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Discussion:VIP MD

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Bell (talk|edits) said:

3 April 2010
Client paid $1500 to their Doctor to retain him as their Doctor. Wow!!! At any rate, is this a medical deduction?

Fsteincpa (talk|edits) said:

3 April 2010
It's actually not so weird. It's the wave of the future. Many practices in NY and other areas have two sets of doors. One for insurance and one for private pay.

Private pay people pay retainers and have less wait time and more individualized care.

http://www.elitehealth.com/boutique_medical.php

Google Boutique Medicine and check it out.

Medical expense - Absolutely.

Tmac (talk|edits) said:

3 April 2010
Prepaid medical care not deductible. If "retainer" needs to be earned or returned then no deduction until service rendered.

Kevinh5 (talk|edits) said:

3 April 2010
Retainer is due whether or not any service is rendered. Being 'on call' or 'available' is all that needs to be done to earn the retainer.

Harry Boscoe (talk|edits) said:

3 April 2010
This is sorta technically awkward. If a "medical expense" by definition has to be paid for the "diagnosis, detection, amelioration, treatment, relief or whatever" of a medical condition, and this payment is being made to the "VIP MD" as you call him how are we supposed to trick ourselves into accepting that the payment is a medical deduction when we don't even know - the patient doesn't even know - the physician doesn't even know - what the condition is?

Kevinh5 (talk|edits) said:

3 April 2010
The condition is that the patient has money and the doctor wants it.

Kevinh5 (talk|edits) said:

3 April 2010
simple 'wallet-ectomy' is prescribed

Harry Boscoe (talk|edits) said:

3 April 2010
OK, I went and looked up the real definition. "...for the diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body." But until you get to the doctor's office, I don't see - for sake of argument - how anybody knows what disease or body part is being treated or affected. So until you get to the doctor's office, what you've got is - for sake of argument - a prepayment.

Harry Boscoe (talk|edits) said:

3 April 2010
If this is happening, then the Service should have published a ruling on it, and we should know the answer. Otherwise, for sake of argument, it's a prepayment.

KeithR (talk|edits) said:

3 April 2010
My first thought (and perhaps the IRS' first thought) was "What specific disease has the doctor diagnosed, cured, mitigated, treated or prevented to earn this money?" Then reality set in. Anyone who seeks out a doctor with this pricing structure is going to have, at a minimum, an annual physical. Services will, therefore, be rendered. They will just be at a higher price than before, allowing the doctor to spend more than the six minutes desired by the friendly, neighborhood insurance company.

KeithR (talk|edits) said:

3 April 2010
And it seems that Harry was having the same thought as me, at the same time.

Fsteincpa (talk|edits) said:

3 April 2010
It is as Keith stated. In reality, it is similar to an insurance payment. It is not a retainer where the future visits are deducted. It is the annual fee required to be treated by the doctor on an ongoing basis. In some cases, a well-care visits may be included.

If I was arguing in front of the IRS, I'd base it on the same argument as you would a health insurance premium. Instead of paying to the insurance company, you are paying to the physician group and that payment entitles you to a different level of service.

Fsteincpa (talk|edits) said:

3 April 2010
And I must respectfully disagree with Harry. It is not a prepayment, it is a current payment for services. My first visit I pay the $1,500 and have my well care visit. Well, there you go, I have just paid $1,500 for one visit. the fact that seeing the doctor 12 more times lowers my per visit cost is a moot point.

Kevinh5 (talk|edits) said:

3 April 2010
and if I choose to NOT show up for my annual physical.....?

Harry Boscoe (talk|edits) said:

3 April 2010
"...having the same thought...." "Having the same thought" is clearly a medical condition, and that medical condition (having any thought) goes away when I drink PBR, so I'm taking a tax deduction for my *medical* beer.

Oh, yeah, I found a doctor who will prescribe it for me. I paid him in advance, on December 31st last year, for the prescriptions that he will write for me this year, and I'm taking the deduction for last year, because *I know* services will be rendered, someday.

And my favorite client came into my office on January 15th and backdated a check *to me* for tax advice and now he expects me to give him the deduction for last year because he backdated the check to December. How can I tell him "no"? ROTFLMAO

Refrigpbrerator, and there's something interesting on the TV, too!!

PollyAdler (talk|edits) said:

3 April 2010
No, no, no. The rich don't pay this to have an annual physical. That's the last thing they want. Everyone knows the quickest way to meet the maker is to have an annual physical. They'll find something wrong with you, and then you'll die.

This is for bragging rights. "I use prestige medicine," they'll say.

Down in Palm Beach and out at Palm Springs, you hear "Don't YOU use concierge medicine?"

I'm going to take the role of the strict auditor, and say: deduction denied.

Harry Boscoe (talk|edits) said:

3 April 2010
In your facts, Fred, in your facts...

CrowJD (talk|edits) said:

3 April 2010
The $1,500 is pretty cheap. I've heard it at $5k here, and that was some time ago.

Kevin is correct, the retainer buys you nothing but access to the doctor. In other words, the doctor takes on fewer patients, so to retain a spot, you pay the retainer. I personally refer to this as a non-refundable retainer. You are not buying a procedure or time, just access.

Agree, it's a toss up and will probably require some kind of ruling at some point.

KeithR (talk|edits) said:

3 April 2010
Kevin, anyone who pays fifteen hundred bucks in advance and doesn't turn up for his annual physical is one of two things - foolish or dead. Heck, the fancy payment may even get you a fancy pair of pre-warmed gloves for when you have to bend over.

Kevinh5 (talk|edits) said:

3 April 2010
What a comforting thought. And for when you turn your head and cough?

Harry Boscoe (talk|edits) said:

3 April 2010
IRS's Pub 502 says this: "You can include [as a deduction on this year's tax return] only the medical and dental expenses you paid this year, regardless of when the services were provided."

Anybody want to try to interpret that statement in the context of this discussion? Not me. I want to watch TV.

JAD (talk|edits) said:

3 April 2010
I went to one of these presentations when my former doc joined this group. They said that it qualified for the deduction and for reimbursement from FSAs. This makes sense to me based upon reading 213(d)(1)(A). There's nothing in the Code that says that you can only deduct the lowest cost of the service that you need. I could see the IRS having a case if the patient made the payment and then didn't see the doc for anything all year long. If it were me, I would take the deduction. If I was really uncertain, I would call MDVIP and talk to them about it. I would think that they would have already "documented the file" on this issue since they go around doing these presentations for the new docs that come into their group.

Harry Boscoe (talk|edits) said:

3 April 2010
Yeah, I forgot to include the MDVIPs among those who should, really should, already have the answer to this question. And at their fingertips.

Matter of fact, if they *don't* have the answer, I would consider that a very loud vote *against* this expense being deductible, because, as we all know, doctors don't know from taxes, 'ceptin when it helps them...

JAD (talk|edits) said:

3 April 2010
I wasn't suggesting asking the doc! As a rule, they are horrible at financial matters, including taxes. I meant the organization. When you sign up, you sign up with a central office. I don't remember where it is located. Maybe the website has that info.

Harry Boscoe (talk|edits) said:

3 April 2010
The MD LTD Program, a "concierge" or "boutique" medical practice in San Francisco, has this to say:

"Is the MD LTD membership fee tax deductible? Please consult your tax advisor for specific guidelines regarding your individual situation."

They may know more, but that's all they've posted on their website.

Actually, I lied; they said more than that. They said that membership in their program may be covered by IRC Section 105, 106, or 125. I don't remember if they also included IRC Section 162(l).

Harry Boscoe (talk|edits) said:

3 April 2010
I've got a sneaking suspicion this coverage might have some discriminatory character to it if it were offered as a fringe benefit to Mr. Big but not to hoi polloi, by an employer...

Bell (talk|edits) said:

4 April 2010
Thanks for all the responses. I feel like FsteinCPA....I think this is no different than paying for medical insurance. I feel aggressive and I am going to take it. I am usually quite conservative. This TP has an on-going medical condition, diabetes and has to have a doctor. Although they told me they can't continue to pay it and will have to find another doctor. What do we do when there are no doctors to find????

Kevinh5 (talk|edits) said:

4 April 2010
H1N1 Visa - import them

Fsteincpa (talk|edits) said:

4 April 2010
It's a common thing now and it's not just for the hoity toity folks. It's payment for service in my eyes and I'd argue it that way. If you feel strongly that it's not, go ahead and tell your clients it's not deductible.

For me personally, if I had a health condition, I'd gladly pay the extra $1,500 or $3,000 annually to have faster, better access to the doctor of my choice.

In a nutshell, you are paying for less lines and a more comprehensive review and question/answer period with a real doctor immediately.

The fact that it costs more has no bearing here. My divorce decree states I pay 2/3 of all out of pocket. My ex doesn't care about what it costs as I basically pay most and then she gets reimbursement through caf plan. She can actually make money on me paying health costs. When kids needed braces, she went to most expensive orthodontist until I said only if she pays the 2/3 and I pay 1/3. She changed dentists. The point being that the price of the services has no bearing on the deductible amount. If I choose to pay $15,000 for braces vs $5,000, that's my call and either amount would be deductible. The $15,000 braces guy has a movie theater waiting room, massages while you wait, all that. Not our call to say it's a waste of money or that a portion of that has to be considered entertainment.

The concierge payment is a payment for the medical service. Should a hypochondriac with no health insurance be denied the deduction because they go to the doctor twice a month and nothing is ever found to be wrong?

If it was a denied deductible, the concierge service could just adjust the way it's sold. First annual health check up is $1,500. You pay this fee and then in addition you get the following. Or, you could just pay for our basic check up and you don't get these things.

deductible issue solved.

Tbm103 (talk|edits) said:

5 April 2010
Seriously? Anybody who pays $1,500 for a retainer for a doctor, probably has income too high to take a medical deduction anyway.

Fsteincpa (talk|edits) said:

5 April 2010
Tbm - I would disagree. $1,500 isn't that much in the grand scheme of things.

Harry Boscoe (talk|edits) said:

5 April 2010
1.) I believe I've caveated most of my responses as "for sake of argument." I would certainly and without hesitation deduct this amount on my return or on my clients' returns, but at the same time, I would expect an IRS agent to disallow it, and I would make sure my client understand that. Disclosure, I'm not sure.

2.) Can I get an "Amen" for the suggestion that IRS should get a ruling out on this presto fasto. Do we agree that we've not found an authority addressing this *simple* <gr> question?

BrockEA (talk|edits) said:

5 April 2010
I anticipate that as soon as someone explains this to our elected representatives, the cries of favoritism and unequal treatment will put an end to these. I don't anticipate these will last.


Having said that, I see that this is really no different from an insurance policy. I actually pay for a benefit from my insurer by them accepting risk throughout the year--in fact I have been driving for 22 years and never filed a claim on my auto. In this case, you are paying for a service which is available and has distinct benefits to the patient, whether used or not.


Having said that, I would expect that the IRS would make this non-deductible since it is unfair and makes the po' man wait longer. And we can't be having that in this age of entitlement, now can we?


BrockEA

Harry Boscoe (talk|edits) said:

5 April 2010
I was talking to my bartender last night and he said that his hairdresser told him that she heard from her plumber that the new health care legislation has the definitive answer to this question. Somebody should read the legislation to see if this is true. Volunteers?

BrockEA (talk|edits) said:

5 April 2010
I nominate someone other than me! :D


BrockEA

Fsteincpa (talk|edits) said:

5 April 2010
I'm still trying to figure out where to send my office max 1099 to.

JAD (talk|edits) said:

5 April 2010
"I anticipate that as soon as someone explains this to our elected representatives, the cries of favoritism and unequal treatment will put an end to these."

I haven't kept up with the final details of the health care bill b/c of the timing during tax season. But I read yesterday that Congress exempted themselves from this bill. Is that true? If so, isn't that favoritism and unequal treatment?

What I wound up doing was leaving the MDVIP practice and seeking out docs who don't take insurance. I pay for what I need, and it is much less than $1500 per year, and I get as much time as I need - and thoughtful answers to my many questions. It's amazing how much better care is available if you pay for it....also amazing the quality of diagnostic tests and information available, again, if you pay. Stuff that the insurance company doesn't cover because it's not "ordinary and necessary".

Do you really think that they can tell the docs that they can't charge the fee? The next step would be to tell docs that they can't opt out of insurance plan contracts. Where does it end?

BrockEA, your post is funny in a twisted sort of way. The age of entitlement. It's infuriating, isn't it?

BrockEA (talk|edits) said:

5 April 2010
Of course Congress exempted themselves from it. For that reason, they should be run out of town by an angry mob of voters.


Of course they can tell the docs what they can and cannot do. They've been doing it to banks, Government Motors, Financial Industry, and Wall Street. Heck just last week Waxman called several corporate CEOs onto the carpet because they dared share what the impact of this bill would do to their earnings. When the Supreme Court didn't do as the almighty tnediserp amabo decreed, he decided to rake them over the coals. There is no limit to the degree with which amabo will go to accomplish a socialist environment. But to his credit, he is doing exactly what he said he would do. Weaken defense, tax the heck out of anything that moves and tax it twice if it doesn't, talk directly with Iran which is to say stand by while they do what they want. We can lay this one at the feet of the voters...kind of like getting mad at Freddie Kruger for killing people after the voters took twice the daily dose of Ambien.


It is my understanding that the reason hillarycare got such a strong response is that it would have made it entirely illegal for me to go pay you cash to provide MD services to me outside of the government plan. Now if that isn't about control, I don't know what is.


BrockEA

JAD (talk|edits) said:

5 April 2010
I agree with you on all counts.

But what does "tnediserp amabo" mean?

Fsteincpa (talk|edits) said:

5 April 2010
President Obama

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