Fishtown Medicine membership is direct primary care for adults in Philadelphia: direct text and video access to Dr. Ash, a 90-minute annual physical, advanced labs read together with no timer, home visits, and one physician covering cardiovascular prevention, metabolic health, hormones, mental health, and sexual health while coordinating every specialist beyond that scope. It costs $2,500 a year, about $6.85 a day, or $250 a month, with no copays or visit fees for Fishtown Medicine care. It runs alongside insurance, which still covers hospital, surgery, specialists, imaging, and prescriptions.
This is the page I send when someone wants to understand the membership in one read. On the annual plan it works out to $6.85 a day, about what two cups of coffee or one specialty latte cost at a café in Fishtown, and that one number covers everything the practice does for you.
Two hot coffees or one specialty latte: about $6.85 a day, which is what membership costs on the annual plan.
What does the membership cost, day to day?
On the annual plan, $2,500 a year comes to $6.85 a day. Paying month to month at $250 comes to $8.22 a day. I put it in coffee terms because a yearly figure is hard to picture, and a daily one is easy to hold up against the rest of your week.
That daily number is all-in for our care. Every visit, every text to me, the home visits, the time I spend reading your labs and records, and the calls I make to your specialists are inside it. The practice sends you no copays, per-visit bills, or add-on fees.
| Billing | Price | Per day | Savings versus month to month |
|---|---|---|---|
| Annual | $2,500 / yr | $6.85 | Roughly two months free |
| Quarterly | $685 / qtr | Roughly one month free over the year | |
| Monthly | $250 / mo | $8.22 | Baseline |
What the daily number does not cover is what your insurance covers: the hospital, specialists' own bills, imaging, and your prescriptions at the pharmacy. Lab draws go through your insurance too, or through our cash pricing with no markup if that costs you less. More on that line below. The membership is generally HSA and FSA eligible, so pre-tax dollars can pay it when your plan allows.
If more than one of you is joining, it is one household plan at a reduced rate for the second person. Knowing both of you helps me, because I see the shared history, the shared stress, and the shared kitchen, and I can say so out loud. Adult children living at home, and parents or in-laws under the same roof, can each be added the same way. The rates are on the full pricing page. If you teach, nurse, serve in the military, respond as police, fire or EMS, serve the public, or work in hospitality or service, the Colleague rate is the same full membership at $195 a month.
What do I get for that?
Four things, and together they are the whole model.
1. Direct access to me
You text, video, or see me in person, same day when you need it, and I am the one who answers. There are no copays and no per-visit billing for our care. Refills come straight to me, so there is no phone tree to get through. Nothing about the relationship is metered.
2. Home visits across Greater Philadelphia
Sometimes getting to an office is the hard part, and sometimes seeing where you live tells me more than an exam room would. Home visits across the Greater Philadelphia Metro are part of membership, with no separate charge.
3. Care that stays ahead of problems
I cover the areas that usually take several clinics: cardiovascular prevention, metabolic health, hormone care including testosterone and menopause, the medication side of mental health, and sexual health. Those systems affect each other, and one doctor reading all of them together can see how.
I also keep watching between appointments. When your biomarker trends or wearable data come in, I review them then, so a number moving the wrong way becomes a conversation that week, well before next year's physical.
Your annual physical runs 90 minutes: history, exam, labs, wearable data, family risk, and the plan for the year ahead. Longer visits are linked to better outcomes and fewer unnecessary prescriptions, which is why the time is built in.
4. Time to get to answers
Visits here have no timer. The records review and the lab review each typically run 60 to 120 minutes, and some run longer, because we stop when you and I are on the same page.
Your labs are advanced, and we read them together. The standard panel is ApoB (the particle count that drives plaque), Lp(a) (an inherited cholesterol particle), fasting insulin, hs-CRP (a marker of inflammation), full thyroid, A1c, vitamin D, ferritin, B12, a complete blood count, and a metabolic panel, with more or fewer depending on your goals and history.
When something needs a specialist, I stay on it. I find someone I trust in Philadelphia, send them a clinical briefing on your behalf, and read what comes back. If you are ever admitted to a hospital, I help you through that too. You never have to carry messages between your own doctors.
Is it worth the money?
For most people, the math works before you count the relationship. Bought piecemeal in Philadelphia, a short primary care visit billed under a deductible commonly runs $150 to $300, and an urgent care visit $180 to $350. An advanced lab panel billed retail can run several hundred dollars, while the same panel through our negotiated cash pricing is about $99, passed through to you with no markup. Concierge practices in the city charge $2,000 to $5,000 a year, often with per-visit fees on top. Membership here is $2,500 a year, at the low end of that range, with the visits, messaging, and follow-through included.
On a high-deductible plan, the math is even more direct. Until you reach your deductible, primary care is already coming out of your pocket at insurance-system prices. Membership turns that unpredictable spending into one flat number, and your insurance keeps covering the large costs above the deductible.
Then there is what the numbers leave out. Bought separately, the care inside membership would mean a hormone clinic, a metabolic program, a preventive cardiology consult, a mental health prescriber, and someone to coordinate all of them, each with its own intake and portal. Here it is one physician who already knows your history when you text, and members tell me that knowing who to reach is the part they value most.
What stays with your insurance?
Membership does not replace insurance. The two work side by side.
| Goes through your insurance | Covered by membership |
|---|---|
| Hospital, ER, surgery | Acute care up to that level |
| Specialists | Finding the right one, briefing them for you, bringing their opinion back into your plan |
| Imaging (MRI, CT, ultrasound) | The decision about when to order |
| Labs (drawn at a partner lab) | The interpretation and the plan |
| Prescriptions (filled at your pharmacy) | The decision and the refills |
A simple way to hold it: insurance covers the big, billable events. Membership covers the ongoing, preventive primary care and follow-through that the insurance system has stopped paying for.
Who is the membership not right for?
The practice is for adults 18 and up, and it welcomes complex chronic illness. A few situations need a practice built for them, and if yours is one, I will tell you on the call and point you somewhere good:
- Leading active cancer treatment (I co-manage alongside your oncologist).
- Transplant management.
- Active labor and delivery. Pregnancy itself is not on this list: I keep caring for you through it, working alongside your OB/GYN, who leads the obstetric care and the delivery.
- Chronic opioid or benzodiazepine maintenance prescribing.
- Patients on Medicare or Medicaid, because the federal billing rules are not compatible with a flat-fee model.
What do the first 90 days look like?
The first 90 days are when we build the plan.
Week 1, orientation. You upload whatever records you have on your member page, or email them in, and we schedule the records visit. We also go over when to text, when to call, and what counts as urgent.
Weeks 2 to 3, the records visit. We read your history, prior labs, and specialist notes together, usually for 60 to 120 minutes. Many members tell me it is the first time a physician has read their whole story start to finish.
Weeks 3 to 6, labs and the deep dive. I order labs for you specifically, chosen for your history and goals, including advanced markers. When they return, usually in 7 to 10 days, we sit down again and read them, and the plan from that conversation guides the next year.
Weeks 7 to 12, putting it to work. Specialist referrals when needed, medication adjustments, follow-up labs, and the check-ins that keep the plan moving.
The next step
Start with the intake and tell me what is going on. The free 20-minute call comes after, and we figure out together whether this is the right fit. If it is, you join and we schedule the records visit. If it is not, I will say so and point you to a practice that fits better.
Frequently Asked Questions
Common Questions
Ready when you are
The chat is our AI assistant, answering from our published guides. To talk it through with Dr. Ash himself, start with the intake.
