix I and Appendix III.
(B) Benefits at Additional Charge: AMG Members will also enjoy the benefit of up to 15 sick visits per fiscal year charged at $33.00 per visit. Such visits may include, but are not limited to, lab tests, x-rays, sonograms, office-based surgeries and physical therapy and all other treatments, testing and care identified on Appendix II and Appendix IV.
(C) Services Not Available: THIS AGREEMENT DOES NOT COVER HOSPITAL STAYS, EMERGENCY ROOM VISITS, SERVICES OF SPECIALISTS NOT EMPLOYED BY AMG, TREATMENT (INCLUDING BUT NOT LIMITED TO IMAGING) PROVIDED ANYWHERE OTHER THAN AT AMG’S FACILITIES, AND ALL LAB TESTS OTHER THAN THOSE IDENTIFIED ON APPENDIX V.
There is a list of covered services posted at http://amgmedicalgroup.com/pdf_form/Classic_Plan_Full_List[1]_5.pdf

 as well as a rather impressed list of "covered labs" http://amgmedicalgroup.com/pdf_form/LabTest_11.pdf


This amounts to a subscription service and they explicitly claim this does not represent insurance. It will serve a basically well population fine and may also be appropriate for patients with chronic conditions such as hypertension. I could see combining this with a catastrophic care program. 


I wonder how this will fare in a world where patients are mandated to buy comprehensive insurance? They might be tempted to change their business model. On the other hand, in a world where is limited access to primary care, there may be substantial patients who will pay the nominal additional fee in order to get access to a visit.  

1 comment:

  1. I've thought about doing that in my practice but am concerned that such a subscription arrangement would eventually be deemed to be insurance and stipulated to knowingly be so a priori to the issuers and the possible retroactive liabilities from that could result in substantial financial and legal penalties. Eventually, especially if this schema were successful, it would represent a political threat to the single payer advocates and would be targeted for destruction with significant punitive measures to practitioners so that it would never be resurrected. The greatest threat to government run health care is a competitive alternative that exposes the government's inadequacies or inefficiencies or outright ineptitude. You never know how bad off you are unless you have something to compare it to. CAM

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