Fishtown Medicine membership is direct primary care for adults in Philadelphia: one flat monthly or yearly fee, no copays, direct text and video access to Dr. Ash, a 90-minute annual physical, advanced labs read together with no timer, and one physician covering cardiovascular prevention, metabolic health, hormones, mental health, and sexual health while quarterbacking every specialist beyond that scope. It runs alongside your insurance (which still covers hospital, surgery, specialists, imaging, prescriptions). Pricing is $250 per month, $685 per quarter (~ one month free over the year), or $2,500 per year (~ two months free).
The full pricing page goes deep. This is the version we send people who just want to understand the membership in one sit-down read.
What you get
The membership covers five things.
- Unlimited access to your doctor. No copays, no per-visit billing for our care. Direct text, video, or in-person with Dr. Ash. Same-day visits when you need one. Home visits across Greater Philadelphia when it makes sense.
- One physician across the lanes that usually take several clinics. Cardiovascular prevention, metabolic health, hormone care including testosterone and menopause, the medication side of mental health, and sexual health, integrated with functional and longevity tools and grounded in evidence. The interplay between those systems is where most answers live, and it only shows up when one doctor reads all of them together.
- A 90-minute annual physical. Not 12 minutes. A deep dive on history, exam, labs, wearable data, family risk, and the plan for the next year. The time is the point: longer visits are linked to better outcomes and fewer unnecessary prescriptions, and the whole model is built to protect them.
- Advanced labs, read with you. ApoB, Lp(a), fasting insulin, hs-CRP, full thyroid, A1c, vitamin D, ferritin, B12, complete blood count and metabolic panel as the standard. We add or subtract based on your goals and history. You see the numbers and the plan, together, at the records visit, with no timer on the conversation.
- A quarterback for everything beyond primary care. When you need a specialist, we find one we trust in Philadelphia, reach out on your behalf with a clinical briefing, and read what comes back. Hospital navigation if you are ever admitted. Prescription refills handled directly. You are never the messenger between your own doctors.
What it costs
| Billing | Price | Savings versus month-to-month |
|---|---|---|
| Monthly | $250 / mo | Baseline |
| Quarterly | $685 / qtr | Roughly one month free over the year |
| Annual | $2,500 / yr | Roughly two months free |
Household and partner pricing is on the full pricing page. The membership is 100% HSA and FSA eligible, so pre-tax dollars pay it.
What should working together cost you? It depends on what you need
The membership is one door, not the only one. The honest answer to "what does it cost" starts with what you are trying to get done - the same walkthrough our pricing page takes you through:
- A focused project with a beginning and an end - a lab result you want read properly, a second opinion, getting a diagnosis sorted, a medication transition: The Reset, $750 for 3 visits across the arc.
- A year of structured visits, on your schedule: The Strategic Roadmap, $975 for 5 visits across the year. You set aside the unlimited messaging and home visits, and keep the unhurried time.
- Ongoing care - prevention, complexity, or just wanting your doctor a text away: membership, $250 a month (or $685 quarterly / $2,500 yearly, which works out cheaper). Unlimited visits and messaging, home visits in the city, and the relationship this whole page describes.
- You teach, nurse, respond, or work in hospitality or service: the same full membership at the Colleague rate, $195 a month.
Not sure which fits? That is half of what the free intro call is for - come with your situation and leave with a straight recommendation, sometimes for the cheapest option on this list.
Is the money worth it? The math, then the product
Whichever door fits, here is what the same care costs bought piecemeal in Philadelphia. A short primary care visit billed under a deductible commonly runs $150 to $300. An urgent care visit, $180 to $350. An advanced lab panel billed retail through a deductible, several hundred dollars - the same panel through our negotiated cash pricing is about $99, passed through with no markup. Concierge practices in this city charge $2,000 to $5,000 a year for access that often still comes with per-visit fees. Membership here is $2,500 a year at the annual rate, sits at the bottom of that range, and the visits, the messaging, and the follow-through are all inside it - and a care package costs less than a run of single specialist consultations.
If you are on a high-deductible plan, the math is even more direct: until you hit your deductible, primary care is cash out of your pocket at insurance-system prices anyway. Membership converts that unpredictable per-visit spending into one flat number, and your insurance keeps covering what it covers best - the big-ticket care above the deductible.
Then there is the part the numbers cannot carry, which is the product itself: a doctor who knows your history without opening a chart cold, answers your text the same day, gives your physical 90 unhurried minutes instead of 12 rushed ones, and has the time to catch things early instead of billing you to react late. Bought separately, the pieces inside membership are 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, its own portal, and no one reading the whole story. Here that is one physician, one relationship, and one plan, and the peace of mind that comes from knowing who to text is the part members mention most. The average American spends more each month on streaming and takeout than this costs, and neither of those calls you back when your labs look off.
What stays with your insurance
Membership does not replace insurance. The line is clear and worth being explicit about.
| 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 + the plan |
| Prescriptions (filled at your pharmacy) | The decision + the refills |
The mental model: your insurance covers things that bill big. Membership covers the proactive, results-focused primary care, the continuity and follow-through, that the insurance system has stopped paying for.
Where we are not the right primary care
We will be honest about this on the call, and it is worth being honest about here. The practice is for adults (18 and up). The following are outside what we do well, and when we see one of these we will say so warmly and point you to a practice that is built for it:
- Active cancer treatment (we co-manage, we do not lead).
- Pregnancy / OB / delivery care.
- Pediatric care (under 18).
- Chronic opioid or benzodiazepine maintenance prescribing.
- Patients on Medicare or Medicaid (the federal billing rules are not compatible with our model).
What the first 90 days look like
This is the part most membership explainers leave out. The first 90 days are the activation period.
Week 1, Orientation. You upload whatever records you have on your member page (or email them in). We schedule the records visit. Communication rules covered (when to text, when to call, urgent versus routine).
Weeks 2 to 3, The records visit. No timer. We read your history, prior labs, specialist notes together, usually 60 to 120 minutes. Most patients tell us this is the first time a physician has read their whole story in one sitting.
Weeks 3 to 6, Labs and the deep dive. Labs ordered specifically for you (advanced markers, not a default panel). When they return (usually 7 to 10 days), we sit down again and read them. The plan that comes out of that conversation is the working document for the next year.
Weeks 7 to 12, Execution. Specialist referrals when needed. Medication adjustments. Follow-up labs. The check-ins that make sure the plan is actually moving.
The next step
Start with the intake: tell Dr. Ash what is going on and pick the path that fits, and the free 20-minute call comes after, where 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, we will say so and point you to a great fit.
Frequently Asked Questions
Common Questions
Ready when you are
Dr. Ash reads every intake himself, and answers questions personally - usually within a few hours.


