Can I use my HSA or FSA to pay for membership?

Yes, you can use your HSA or FSA to pay for membership. The 2025 Primary Care Enhancement Act formally classified DPC membership as a qualified medical expense, which makes it eligible for pre-tax dollars without superbills.

Will I get billed twice if I use insurance for labs?

No, you will not be billed twice. The membership covers Dr. Ash's time. The labs you do at Quest or LabCorp bill your insurance separately. There is no double charge.

Does Fishtown Medicine accept Medicare?

Fishtown Medicine has opted out of Medicare for membership purposes. We can still order Medicare-covered labs, imaging, and prescriptions for Medicare patients. Medicare members cannot submit membership fees for Medicare reimbursement.

Can I use my employer benefits with Fishtown Medicine?

Yes, many employer benefits work with Fishtown Medicine. HSA, FSA, lifestyle accounts, and some health stipends apply to membership. Your employer's benefits portal (or HR team) can confirm what is eligible.

What if I lose my insurance?

If you lose your insurance, your membership at Fishtown Medicine remains active. We can still provide unlimited visits and care. Labs and imaging shift to direct-to-consumer pricing, which is often surprisingly affordable.

Does my insurance know I am paying for DPC?

Your insurance does not need to know. The membership is a private contract between you and the practice. They only see the labs, imaging, and prescriptions we order through them.

Are there hidden fees beyond membership?

There are no hidden fees beyond membership. We do not bill copays, no-show fees, or surprise charges. The few exceptions (like a third-party home visit outside our coverage area) are clearly disclosed up front.

Why does the hybrid model exist instead of pure DPC or pure insurance?

The hybrid model exists because most patients still need insurance for major medical events (surgery, hospitalization, MRI). Pure DPC without insurance leaves you exposed to catastrophic costs. We pair our retainer-based primary care with traditional insurance for the expensive episodes, which is the most economically rational structure for most members.

How does the membership compare to a traditional copay structure?

A traditional copay structure charges $25 to $75 each visit, plus the time cost of a 15-minute appointment. The membership replaces all those copays with a flat monthly fee and gives you unlimited time and access. Members who would have had even monthly visits in a traditional system save money in addition to time.

What insurance plans work best alongside Fishtown Medicine?

High-deductible plans paired with an HSA work best alongside Fishtown Medicine. The HDHP keeps premiums lower while the HSA pays for the membership pre-tax. PPO plans add out-of-network reimbursement potential. HMO plans still work but limit specialist referrals to their network.

How do I figure out my exact out-of-network reimbursement?

Call your insurance and ask three questions: What is my out-of-network deductible? What percentage do you reimburse after the deductible is met? What is the usual and customary rate for primary care visit codes 99205 and 99215? The answers tell you how much you may receive back from a superbill.

What is the difference between a superbill and an itemized receipt?

A superbill includes diagnosis codes (ICD-10) and procedure codes (CPT) needed for insurance submission. An itemized receipt is a simpler document showing what you paid. Both can satisfy HSA documentation, but only a superbill works for insurance reimbursement.

How does the practice handle prior authorizations?

The practice handles prior authorizations directly. When a medication, imaging study, or specialist procedure needs prior auth, our team submits the paperwork and follows up with insurance. You do not have to fight that battle.

Will my deductible reset every year affect my care?

A deductible reset can affect labs, imaging, and prescriptions in January. We help time non-urgent labs after the deductible has been met (typically later in the year) when that saves you money. The membership itself is unaffected by deductible resets.

How do you handle out-of-state members or travel coverage?

We provide telemedicine to many states (currently 42 and growing). For labs, members can use any Quest or LabCorp nationwide. For travel emergencies, your insurance covers in-network or out-of-network care depending on your plan, and we coordinate from a distance.

What happens if I become uninsured during membership?

If you become uninsured, you keep the same care from us and shift labs, imaging, and prescriptions to cash-pay or direct-to-consumer pricing. Many advanced labs are surprisingly affordable when paid directly. We help you build a temporary bridge plan.

How does the practice handle workplace injury or workers' comp?

Workplace injuries are typically routed through your employer's workers' comp system, not personal insurance. We can document, treat, and coordinate the workers' comp specialists. We do not bill workers' comp directly, but we provide the documentation needed for benefits.

Can my employer reimburse my membership pre-tax?

Some employers can reimburse DPC membership pre-tax through HRAs, lifestyle benefits, or specific DPC carve-outs. The 2025 Primary Care Enhancement Act expanded these options. Talk to your benefits team. We can provide documentation to support the request.

Are there tax deductions outside of HSA?

Outside of an HSA, you can sometimes deduct DPC membership as a medical expense if you itemize and total medical costs exceed 7.5 percent of adjusted gross income. Most members get a bigger benefit from HSA or FSA usage. Talk to your tax advisor for your specific situation.

TL;DR · 30-second take

Fishtown Medicine uses a hybrid model. Your insurance still covers labs, imaging, prescriptions, and specialist referrals just like a traditional doctor. The membership covers Dr. Ash's time directly, and you can pay it with pre-tax HSA or FSA dollars under the 2025 Primary Care Enhancement Act.

Insurance & Benefits Guide: The Hybrid Model Explained

Q: Do you take insurance?

We use a hybrid model. We do not bill insurance for the membership itself, but we send labs, imaging, prescriptions, and specialist referrals through your insurance just like any traditional practice. So in practical terms, your insurance is still doing most of the heavy lifting outside our visits.

TL;DR: The most common question we get is, "Do you take insurance?" The honest answer is that we use a hybrid model.

External Medical Costs (Labs, Imaging, Meds): Billed directly to your insurance, just like any other doctor.
Membership (Dr. Ash's Time): Paid directly by you (or your FSA/HSA for an effective pre-tax discount). Not billed to insurance.

This combines the time and access of concierge care with the coverage of a traditional plan for the expensive stuff.

What does membership cover versus what does insurance cover?
How does imaging work (ultrasound, X-ray, MRI)?
How do labs and blood work get billed?
How do FSA and HSA eligibility work?
How does reimbursement through out-of-network benefits work?
Common Questions
Deep Questions

What does membership cover versus what does insurance cover?

Membership covers Dr. Ash's time and the practice's clinical infrastructure. Insurance covers the expensive external care that everyone needs occasionally. Think of Fishtown Medicine as a medical retainer. You are hiring Dr. Ash directly to be your physician, and insurance is the tool for the heavy lifting outside our office.

Service	Who Pays?	How It Works
Dr. Ash's Time	Membership	Unlimited visits, texts, video calls, and home visits. No copays.
Labs (Quest/LabCorp)	Insurance	We send orders to your insurance-covered lab.
Imaging (X-Ray, MRI, CT)	Insurance	We refer you to in-network centers (Penn, Jefferson, Temple).
Prescriptions	Insurance	We send scripts to your pharmacy, covered by your plan.
Specialist Referrals	Insurance	We refer you to in-network specialists.

How does imaging work (ultrasound, X-ray, MRI)?

Imaging works through your insurance, coordinated by us. We often get asked, "Do you do ultrasounds or X-rays at the office?" We do not. We coordinate them at high-quality facilities that accept your insurance. The workflow:

Dr. Ash determines you need imaging (for example, an abdominal ultrasound).
We generate a digital order.
We send that order to a facility in your network (Penn Outpatient Imaging, Jefferson, Temple, or another center near you).
You arrive, present your insurance card, and get the scan.
The results return to Dr. Ash for review and a follow-up plan.

This way you get hospital-grade imaging covered by your plan, rather than paying out of pocket for a cash-only scan elsewhere.

How do labs and blood work get billed?

Labs and blood work get billed through your insurance. Even though we are out of network for membership care, the lab order we write is valid at any facility your insurance covers.

We typically send orders to Quest Diagnostics or LabCorp.
When you arrive at the lab, you hand them your insurance card.
The lab bills your insurance directly. You pay your standard copay or whatever applies under your deductible.

For uninsured or self-pay members, we can also use direct-to-consumer pricing, which is often cheaper than insurance for advanced panels like ApoB or fasting insulin.

How do FSA and HSA eligibility work?

FSA and HSA eligibility now applies to most of what we do. Thanks to the Primary Care Enhancement Act, most patients can use a Flexible Spending Account (FSA) or Health Savings Account (HSA) to pay for the Fishtown Medicine membership.

How to Pay: Enter your FSA or HSA card as the payment method in our secure portal.
Documentation: If your plan administrator asks for a receipt, we provide a detailed superbill or invoice upon request.
Effective Discount: Using pre-tax dollars saves you 25 to 35 percent depending on your tax bracket.

How does reimbursement through out-of-network benefits work?

Reimbursement through out-of-network benefits varies by plan. If you have a PPO (such as Independence Blue Cross Personal Choice PPO), you may have out-of-network benefits.

Your insurance may reimburse you for a portion of membership fees or visit costs.
We can provide a superbill (a medical receipt with diagnosis and procedure codes) that you submit to your insurance for potential reimbursement.
Reimbursement amounts depend on your plan's out-of-network deductible and percentage.

Note: Medicare patients cannot submit for reimbursement of DPC membership due to federal regulations.

Actionable Steps in Philly

Set yourself up to maximize your benefits.

Confirm Your HDHP: Check whether your insurance is a high-deductible health plan that supports HSA contributions.
Update Your Payment Method: Add your HSA or FSA card to the Fishtown Medicine portal.
Save the Lab Order Workflow: When we send a lab order, route it through Quest or LabCorp so insurance handles the billing.
Request Superbills Yearly: Ask for an annual superbill in January for tax records and possible PPO reimbursement.
Pick a Preferred Imaging Center: Tell us your preferred Philly imaging center (Penn, Jefferson, Temple) so referrals route there automatically.

Scientific References

Cole ES, et al. Direct Primary Care: Applying Theory to Potential Changes in Delivery and Outcomes. J Am Board Fam Med. 2018;31(4):605-611.
Eskew PM, Klink K. Direct Primary Care: Practice Distribution and Cost Across the Nation. J Am Board Fam Med. 2015;28(6):793-801.
American Academy of Family Physicians. Direct Primary Care: A New Way to Pay for Health Care. Fam Pract Manag. 2018;25(1):16-20.

Medical Disclaimer: This resource provides clinical and financial context for educational purposes. It is not legal, financial, or tax advice. Consult a qualified tax professional for your specific situation, and consult Dr. Ash to determine which clinical interventions are right for you.

Dr. Ash is a board-certified internal medicine physician specializing in preventive medicine and healthspan optimization at Fishtown Medicine in Philadelphia.

Fishtown Medicine | About

2418 E York St, Philadelphia, PA 19125(267) 360-7927 hello@fishtownmedicine.comHSA/FSA Eligible

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