Fee Considerations

Pre-tax vs post-tax

The tax authorities have not made clear how concierge medical fees fit into the Health Savings Account (HSA) or Flexible Savings Account (FSA) payment model, as my fee details page discusses. Many of my patients have elected to pay my fee via an HSA or FSA account, making the cost approximately 30% - 50% less on an after-tax basis.

No co-pays

In general, you pay me one fee per year (some vaccines are not covered). This means that you have no co-pays from me, which should be considered both on a money basis and a hassle factor basis.

Fewer specialist and ER visits

While this isn't a guarantee, in general concierge doctors can reduce overall specialist referrals because we have so much more time to spend with patients. Instead of immediately referring you to someone else, as has become the norm in traditional health care, I can take care of many of those issues myself. Just one referral reduction can in some cases equate to most or all of my annual fee. This also reduces your overall hassle factor. Moreover, patients of mine frequently avoid visits to the emergency room. The cost savings in avoiding a single emergency room trip is significant.

No incentive to overcharge you

A Time Magazine cover story recently explained how hospitals will bill you and your insurer $1,200.00 for an EKG test. I have an EKG device in my office, and will perform one on you if needed, at no extra charge. (The reality is the cost is at most $50.) Or charging $546 for a 44 cent bag of saline solution. Or $500 for a single stitch. Unlike a big health system, I have no financial incentive to do extra procedures or tests, saving you, your insurer, and/or the government a lot of money and time.

Another example: I do not mark up vaccines that you may need. If it's not a standard vaccine like the flu shot, and you need to pay, you get the price I pay. This often saves my patients several hundred dollars per vaccine.


An unfortunate development in traditional health care is that the increasingly few internal medicine doctors who remain are overwhelmed. They don't have time to review carefully all the medications a patient is taking to see if there is a more cost-effective way to put together the list. Because my practice is less than a quarter the size of those traditional practices, I can do this and sometimes save patients a lot of money.

No complicated billing

Because you pay me just one fee per year, on one invoice (see above), there are no complicated bills and no endless surcharges. These are so prevalent today that Time Magazine wrote a 40,000 word cover story on them. And because no one else pays me other than you, I have no conflicts of interest. My approach is simple and convenient for you.

In summary

I have patients who believe, when they consider all the factors above, that their net expense is very small, for which they get amazing, personal, convenient medical care.