Is anyone familiar with Qlience Health Coverage?

[gateley]

My apologies if this has been discussed previously, but a friend just sent me this link and it was the first I'd heard of it. In theory, it sounds good. Just gotta wonder -- too good to be true? Anybody have first hand experience? Here's some stuff off the home page and a link:

Traditional Primary Care
Traditionally, over 40¢ of every $1 you spend on health care goes toward insurance billing and overhead. This means your clinician must work harder and faster, seeing more patients each day just to make ends meet. As a patient, you experience longer wait times, shorter appointments and higher costs.

The Qliance Concept
Qliance is like a health club membership, but for health care. Your membership gives you unrestricted access to your Qliance clinician and services for one monthly fee. Instead of dealing with costly overhead, we reinvest that 40¢ in our clinics, electronic medical records and in patient services. You experience shorter wait times, longer appointments and lower costs.

Patient Care Options

Qliance offers two levels of patient care:
Please see our Services Page for the specific services offered at Qliance.

Qliance Level 1 Provider Type:
Family or Internal Medicine MD or ARNP
Hospital Care:
Remote coordination and supervision at any hospital and coordination with your specialty care clinician by your Qliance clinician.
After Hours Coverage:
Shared by all Level 1 clinicians

Qliance Level 2 with
BEDSIDE hospital coordination.

Provider Type:
Family or Internal Medicine MD
Hospital Care:
On-site rounds by your Level 2 clincian at a specified hospital to inform and coordinate your care provided by local hospitalists and specialists.
After Hours Coverage:
Personal on weekdays & shared by Level 2 clinicians on weekends.

http://www.qliance.com/

[subterranean]

1. I've heard of it, and it's legitimate.

It's a group of primary care doctors who don't accept insurance, but instead charge a monthly membership fee for unlimited access. I have no first-hand experience with it, but it sounds like it's worth looking into if you go to the doctor on a regular basis (I don't). You also might get more personalized service. The fee doesn't include specialist fees or hospitalization, so you'd need separate insurance coverage for those.

[Cleita]

2. Yes, but all it covers is doctors' visits for a particular clinic that is offering

the plan. It doesn't cover a lot of outside lab work, MRIs and hospitalization.

Read this from their own website. They advise you to have insurance for these situations.

What if I have an emergency?
If you have a life-threatening medical emergency, please call 911 immediately. For urgent, non-life threatening medical problems you may call our office 24 hours a day, 7 days a week to speak with the clinician on call. If you need to be seen during office hours, we will see you as quickly as possible. If your clinician determines that you need emergency care, you will be referred to the nearest emergency room. Before you arrive, we notify the emergency room of your arrival and provide them with pertinent medical information. Your Qliance clinician will also consult with the emergency room physician after your evaluation to discuss and coordinate your after-care.
Please Note - Your Qliance monthly care fee does not cover ambulance, emergency room or other hospital services. If you have insurance, we encourage you to check with your carrier to determine your emergency room coverage. If you are uninsured, we encourage you to explore payment options with the hospital’s financial services coordinator as many hospitals offer charity care and payment plans.

What if I need to be admitted to the hospital?
If you require hospitalization, your Qliance clinician will refer you to a hospital and coordinate your admission, discharge and follow-up care. When you become a Qliance member, you may designate a preferred hospital or we can help you choose a hospital.

What if the clinician I want to see is not accepting new patients?
To provide the highest quality and unhurried care, we limit the number of patients assigned to each health care clinician. If your preferred clinician’s practice is closed, you may choose another provider and may ask to be placed on a waiting list should space become available.
Please note that your Qliance monthly care fee does not cover any costs associated with your hospitalization, except the coordination of care. If you have insurance, we encourage you to contact your carrier to ensure your hospital coverage. If you are uninsured, we encourage you to discuss payment options with the hospital’s financial services coordinator as many hospitals offer charity care and payments plans.

What if I have to see a specialist?
When your medical needs extend beyond the scope of primary care, we will refer you to an appropriate specialist. We will provide that specialist with relevant portions of your medical record needed to optimize your care. When his or her evaluation is complete, your Qliance clinician will coordinate your follow-up care. Please note that your Qliance monthly care fee does not cover outside specialty care. If you have insurance, we encourage you to check with your insurance carrier to ensure your specialist will be covered by your policy.

These memberships are nothing new, and they are limited in what they can offer. The advantage that they offer is that pre-existing conditions and being denied health care because of them wouldn't be an issue.

[JuniperLea]

3. It's a primary care capitation plan...

Much like the original capitation dental plans that began in the late 50's. Flat monthly fee for basic service. The problem is there's no emergency or out of network coverage. For people with no insurance at all, this is better than nothing, no question. But it shouldn't be confused with health insurance.