Is the membership the same as insurance?

The membership is not the same as insurance. Membership covers Dr. Ash's time and the practice's services. You still need insurance for hospitalization, surgery, specialists, imaging, and prescriptions. Most members keep a high-deductible plan or PPO alongside membership.

Can I use my HSA or FSA to pay for membership?

Yes, you can use your HSA or FSA to pay for membership. The 2025 Primary Care Enhancement Act formally classified DPC membership fees as qualified medical expenses.

Are visits really unlimited?

Yes, visits are essentially unlimited. We never charge per visit. Most members have 4 to 8 substantive interactions per year with messaging in between. The only constraint is medical necessity.

Can I cancel anytime?

You can cancel anytime with no penalty. Your access continues through the end of the billing cycle you have paid for; we do not issue partial refunds for the unused portion. We also transfer your medical records to your next physician at no charge.

Will I always see Dr. Ash directly?

Yes, you will always see Dr. Ash directly. There are no mid-levels and no handoffs. The same physician knows your story across years.

Does membership cover my family?

Membership covers the individual member. Family members can join at partner or family rates that lower the per-person cost. Many members add a spouse or adult children during the first month.

What is included in the annual physical?

The annual physical is a 90-minute deep evaluation that includes a thorough history, physical exam, advanced lab review (ApoB, Lp(a), fasting insulin, full thyroid, hs-CRP, A1c, vitamin D, complete blood count), wearable data review, and a written plan for the next year.

How is this different from a concierge medicine practice?

This is different from concierge medicine because we do not bill insurance for our care. Many concierge practices charge a membership and still bill insurance for visits, leading to copays and surprise bills. Direct Primary Care eliminates that double-charge structure entirely.

Does the practice scale, or do new members get worse care?

The practice does not scale through volume. We cap membership numbers to protect time per patient. As demand grows, we add resources (care coordination, technology) rather than ramping appointment volume. Quality stays constant by design.

How do you handle patients with complex chronic disease?

We handle complex chronic disease through deeper time, integrated data, and tight specialist coordination. Members with diabetes, autoimmune disease, complex GI issues, or recurrent cardiovascular concerns benefit from continuous communication that a 15-minute visit cannot provide.

What is included that other DPC practices skip?

Compared to many DPC practices, we go deeper on advanced diagnostics, wearable integration, and longevity-specific markers. We also provide home visits at the executive tier and structured care coordination across Penn, Jefferson, Temple, and Mainline systems. The comprehensive scope is documented in our scope of practice.

How does the membership change as I age?

The membership adapts as your needs evolve. In your 30s and 40s, the focus is prevention and optimization. In your 50s, hormone health, cardiovascular protection, and cancer screening intensify. In your 60s and beyond, chronic disease management and quality-of-life conversations become more central. Same physician, evolving plan.

Can I keep my current PCP and join Fishtown Medicine?

Some members keep their current PCP for a transition period. Most consolidate care here within a few months because coordinating two primary care doctors creates confusion. We do not require you to drop anyone, and we coordinate with whoever is on your team.

What happens if Dr. Ash is on vacation or out?

When Dr. Ash is out, we set clear coverage. Routine messages may have a slight delay, urgent issues route to a covering physician we trust, and emergencies route to the standard emergency system. We always notify members in advance.

Is the membership tax-deductible if I do not have an HSA?

The membership may be deductible if you itemize medical expenses on Schedule A and your total medical costs exceed 7.5% of adjusted gross income. Most members benefit more from HSA or FSA payments. Talk to your tax advisor for your specific situation.

How does Fishtown Medicine integrate with employer benefits?

Many employer benefits work with Fishtown Medicine. HSAs, FSAs, lifestyle accounts, and certain DPC carve-outs apply. Some Philly employers in tech and consulting offer reimbursement options for DPC. We provide the documentation needed to support those requests.

What is the difference between Direct Primary Care and traditional fee-for-service?

Direct Primary Care charges a flat fee for unlimited primary care, removing per-visit billing entirely. Traditional fee-for-service bills your insurance per visit, which incentivizes shorter visits and more billable encounters. DPC inverts those incentives toward time, depth, and prevention.

How do you measure whether membership is working for me?

We measure success through a combination of patient-reported outcomes (energy, sleep, mood, stress, satisfaction), advanced biomarker trends (ApoB, A1c, hs-CRP, hormones), wearable data trends, and life events avoided (ER visits, hospitalizations, unnecessary procedures). We review progress at each major visit.

Membership | Fishtown Medicine

TL;DR30-second take

Fishtown Medicine membership is a flat-fee Direct Primary Care plan covering unlimited visits, direct messaging with Dr. Ash, advanced diagnostics, and care coordination. Plans start at $250 per month, with HSA and FSA dollars eligible, so you get longer visits and proactive longevity care without insurance friction.

Fishtown Medicine is a Direct Primary Care practice. That means I work for you, not for insurance companies. I designed this membership model to provide a level of access, time, and strategic thinking that is impossible inside the traditional system.

What does Fishtown Medicine membership include?

The membership includes three connected layers: unlimited access to me, deep diagnostics, and active patient advocacy. Each layer is built into a single flat fee with no copays, no surprise bills, and no insurance billing for our care.

1. Unlimited Access

No Copays: Whether we talk once a year or ten times a month, your membership covers it.
Direct Communication: Text or video your physician directly. No call centers, no gatekeepers.
Same-Day or Next-Day Appointments: When you need us, we fit you in.
Sick Visits Included: We treat acute issues like flu, colds, UTIs, and rashes quickly, usually through messaging or a brief video call.

2. Detailed Diagnostics

Annual State of the Union Physical: A 90-minute deep dive into your metabolic, cardiovascular, and cognitive health.
Advanced Blood Work: We track markers like ApoB, fasting insulin, hs-CRP, full thyroid, and Lp(a) to spot trends early.
Wearable Integration: We review your Oura, Whoop, Apple Watch, or CGM data to optimize sleep and recovery.

3. Patient Advocacy

Care Coordination: If you need a specialist, we find the best one in Philadelphia, send a referral, and include a clinical briefing so you do not waste the first visit.
Specialist Curbsides: We leverage our professional network to get expert opinions on complex cases internally so you are not bouncing from doctor to doctor.
Hospital Navigation: If you are hospitalized, we communicate with your hospital team and manage the discharge transition.

How much does the membership cost?

The membership uses transparent, flat pricing. There are no surprise bills.

The Standard Membership

Designed for individuals and families who want a proactive medical partner.

Monthly: $250 per month
Quarterly: $685 per quarter (1 month free vs. month-to-month over the year)
Annual: $2,500 per year (2 months free vs. month-to-month)
Partner or Spouse Add-on: $1,950 per year (2 months free vs. month-to-month)

HSA and FSA dollars are eligible thanks to the Primary Care Enhancement Act, which often makes the effective cost 25% to 35% lower depending on your tax bracket.

Actionable Steps in Philly

Decide whether to join in five steps.

Read the Membership FAQ: Skim our membership FAQ for the most common questions.
Book a Warm Invitation Call: A 20-minute call clarifies fit. No pressure, no obligation.
Confirm HSA Eligibility: Most modern HSA cards now process DPC payments without issue.
List Your Top Three Goals: Bring them to the Diagnostic Evaluation so we focus on what matters to you.
Plan Your First 90 Days: Pick a clear outcome (better sleep, lower ApoB, more energy, less anxiety) for the first quarter.

Scientific References

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

Fishtown Medicine | About

2418 E York St, Philadelphia, PA 19125(267) 360-7927 hello@fishtownmedicine.comHSA/FSA Eligible

Schedule Your Intro Call

Frequently Asked Questions

Common Questions

No. We do not serve patients on Medicare or Medicaid. The federal rules around those programs are not compatible with our flat-fee membership, and taking them on would mean cutting into the access we promise everyone else. If you are Medicare-eligible and looking for a primary care home, we are glad to point you to practices built for that, such as Oak Street Health or Dedicated Senior Medical Center.

Deep-Dive Questions

Ready when you are

Start your intake

Dr. Ash reads every intake himself, and answers questions personally - usually within a few hours.

TL;DR30-second take