What is Direct Primary Care?

Direct Primary Care (DPC) is a model where patients pay a flat membership fee directly to the practice for unlimited primary care, instead of paying per visit through insurance. This frees the physician from short visits and lets them spend real time with patients.

Is membership tax-deductible?

Membership can be paid pre-tax through HSA or FSA accounts. If you itemize medical expenses, membership may also be deductible if your total medical spending exceeds 7.5 percent of adjusted gross income. Talk to your tax advisor for your specific situation.

Do you treat children or just adults?

Dr. Ash focuses on adult internal medicine. We can advise on pediatric questions for member families, but we recommend a pediatrician for primary care of children.

Are visits really unlimited?

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

Can I add my partner or family?

Yes, you can add a partner or family member at any time. We offer partner and family rates that lower the per-person cost. Most members add a spouse during the first month.

What hours can I reach you?

You can message us through Ultralight 24/7. We respond within minutes during business hours and within an hour for urgent issues after hours. For non-urgent items, expect a same-day reply.

What if I have an existing condition?

Existing conditions are welcome. Many members join because their conditions (autoimmune disease, hypertension, diabetes, complex hormones) need more time and continuity than a typical practice provides.

Can I keep my current PCP and add Fishtown Medicine?

Some members do keep an existing PCP for a transition period. Most eventually consolidate care here because coordinating two primary care doctors gets confusing. We do not require you to drop anyone, and we coordinate with whoever is on your team.

How does Direct Primary Care actually save money long term?

Direct Primary Care saves money long term by preventing expensive downstream events. Members average more time with their physician, which catches problems earlier. Independent studies show DPC patients have lower hospitalization and ER usage. The membership cost is often offset by avoided copays, urgent care visits, and surprise bills.

How do you handle complex chronic disease as a small practice?

We handle complex chronic disease through deeper time, better data, and tight specialist coordination. Members with diabetes, autoimmune conditions, or complex GI issues benefit from continuous communication and detailed lab tracking that a 15-minute visit cannot match. We refer when needed and quarterback the rest.

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

When Dr. Ash is on vacation, we set clear coverage. Routine messages may have a slightly delayed reply, urgent issues route to a covering physician we trust, and emergencies route to the standard emergency system. We always tell you in advance.

How does this practice scale without losing quality?

The practice scales by capping membership numbers, not by adding mid-level providers. Quality depends on time per patient. We grow slowly, add resources to support clinical work (like care coordination), and maintain a small, dedicated practice size.

Can I use Fishtown Medicine for travel medicine, vaccines, or pre-op clearance?

Yes, we cover travel medicine, vaccines, and pre-op clearance as part of membership. We offer travel consults with custom vaccine and prophylaxis plans, basic in-office or community vaccine routing, and pre-op clearance letters for surgery.

What is the relationship with insurance carriers?

We have no contracts with insurance carriers for membership. Your insurance still pays for labs, imaging, prescriptions, and specialists. We are not in any insurance network. PPO members may submit superbills for partial out-of-network reimbursement.

How do you handle billing disputes or insurance issues?

We help you understand and dispute billing issues with labs, imaging centers, or insurance. We can write letters of medical necessity, dispute coding errors, and identify in-network alternatives. We do not bill or negotiate directly with insurance, but we equip you to do it successfully.

How do you protect privacy as a small practice?

We protect privacy through HIPAA-compliant systems, encrypted messaging, secure document sharing, and strict access controls. Our small size actually strengthens privacy because fewer people touch your chart. We never sell or share data for marketing.

What happens to my records if I leave the practice?

Your records belong to you. If you leave, we transfer them securely to your next physician at no charge. We follow standard retention guidelines for the legal minimum after departure.

How do you handle disagreements between patient preference and clinical recommendation?

We handle disagreements through conversation. Dr. Ash explains his reasoning, listens to yours, and works toward a plan you can both stand behind. Sometimes that means accepting a patient's choice and monitoring closely. Sometimes it means revisiting the recommendation with new evidence.

Can I use Fishtown Medicine if I am also seeing a functional medicine practitioner or naturopath?

Yes, you can use Fishtown Medicine alongside other practitioners. We act as the medical quarterback and integrate complementary approaches when they are safe and evidence-supported. We are honest about what we agree with and what we cannot endorse, but we do not require you to choose sides.

How do you handle members who travel often or split time between cities?

For members who travel often, we provide telemedicine to many states (currently 42 and growing) and coordinate labs nationwide through Quest or LabCorp. For acute illness while traveling, we triage by message and coordinate local care. We design care that adapts to your real life.

What is the ideal timeline to see meaningful results from joining?

The ideal timeline depends on your starting point. Most members feel the difference (in access and clarity) within the first month. Lab improvements often appear by 3 months. Major trajectory changes (body composition, metabolic health, longevity markers) become measurable by 6 to 12 months.

TL;DR · 30-second take

Fishtown Medicine is a Direct Primary Care (DPC) practice. You pay a flat monthly or annual fee for unlimited access, longer visits, and direct communication with Dr. Ash. Insurance still covers labs, imaging, and specialists, and HSA or FSA dollars cover the membership.

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.

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?

We do not bill insurance for membership. We are a Direct Primary Care (DPC) practice. You pay a flat monthly or annual fee for unlimited access and deep-dive care. This 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.

What does membership cost?

Membership uses simple, transparent pricing. You can view all our current membership plans, pricing, and features on our Membership page.

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.
Prorated Refunds: If you cancel mid-period, we refund the unused portion of your membership fees.
No Surprise Fees: We handle the transfer of your medical records seamlessly 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.

Log in to the Billing Portal.
Select your active subscription.
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:

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

How do I upload my genetic data?

We turn raw data into a plan.

Download your raw data from MyNucleus, 23andMe, or Ancestry.
Send it to us securely through Ultralight.
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."

Actionable Steps in Philly

Decide whether membership is the right fit.

Read the Membership Page: Compare the tiers and pick the one that fits your needs.
Book a Warm Invitation Call: A 20-minute call clarifies whether the model fits your situation.
Confirm HSA Eligibility: Check if your account supports DPC payments (most now do).
List Your Top Three Concerns: Bring them to your first visit so we can tackle them directly.
Plan a 90-Day Goal: Pick one outcome (better sleep, lower ApoB, more energy) for your 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.

Medical Disclaimer: This resource provides clinical and operational context for educational purposes. In the world of Precision Medicine, there is no "one size fits all", the right care plan must be matched to your unique health needs and goals. Consult Dr. Ash to determine if this approach is right for you, especially if you have chronic health conditions or are taking prescription medications.

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

Fishtown Medicine | About

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

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TL;DR · 30-second take

The Membership FAQ: Clear Answers on Care

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