Specialists in the Valley are trading insurance for membership fees

Four physicians in Scottsdale are running practices built on a simple exchange: a monthly membership fee in return for longer appointments and direct access to their doctors. They are part of a growing group of specialists in the Valley who are moving away from the traditional insurance model. This shift is driven by patients who need ongoing care for chronic conditions and doctors who feel the standard 15 to 20 minute visit is no longer enough.

Todd Levine, a neurologist with HonorHealth Concierge Neurology, has spent 30 years treating neuromuscular diseases, including ALS. He notes that the national shortage of neurologists often leaves little time for the kind of detective work his patients require. His concierge panel is capped at 275 patients, a number he says allows him to provide the depth of care he prefers. A typical neurology appointment elsewhere lasts 20 minutes, while his run an hour or more. This extra time lets him coordinate with other providers and adjust medications for conditions like neuropathy without waiting three to six months for a follow-up.

Heather Saran, who runs Bright Endocrinology, faced burnout after nearly a decade of seeing 20 to 30 patients a day. She left traditional practice to regroup and eventually opened her own concierge clinic. Now she sees no more than 10 patients per day. Her new-patient visits last an hour, and follow-ups are 30 minutes long. Saran argues that endocrinology suits this model because the conditions are chronic and deeply personal. She knows details like when her diabetes patients eat or walk their dogs, which helps her build strategies for when she is not in the room. Patients can text her directly about thyroid medication adjustments instead of waiting months for an appointment.

Michael Wolff, a physiatrist at Southwest Spine & Sports, focuses on nonsurgical care for spine and joint injuries. He says he spent too much time fighting insurance approvals for treatments he believed were appropriate. Fifteen years ago, he began offering regenerative treatments like platelet-rich plasma, which insurance often does not cover. This moved some patients to a cash-pay concierge side of his practice. Concierge patients get 30 to 60 minutes for new visits and 30 minutes for follow-ups. Wolff says this time allows him to listen to the whole picture rather than just a single problem. He continues to treat some patients through traditional insurance channels to keep access open for different types of patients.

Anne-Marie Feyrer-Melk, a cardiologist, launched her concierge practice in 2011 after deciding she wanted to prevent heart disease rather than just treat it. She says a consultant once told her to cut her appointments from 30 minutes to 10, a change that pushed her toward the membership model. Today, she looks for silent arterial disease and treats it with targeted medications and lifestyle changes. She says this approach requires quarterly labs and constant adjustment of therapies. Feyrer-Melk notes that many of her patients arrive thinking they are healthy but leave with a specific plan to protect their hearts.

All four doctors acknowledge the trade-offs of the model. Saran notes that some people are getting better access while others face limited access as doctors leave insurance-based practice. She also dispels the idea that concierge medicine is about getting rich, saying she is not making more money than before. Levine points out that his concierge patients still use insurance for testing and referrals. Wolff says the concern about limited access is legitimate. The next step for these practices is continuing to refine their care models as more specialists consider leaving the traditional system.