Joining a concierge practice is a bigger decision than most people treat it as. It is a year of your medical care, a meaningful amount of money, and a relationship you will lean on when something frightening happens. Most people decide on the basis of a tour, a warm conversation, and a good feeling.
Here are ten questions that surface what the tour will not. I would be glad to be asked all ten.
1. How many patients do you carry?
Ask for the number, not the adjective. "A small panel" means nothing. A few hundred is a real concierge panel. Two thousand with a membership fee attached is a conventional practice with a membership fee attached.
Then ask what the cap is and whether it is enforced, because a panel that is small today and uncapped is a panel that will not be small in three years.
2. Will my visits still be billed to my insurance?
In most concierge programs the answer is yes, which means the membership fee is in addition to your premium, your deductible, and your copays rather than instead of them. That is a legitimate model. It is also frequently a surprise, and it should not be one.
3. Is there an initiation fee?
Many programs carry one on top of the annual membership, and it does not always appear in the number you are quoted first. Ask plainly, and ask whether it recurs if you leave and come back.
4. When I text, who reads it?
This is the question that most reliably separates the marketing from the practice. "Direct access" can mean a physician's cell phone. It can also mean a shared inbox monitored by staff during business hours.
Ask what happens at nine on a Sunday night. Ask who answers when your physician is on vacation. Neither answer disqualifies a practice. Not knowing does.
5. Do you make money on the labs, supplements, or imaging you recommend?
The single most clarifying question on this list.
If the answer is yes, every recommendation is simultaneously a clinical judgment and a revenue line, and you have no reliable way to tell which is driving a given suggestion. Ask what a panel costs the practice versus what you are charged. A practice billing at cost answers instantly because there is nothing to hide.
6. What is actually included, and what is extra?
"Included" and "at cost" are different things, and practices are not always careful about the distinction.
In mine, the visits, the 24/7 text access, the house calls across the Charlotte metro, the annual well visit at home, and the medical acupuncture are included. Labs and medications are at cost, which means you pay exactly what I pay and you see the invoice. Both are good deals. They are not the same deal, and you should know which one you are being offered.
7. What happens if I am hospitalized?
Concierge membership is not insurance and does not replace it. You keep your plan for hospitals, surgery, specialists, and emergencies, and emergencies are 911.
The useful question is what your physician does while you are in there. Do they call the hospitalist. Do they know your history well enough for that call to be worth making. That is the part a membership can actually deliver.
8. Do you coordinate with my specialists?
You likely have a cardiologist, an OB, a dermatologist, a surgeon. A concierge physician who works around them rather than with them is creating a second silo instead of fixing the first.
Ask whether you get your plan in a form you can hand to another physician. Mine is written that way deliberately.
9. What do you compare my labs to?
This is the medical question hiding inside a list of logistical ones, and almost nobody asks it.
Most practices compare your results to the lab's reference range, which is built from the general population and drawn to catch disease. It is a floor, not a target. Health Optimization Medicine compares your biology to optimal ranges derived from healthy 21 to 30-year-olds, which is a completely different question and produces a completely different plan.
It is the difference between being told your ferritin of 35 is normal and being told it is well under what you need to stop losing hair and feeling tired at three in the afternoon.
10. How do I leave?
Ask before you join. A practice confident in its work has a clean answer.
Mine is month to month. You can stop after the starting quarter with a refund minus testing costs and my time pro-rated, no questions asked except one, which is what I could have done better.
The short version
If you only get through three of these, make it these three.
| Ask this | Because it tells you |
|---|---|
| Will my visits still be billed to insurance? | Whether the fee is instead of your existing costs, or on top of them |
| Do you profit from the labs, supplements, and imaging you recommend? | Whether a recommendation is a clinical judgment or a revenue line |
| What do you compare my labs to? | Whether you are buying better access to the same reading, or a different reading |
The first two are about the business. The third is about the medicine. Most people ask only about the first, which is why so many end up paying more for the same fifteen-minute conclusion delivered in a nicer room.
Ask me all ten
I mean that. If you are working through a list of practices in Charlotte, run this on all of them, mine included, and go where the answers fit you best. A physician who is annoyed by these questions has answered the most important one.
How my practice answers them, with the numbers, is on the concierge medicine page and the cost breakdown.
