A $300 monthly concierge payment can require a $3,600 annual commitment. Check the agreement's term before paying.[1]
Before joining, read the membership agreement alongside the practice's benefits page. Establish what you are buying, how long you are committing, and what happens if you or the doctor ends the relationship.
The American Medical Association's ethics guidance calls for physicians to explain retainer terms clearly and distinguish membership charges from services that insurance reimburses.[2] You should be able to get those explanations before paying.
1. Separate the payment schedule from the commitment
Find the agreement's start date, initial term, total fee, and installment schedule. Read those provisions together.
For example, Praeventus Health, a practice in Virginia, publishes membership terms listing $3,600 per adult annually, payable at $300 monthly. Its September 2026 terms expressly describe installments as payments toward an annual fee.[1]
Dr. Rebecca Sinai's published agreement also makes both payment options a 12-month commitment. The annual option costs $1,800, while the monthly option costs $175 a month, or $2,100 across 12 months.[3]
These are specific practices' published terms, rather than a universal pricing or contract standard.
Ask: “If I leave after four months, exactly how much would I still owe?” Request a written calculation that includes any enrollment fee or annual-payment discount.
2. Read cancellation and refunds as separate questions
Permission to give notice does not necessarily release you from future installments or entitle you to a refund. Sinai's agreement allows written termination notice but states that patients using monthly payments remain responsible through the annual term. It also describes membership payments as nonrefundable.[3]
Praeventus publishes a different arrangement. During the first 90 days, it offers a full refund if the member has not had the executive physical, or a 50% refund if they have. After that period, early release and refunds are discretionary.[1]
Find answers to four questions:
How do you submit cancellation, and when does it take effect?
When do charges stop?
How does the practice calculate any refund?
Does receiving a physical or another included service change that calculation?
If the agreement promises a prorated refund, ask what it deducts before returning the unused portion. For illustration, a $3,600 annual fee divided evenly over 12 months equals $300 per month. Eight unused months would equal $2,400 before any permitted deductions. That calculation applies only if the agreement actually uses that refund method.
Keep a copy of your notice and the practice's acknowledgment.
3. Check automatic renewal and price increases together
Locate the renewal date, the deadline for declining renewal, and the required notice method. Then find the provision allowing the practice to change fees.
Praeventus's terms provide for automatic annual renewal and at least 30 days' written notice of a fee change, effective at renewal.[1] Your prospective practice may use different terms.
Ask whether you will receive the new price before your nonrenewal deadline. Also establish what happens if a price notice arrives after that deadline.
Put the deadline on your calendar when you enroll. Save the agreement, fee schedule, and any later amendment so you can compare the renewal offer with what you originally accepted.
4. Identify what the membership buys and what gets billed separately
Ask for a written list of included services and exclusions. Have the office separate the membership charge from visit charges, outside testing, prescriptions, and specialist bills.
For each advertised benefit, establish who provides it, who bills for it, and whether you could owe a deductible or copayment. An appointment, a blood draw, the laboratory's analysis, and a follow-up discussion deserve separate answers.
Medicare does not cover concierge membership fees. Medicare also says physicians who accept assignment, meaning they accept the Medicare-approved amount as full payment, cannot charge extra for Medicare-covered services. Additional state laws and consumer protections may apply.[4]
If you use Medicare, ask the practice to explain its participation status and distinguish membership benefits from covered medical services. Confirm your own insurance arrangements before changing them.
Use our guide to choosing a concierge or direct primary care doctor alongside the agreement. Direct primary care (DPC) is another membership model, and its name alone does not establish the terms you are accepting.
5. Define access to your doctor and coverage during absences
Read the agreement for the name of the entity providing membership and any provision allowing substitute clinicians. Establish whether you are joining a particular physician's practice or buying access to a group.
Ask who covers vacations and illness, what records that clinician can see, and whether you may leave without a financial penalty if your chosen doctor permanently departs.
For access promises, request specifics:
Which number or app should you use for an urgent concern?
Who responds after hours?
What response time does the practice commit to?
Does an appointment promise apply on weekends and holidays?
What happens if the practice repeatedly misses a stated commitment?
Our guide to what 24/7 access means covers these questions in detail. Keep the practice's written communication instructions with your enrollment documents.
6. Establish what happens when the practice ends your membership
Read the practice's termination rights as carefully as your own. Look for notice requirements, refund provisions, and circumstances that allow earlier termination.
Ask what happens if the doctor retires, the office closes, or another owner takes over. Can the practice transfer your membership? Can you decline the change? Who returns unused prepaid fees?
Financial terms and continuity of care each need an answer. The American Medical Association's ethics guidance says physicians withdrawing from a case must give enough advance notice for the patient to secure another physician and facilitate transfer when appropriate.[5] This is professional ethics guidance, rather than a universal contractual notice period.
Before signing, establish who will address pending test results, prescription requests, and referrals during a transition. Ask how to obtain your records and when portal access ends.
For providers covered by the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, federal guidance generally gives patients access to their medical and billing records, with limited exceptions. A covered provider cannot deny you a copy because you owe for care.[6]
7. Read the documents the agreement incorporates
If the agreement refers to a separate fee schedule, cancellation policy, or terms on a website, request those documents before signing. Save the versions you accept.
Read any provision about changing the terms. Ask how the practice notifies you, when changes take effect, and whether you can decline them without paying another year's fee.
If the packet includes arbitration or a class-action waiver, ask which disputes the provision covers, how costs work, and whether there is an opt-out deadline. Seek legal advice if you need to assess how a provision affects your rights.
When an office explanation differs from the paperwork, request a corrected agreement or written amendment before paying.
A checklist to use before signing
You should be able to fill in each blank:
Commitment: My initial term ends on , and my total obligation is $.
Cancellation: I must send notice by using , and any remaining balance is ___.
Refund: The calculation is , including deductions for .
Renewal: My next price arrives by , and I can decline renewal until .
Care: My physician is , coverage comes from , and separately billed services include ___.
Transition: If either side ends membership, care continues until and records come from .
Ask the office to resolve any blank you cannot complete from the agreement.
FAQ
Does paying monthly mean I can cancel monthly?
No. Published concierge agreements include monthly installments toward a 12-month commitment.[1][3] Check the term and cancellation provisions together.
Will I get a refund if I leave early?
It depends on the agreement and applicable law. The examples above include conditional refunds, discretionary refunds, and nonrefundable fees.[1][3][4] Request a written calculation for your proposed departure date.
What if my chosen doctor leaves?
Check whether the agreement ties membership to that physician or the practice, then ask about cancellation, refunds, and transfer of care. Physician ethics guidance also addresses continuity when a doctor ends a patient relationship.[5]
You can browse concierge and DPC practices on NextMD, compare their stated offerings, and request current membership documents directly from the offices you are considering.
Sources
Praeventus Health. (2026). Praeventus Membership Terms, version 2026.09, sections 1, 2, and 7. Membership terms, annual commitments, cancellation, and refunds.
American Medical Association. (n.d.). Retainer Practices, Code of Medical Ethics Opinion 11.2.5. Ethics guidance on retainer terms and transparent billing.
Rebecca Sinai, D.O. Concierge Medicine. (2026). Concierge Medicine Program Application and Agreement, updated April 6, 2026, payment options and section 5. Membership payment and termination terms.
Centers for Medicare & Medicaid Services. (n.d.). Concierge Care. Medicare.gov. Membership fees and Medicare billing rules.
American Medical Association. (n.d.). Terminating a Patient-Physician Relationship, Code of Medical Ethics Opinion 1.1.5. Notice and continuity-of-care guidance.
U.S. Department of Health and Human Services. (2025). Your Medical Records, reviewed May 30, 2025. Patient access to medical and billing records.