The Membership FAQ: Clear Answers on Care

TL;DR: We believe in radical transparency. We have compiled the most common questions about our Direct Primary Care (DPC) model, insurance, and clinical operations to help you decide if our practice is the right fit for your health goals.

Table of Contents

• Insurance and Financials
• Clinical Care and Access
• How we differ from other models
• Logistics and Strategies
• Guidelines from the Clinic
• Common Questions
• Deep Questions

Insurance and Financials

Do you take insurance?

Yes to the part most people are asking: the membership is 100% HSA and FSA eligible, so pre-tax dollars pay it. The insurance plan itself does not pay the flat fee, because we are a Direct Primary Care (DPC) practice and do not bill insurance for our care, which is what lets Dr. Ash spend 60 to 90 minutes with you instead of the standard 7 to 15. Your insurance still covers labs, imaging, prescriptions, and specialist referrals just like with a traditional doctor, and PPO or POS plans may reimburse part of the fee out-of-network with the superbill available anytime in your billing page under Invoices.

What does membership cost?

Membership uses simple, transparent pricing, offered monthly, quarterly, or annually. The annual plan is the best value, 2 months free versus paying month to month, and paying once a year keeps your care continuous without a recurring bill in view. The membership is HSA and FSA eligible, so pre-tax dollars can cover it, which often makes the effective cost 25% to 35% lower depending on your tax bracket. You can view all current plans, pricing, and features on the Membership page.

What if the membership is more than fits my budget right now?

Fishtown Medicine has lower-commitment options so cost does not have to be the barrier to good care. If you serve other people for a living, the same full membership is available at the Colleague rate of $195 a month (Colleague membership). If a monthly rhythm is not the right fit, the same membership is billed quarterly at $685, which comes out lower per month. There are also annual care packages built around a defined stretch of work, where Dr. Ash orders and interprets advanced labs (the lab and imaging costs are billed through your insurance or our cash-pay rates, separate from the package), and they renew each year for continuity of care. The best next step is the free intake: tell Dr. Ash what is going on, and your free 20-minute call comes after, where he points you toward the most affordable path that fits. Doing the intake first is how we make sure the practice is a good fit for you before anything gets scheduled.

Do you have a discount for teachers, nurses, first responders, or service workers?

Yes. Fishtown Medicine offers a Colleague rate, the same full membership at $195 a month, for the people who spend their working lives caring for others: educators, healthcare workers, first responders, and hospitality and service industry workers. It includes everything the standard membership does, at a lower monthly price, because these are the neighbors we most want in proactive care. You can read more and enroll on the Colleague membership page, or start with the intake and raise it on the free 20-minute call that follows.

What is the cancellation policy?

You should stay because you love the care, not because of a contract.

• Cancel Anytime: No long-term lock-in. No initiation or cancellation fees.
• Access Through Your Paid Cycle: If you cancel mid-period, your access continues through the end of the billing cycle you have paid for. We do not issue partial refunds for the unused portion.
• No Surprise Fees: We transfer your medical records to your next physician at no charge if you choose to transition care elsewhere.

How do I update my card or manage my subscription?

Current members can update their credit card, download past invoices, change their billing interval, or cancel their membership securely through the Billing Portal.

How do I get an itemized receipt for HSA or FSA?

You can generate a compliant, itemized receipt directly from the billing platform.

1. Log in to the Billing Portal.
2. Select your active subscription.
3. Click on "Invoice History" and download the invoice you need. The invoice includes the necessary NPI and tax ID information for HSA or FSA submission.

If I pay for membership, do I still need insurance?

You still need insurance for the big things: specialists, hospitalizations, surgeries, and emergency care. Our membership covers your day-to-day primary care home, while insurance handles high-cost events.

Can I use my HSA or FSA?

Yes, you can use your HSA or FSA. Thanks to the Primary Care Enhancement Act, DPC memberships are now eligible for payment with pre-tax HSA or FSA dollars.

Clinical Care and Access

How do I reach Dr. Ash after hours?

All members use the Ultralight app to message or video Dr. Ash directly. Because we maintain a small practice size, response times are dramatically faster than traditional clinics. For true emergencies, you still call 911.

Will I always see the same doctor?

Yes, you will always see Dr. Ash. There are no mid-levels, no handoffs, and no repeating your story to a stranger. You get the same board-certified internal medicine physician every visit.

Do you do home visits?

Yes, we do home visits when clinically indicated. For example, if you are too sick to travel or have a mobility limitation, we provide doorstep home visits across the Philadelphia metro area.

What if I need a specialist?

We handle specialist coordination. We identify the right specialist (at Penn, Jefferson, Temple, or Mainline), provide them with a detailed clinical briefing, and follow up to integrate their results back into your overall strategy.

How we differ from other models

How is this different from concierge medicine?

Traditional concierge medicine often bills insurance on top of a membership fee. We are direct: we cut out the insurance billing for our care entirely. The result is more cost-effective and lets us focus on your health, not on paperwork.

What is Medicine 3.0?

Medicine 3.0 is a framework that prioritizes proactive prevention over reactive treatment. We do not just treat disease. We aim to prevent it decades before it starts.

Logistics and Strategies

How do I request a medication refill?

Medications are tools, not crutches. We review every refill to confirm it still serves your goals.

To request a refill:

1. Open the Ultralight app.
2. Send a message with a clear photo of your bottle (name, dose, and frequency visible).
3. Mention any changes in symptoms or side effects.

How do I upload my genetic data?

We turn raw data into a plan.

1. Download your raw data from MyNucleus, 23andMe, or Ancestry.
2. Send it to us securely through Ultralight.
3. Review: We screen it for risks and opportunities (methylation, lipid metabolism, athletic performance) and integrate findings into your plan.

What happens if I go to the hospital?

While we do not round in the hospital, we act as your control tower from the outside.

• Notify us as soon as you are safe and able.
• Coordination: We speak with your bedside team to share your full history.
• Discharge: We review all hospital notes and handle the transition home to prevent readmission.

Guidelines from the Clinic

"The most common thing I hear from new members is, 'I didn't realize a doctor's visit could feel this way.' This model returns medicine to its root: the relationship between the physician and the patient. No call centers, no phone trees, just direct access and high-resolution data."

Scientific References

1. Eskew PM, Klink K. Direct Primary Care: Practice Distribution and Cost Across the Nation. J Am Board Fam Med. 2015;28(6):793-801.
2. 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.
3. Doherty M, et al. Direct Primary Care Outcomes: A Scoping Review. J Am Board Fam Med. 2022;35(2):363-374.

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