What is this fee for?
It helps us cover the growing gap between what it costs to run an independent medical practice and what insurers - including Medicare - actually pay us for the care we provide. It is not a charge for any additional service; it supports the practice as a whole.
Does paying this fee get me faster appointments, extra time with my doctor, or any other special treatment?
No. This is not a concierge-medicine arrangement. Every patient will continue to receive the same quality of care, the same access to appointments, and the same attention from their physician.
Why is this happening now?
The pressure has been building for years. Medicare reimbursement, adjusted for inflation, has declined roughly 33% since 2001, according to the American Medical Association. Our private insurance contracts have not kept pace with inflation either - some have increased only slightly over periods as long as a decade. Meanwhile, the cost of staffing, technology, rent, supplies, and regulatory compliance keeps rising. We held off on asking anything of our patients for as long as we reasonably could.
Is this a copay, and will my insurance reimburse me for it?
No, it is not a copay or a covered medical service, so it is not something we can bill to insurance. It's a practice administrative fee, separate from any charges tied to a specific visit or procedure.
Why doesn't insurance just pay doctors more?
Medicare's payment formula is required by law to be budget-neutral, which means that any increases in one area must be offset by cuts elsewhere - so payment updates rarely keep pace with the actual cost of running a practice. Private insurers negotiate independently with each practice and those negotiated increases have also consistently lagged behind inflation.
Why does it matter that your practice is independent?
Independent, physician-owned practices like ours are becoming rare: according to the AMA, the share of physicians in wholly physician-owned practices fell from about 60% in 2012 to about 42% in 2024. When a practice is bought by a hospital system, insurance company, or private equity firm, decisions about your care start to reflect that owner's priorities rather than your physician's judgment. Staying independent means your doctors are the only people deciding how best to care for you.
Are other practices doing this too?
Yes. Annual or membership-style fees, in various forms, have become increasingly common among independent practices facing the same reimbursement pressures we describe here.
Who can I talk to if I have more questions?
We're glad to discuss this with you directly - please reach out to the administrative staff or your neurologist with any questions or concerns.