Dealing with Doctors Who Only Take Cash

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As to why doctors decide to switch to a concierge practice, the answer is almost always frustration.

“About four years ago, one insurance company was driving me crazy saying I had to fax documents to show I had done a visit,” said Stanford Owen, an internal medical doctor in Gulfport, Miss. “At 2 a.m., I woke up and said, ‘This is it.’ ”

Dr. Owen stopped accepting all insurance and now charges his 1,000 patients $38 a month.

“When I decided to abandon insurance, I didn’t want to lose my patient base and make it unaffordable,” he said. “I have everything from waitresses and shrimpers to international businessmen. It’s a concierge model, but it’s also the personal doctor model.”

Dr. Owen, who once had three nurses and 10 examining rooms, said it was now just him and a receptionist. He has become obsessed with keeping overhead low, but he said that, for the first time since the 1990s, his income was going up.

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The biggest concern for a doctor is running afoul of insurance regulations that prevent doctors from billing twice for the same service — for the care, which is submitted to the insurance company, and for the concierge fee, if the fee doesn’t cover something extra. Some insurance companies also bar doctors from offering concierge services.

David Hilgers, chairman of the law firm Brown McCarroll, said the risk to a doctor with a practice dependent on Medicare reimbursements was particularly acute.

“Medicare will not allow you to charge a patient in addition to what the government pays,” Mr. Hilgers said. “There is a risk of losing your practice and your license and being penalized by the federal government for doing so.”