‚ÄčConcierge medical care violates the terms of your provider agreement with AmeriHealth

February 9, 2021

‚ÄčAs a reminder, Participating Providers who require members to pay a designated fee (e.g., a surcharge) for Covered Services to remain in their practice are in violation of their AmeriHealth Professional Provider Agreement (Agreement) and are subject to termination from the AmeriHealth network. This is typically referred to as concierge medical care, or retainer medicine, and is in violation of the terms of your agreement.

Participating Providers are required to comply with the terms and conditions of their Agreement, which requires them to accept payment from AmeriHealth as payment in full for all Covered Services.

Covered Services include:

  • well-patient visits
  • emergency telephone consultation available 24 hours a day, seven days a week
  • treatment of acute conditions
  • coordination of medically necessary care
  • referrals to appropriate specialists for treatment

Under your Agreement, it's mandatory that you provide Covered Services during normal business hours, in addition to 24/7 telephone access for consultation on medical concerns and emergencies.

If you have any questions, review your contract or contact your Network Coordinator.