The Cost of a 99211

The Concierge Physician Network

Issue No. 3 November 2012

Greetings!

Concierge medical practices, in which doctors shun managed care contracts and are paid in cash by patients, are surely gaining adherents. And while there have been philosophical and logistic criticisms of the model, some of those are steadily breaking down, mainly for two reasons:

Low and decreasing insurance reimbursements, particularly from Medicare, are making it harder to meet practice overhead expenses, and
Increasingly more doctors, particularly primary care physicians, seek greater control over their patient visits and patient relations.

The Cost of a 99211

A patient comes to you with a cold. You charge $79. If you took insurance, you would probably use CPT code 99211 (for a level-1 established patient encounter) and send the insurer a bill for $79.

After who knows how long, they might send you a check for $43.
To endure that process: bill the insurer, have the computers, etc., costs you ~$20/claim.
So now you're down to $23.
Your overhead: the staff, the lights, you -- costs $30.
So you've lost $7 to treat your patient's cold.

With concierge, a cold is a brief visit, maybe ~$50.

That's a win for you. You've gone from losing $7 to a $20 profit, because your overhead is still $30.

A Revolutionary Model For Physicians

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