Reimbursement for Health Care "Retainer" Paid To Doctor

[Guest EMC]

I have been seeing more and more physicians' practices, tiring of insurance claims, moving to a system whereby the patients pay the practice a flat fee up front per month for the year. That fee entitles the patient to receive physician services as often as needed during the year with no additional charge. The fee is not refunded if it is not "applied" to specific treatment during the year.

Query: May the patients make these payments on a pre-tax basis via a health care FSA (or through a cafeteria plan)? Because the payments are not directly linked, at the time of payment, to a specific provision of medical expenses that have been incurred by the partcipant, it seems like it would be hard to "substantiate" these claims.

Has anyone seen the arguments for or against this practice (i.e., the pre-tax payment of these expenses through a health FSA) articulated anywhere?

[KIP KRAUS]

EMC:

I’m curious. I haven’t seen this type of practice in the Rochester, NY and surrounding area whereby physicians are charging this monthly fee. Where are you located? Are these people in HMOs or PPOs?

[Guest MSMA]

I have read about this in the Boston Globe on several occasions.

This seems to have really taken off in the metropolitan areas of Massachusetts. AND just recently, I heard of a physician in Maine doing the same thing. They are not affiliated with any insurance companies and will not participate in "ad hoc" arrangements etc. What they are essentially doing is creating their own little managed care program by charging the monthly "premium" but without the co-pay at the time of service. The physicians claim that it allows them the freedom to treat patients as they see fit, set their own schedules etc without being second-guessed by insurance companies. The physician in Maine that I read about does not even have an "office" - he wants to do only house calls.

As for reimbursing these fees? In MY opinion, the monthly fee is a premium and as such is not an eligible expense.