The Physician Concierge Services Policy has been updated to reflect that BCBSRI will now allow providers who provide concierge services to be in our network. Prior to the revised policy, physicians that offered this practice model were excluded from network participation with BCBSRI. BCBSRI acknowledges a Commercial member’s choice to receive these enhanced services from a concierge practice and will allow concierge practice providers to participate in the plan’s provider network, assuming they meet all of BCBSRI’s standard network credentialing and contracting requirements and follow all of BCBSRI participation requirements.

BCBSRI will only consider concierge practitioners who are doctors of medicine (MD) and doctors of osteopathy (DO), with a designation of primary care practitioner (internal medicine, family medicine, and pediatrics) and who meet all BCBSRI credentialing requirements as qualifying to participate in the network as a primary care physician. Mid-level providers or specialist providers who practice concierge medicine will not be allowed entrance into the provider network, or permitted to remain in the provider network after transitioning to concierge. Providers who require BCBSRI subscribers to participate in concierge practices in order to receive services from the provider, do not qualify for CERTAIN programs; including but not limited to any and all funding provided by BCBSRI for patient-centered medical homes or BCBSRI quality programs at BCBSRI’s sole discretion.

Retainer/access fees are not covered by BCBSRI. Network providers may not apply retainer/access fees toward services that are covered under the member’s contract, nor should BCBSRI be billed for any concierge practice fees. Claims for all covered health services shall be submitted, and the provider shall only be able to collect all applicable copayments, coinsurance, or deductibles as outlined in the members benefit plan.

BCBSRI reserves the right to identify concierge providers in provider directories and/or remove them from the directory at BCBSRI’s sole discretion. Providers must identify themselves as concierge upon initial application to become a participating provider. Providers who are already participating in the BCBSRI network must provide 90-day written notice to BCBSRI detailing their intent to establish a concierge practice, including details on whether they will be operating exclusively as a concierge practice or a partial concierge practice. This notice should be sent via email to ProviderRelations@bcbsri.org. View this version of the policy.