Concierge Medicine vs. Direct Primary Care: What Your Coffee Shop Can Teach You
Imagine you own a coffee shop. Customers come in, you make them a great cup of coffee, they pay, and hopefully they leave happy enough to return and bring friends.
Simple, right?
Any business owner or baristas reading this can stop rolling their eyes. I know there is much more to making coffee happening behind the counter. The same is true in a doctor’s office.
Patients usually understand that a medical visit costs money, but because insurance handles much of the payment, few think about how the clinic actually gets paid. Instead of paying the doctor directly, the office submits a claim using billing and procedure codes. The insurance company then decides whether to approve, reduce, or deny payment—much like an insurer reviewing a claim for storm damage to your roof.
Over time, this system became a tug-of-war. Clinics submit claims, insurers deny or delay them, and the office must provide more paperwork before getting paid. That means hiring staff to chase payments while still covering payroll, rent, supplies, and utilities. It is one reason many independent practices have struggled to survive: insurers increasingly determine how doctors are paid and, indirectly, how they practice.
There are two basic ways around this:
Charge patients more to cover the cost of working with insurance,
or stop billing insurance and charge patients directly.
That distinction helps explain the difference between concierge medicine and direct primary care.
Concierge practices often continue billing insurance while also charging patients a substantial membership or retainer fee, sometimes thousands of dollars per year. Patients still pay insurance deductibles, co-insurance and copays, while the additional fee helps support longer visits and greater access.
Direct primary care takes a different approach. DPC practices generally do not bill insurance for primary care. Without the cost and administrative burden of filing claims, appealing denials, and negotiating payment, the practice can charge a more predictable monthly membership fee, often around $90 per month.
That gives the doctor more time to focus on patient care and relationships instead of paperwork. Like your favorite coffee shop, the goal is simple: provide excellent service, earn your trust, and give you a reason to keep coming back.
Concierge medicine charges more to survive the insurance tug-of-war; DPC steps out of the contest and gets back to serving the coffee.
Dr. Sharma is a board-certified family medicine physician and the founder of HealthWinds, a virtual-first family medicine practice serving DuPage County and the surrounding Chicago suburbs. He comes with over 11 years of experience specializing in family medicine with Duly Health and Care and Loyola Medicine's MacNeal Hospital, among others. He sees patients ages five and up, with longer visits and direct access built around a membership model rather than insurance.
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