What is the main difference between concierge medicine and Direct Primary Care?

The main difference is insurance. Traditional concierge medicine charges a membership fee on top of insurance billing for every visit. Direct Primary Care charges a flat fee that replaces insurance for primary care entirely. DPC is usually more transparent and less expensive.

Can I keep my insurance if I join a DPC practice like Fishtown Medicine?

Yes. We strongly recommend keeping your insurance for specialist visits, imaging, hospital care, and emergencies. The DPC fee covers primary care and optimization on top of your insurance.

How much does each model cost in Philadelphia?

Traditional concierge runs $2,000 to $28,000 per year plus insurance billing. DPC runs $600 to $3,600 per year ($50 to $300 per month). Fishtown Medicine sits in the precision DPC range. See [our pricing](/membership) for current numbers.

Do concierge or DPC doctors take Medicare or Medicaid?

Most concierge practices participate in Medicare and bill it like traditional doctors. Most DPC practices opt out of Medicare and Medicaid because the regulatory structure does not fit a flat-fee model. We help Medicare-eligible patients find appropriate alternatives like Oak Street Health or Dedicated Senior Medical Center.

Will my employer pay for concierge or DPC?

A growing number of Philadelphia employers (especially small businesses, law firms, and tech companies) are adding DPC as a benefit because it lowers total healthcare spend. Some self-funded employer health plans contract directly with DPC practices.

Can I use my HSA or FSA to pay for these services?

Yes for both. Concierge and DPC fees are eligible HSA and FSA expenses. Always confirm with your accountant. The vast majority of our members use HSA or FSA dollars to fund membership.

How long are appointments in each model?

Traditional concierge: typically 30 to 60 minutes. Corporate concierge (MDVIP): typically 30 to 45 minutes. DPC: typically 45 to 60 minutes. Fishtown Medicine: 90-minute initial visits, 30 to 60-minute follow-ups.

Is concierge medicine worth it if I am healthy?

It depends on your goals. If you want acute care access, traditional primary care plus an urgent-care plan may be enough. If you want longevity optimization and proactive risk reduction, the precision DPC tier is usually a better fit.

Why do most traditional concierge practices still bill insurance?

Most concierge doctors trained in insurance-based systems and rely on insurance revenue for sustainability. The membership fee adds a margin for time and access. DPC practices are willing to walk away from insurance billing because they have built revenue models around the flat fee alone.

What happens to my insurance deductible in a DPC model?

Your deductible still applies to specialty care, imaging, and hospital services covered by your insurance. The DPC fee runs in parallel and does not count toward the deductible. For most patients with high-deductible plans, DPC actually lowers total annual spend on routine care.

How does Fishtown Medicine handle prescriptions and referrals without insurance billing?

We send prescriptions directly to your pharmacy. Your insurance pays for medications as usual. Referrals go to specialists at Penn, Jefferson, Temple, or Main Line Health, who bill your insurance for their services. We coordinate the consultation, review the notes with you, and integrate the recommendations.

What is the legal structure of DPC vs. concierge medicine?

DPC operates outside the insurance system. About 30 states (including Pennsylvania) have passed DPC-friendly legislation that clarifies DPC is not insurance. Concierge medicine operates inside the insurance system with an additional membership contract.

Can a DPC or concierge practice offer high-cost services like CGMs and advanced labs?

Yes. We negotiate wholesale rates with Labcorp and Quest and pass them through at cost (often 50 to 80% off retail). We prescribe CGMs through Independence Blue Cross or out-of-pocket pharmacy options. We are agnostic about lab provider, so you get the best price.

How do concierge and DPC models support patient privacy?

Both models reduce the data trail because there is no insurance claim for routine visits. Lab and imaging records still flow through insurance when used. We use encrypted messaging, HIPAA-compliant video, and secure patient portals to protect what we do hold.

What is the role of telehealth in modern concierge and DPC practices?

Telehealth has become a core delivery channel for both models. Fishtown Medicine handles 80 to 90% of routine care through encrypted text and video, with home visits for the rest. The hybrid lets us serve patients across 42 states efficiently.

How does Fishtown Medicine handle emergencies?

For non-life-threatening emergencies, you text us first. We triage, prescribe, or refer to urgent care if needed. For true emergencies (chest pain, stroke symptoms, severe injury), call 911 and head to the nearest ER. We coordinate with Penn, Jefferson, and Temple emergency departments after the fact.

Why does panel size matter so much?

Panel size sets the upper limit on how much time your doctor can spend with you. A 2,500-patient panel forces 12-minute visits and reactive medicine. A 200- to 300-patient panel enables 60- to 90-minute visits and proactive systems thinking. Time is the rate-limiting nutrient in primary care.

What is "Performance Primary Care" and how is it different from longevity medicine?

Performance Primary Care (our term) blends standards-of-care primary care, advanced diagnostics (ApoB, fasting insulin, VO2 Max), and longevity science into one integrated relationship. Pure longevity clinics often skip routine sick care. Performance Primary Care does both.

Can I switch from concierge to DPC mid-year?

Yes. Most reputable practices allow cancellation with 30 to 90 days notice. Avoid practices that lock you into 12-month contracts without an exit clause.

How do I know which model fits me best?

Three quick questions: Do you want unlimited primary care included in one fee? (Lean DPC.) Do you want a doctor who can also bill your insurance for visits? (Lean concierge.) Do you want longevity-grade optimization plus direct access? (Lean precision DPC like Fishtown Medicine.)

TL;DR · 30-second take

Concierge medicine traditionally means you pay an annual access fee on top of insurance billing. Direct Primary Care (DPC) means you pay a flat monthly or annual fee that replaces insurance for primary care entirely. Fishtown Medicine is a hybrid: we do not bill insurance (like DPC) but offer the high-touch, advanced care of elite concierge practices.

Concierge vs. Direct Primary Care (DPC): What Is the Difference?

TL;DR: Traditionally, concierge means "pay a fee to access a doctor who still bills your insurance." DPC means "pay a flat fee for everything, no insurance involved." Fishtown Medicine is a hybrid: we do not take insurance (like DPC) but offer the high-touch, advanced service levels of elite concierge practices.

At A Glance

Feature	Traditional Concierge	Direct Primary Care (DPC)	Fishtown Medicine
Insurance	Bills your insurance plus a membership fee	No insurance billed	No insurance billed
Focus	Access and convenience	Affordability and access	Outcome and optimization
Tech Stack	Often dated (fax, phone)	Modern (text, app)	Hyper-modern (data, wearables)
Ideal for	Seniors with complex illness	Families and the uninsured	High-performers and optimizers

What Is the Traditional Concierge Model?

Think country-club medicine. You pay a retainer ($2,000 to $10,000 per year) just to be in the club. The doctor has fewer patients, so they answer the phone. They still code every visit, bill your insurance, and stay bound by insurance rules ("we cannot order that test because Blue Cross will not pay").

What Is the Direct Primary Care (DPC) Model?

Think of DPC like a Netflix subscription for primary care. You pay a flat monthly fee ($80 to $150) and routine services like a strep test, stitches, or a physical are included. DPC cuts out the insurance middleman to make care affordable and accessible. It is great, but the focus is often basic primary care rather than longevity-grade optimization.

What Is the Fishtown Hybrid: "Performance Primary Care"?

We evolved the DPC model.

Fishtown Medicine

A 90-minute conversation with Dr. Ash. A written plan you can actually follow.

Book a Free 20-Min Call

Like DPC: We do not bill insurance. We work for you, not the insurer. That means we can order advanced lipid panels, CGM prescriptions, and genetic tests without waiting for permission.
Like Concierge: We are low-volume (max 300 patients, not 2,500). We know your name, your pet's name, and your VO2 Max. We also do house calls. If you need hands-on care, we come to you.

Why We Reject the "Sick Care" System

Both traditional concierge and basic DPC are often still reactive (waiting for you to get sick). We are proactive. We use the membership model to fund the time and technology needed to prevent disease and optimize performance. Do not just pay for access. Pay for outcomes.

Actionable Steps for Philadelphians

Pick the right model for your goals, not the loudest brand.

Define Your Goal: Access (concierge), affordability (DPC), or optimization (hybrid)?
Ask About Insurance Billing: Always ask, "Do you bill insurance?" before paying any fee.
Check Panel Size: A panel under 300 is the threshold for true concierge-style attention.

Scientific References

Eskew PM, Klink K. Direct Primary Care: Practice Distribution and Cost Across the Nation. J Am Board Fam Med. 2015.
Klemes A, et al. Personalized preventive care reduces hospitalization rates. Am J Manag Care. 2012.
AMA Council on Medical Service. Direct Primary Care: An Innovative Alternative to Conventional Health Insurance. 2018.

Medical Disclaimer: This resource provides educational context only. In the world of Precision Medicine, there is no "one size fits all." Consult Dr. Ash to determine if this approach is right for you, especially if you have chronic health conditions or are taking prescription medications.

Frequently Asked Questions

Common Questions

Deep-Dive Questions

Still have a question?

He answers personally. Usually within a few hours.

TL;DR · 30-second take

Concierge vs. Direct Primary Care (DPC): What Is the Difference?

At A Glance

Feature	Traditional Concierge	Direct Primary Care (DPC)	Fishtown Medicine
Insurance	Bills your insurance plus a membership fee	No insurance billed	No insurance billed
Focus	Access and convenience	Affordability and access	Outcome and optimization
Tech Stack	Often dated (fax, phone)	Modern (text, app)	Hyper-modern (data, wearables)
Ideal for	Seniors with complex illness	Families and the uninsured	High-performers and optimizers

What Is the Traditional Concierge Model?

What Is the Direct Primary Care (DPC) Model?