Direct care and concierge medicine both describe healthcare paid outside direct insurance payment. They get used interchangeably, but they are not the same thing.
Concierge care
When most people hear concierge care, they think of something fancy. The reality is more pragmatic. There are many different concierge models, but the structure usually looks the same: the patient pays a monthly or annual fee to be part of the practice’s patient panel. The clinic earns from that fee and from what it can collect from insurance for visits.
By limiting how many patients the panel holds, the practice does not have to lean on insurance reimbursement the way a high-volume clinic does. The patient gets more flexibility and more time with the clinician. The trade-off is that insurance agreements still shape how care can be delivered.
Direct care
Direct care goes a step further. Most direct-care clinics charge a flat membership fee and do not bill insurance directly. The clinic is not shaped by insurance-company visit rules, which means the physician can treat based on clinical judgment rather than what the plan will reimburse.
Less paperwork. More time with patients. Less interference between the physician and the care plan.
Where NorCal ADHD lands
NorCal ADHD is built around the direct-pay end of this spectrum. Patients pay the practice directly. Insurance is still required because broader medical care may be needed, but NorCal ADHD does not bill insurance directly. Medicare and Medi-Cal patients can be accepted when they pay cash/directly. The trade-off is honest: out-of-network reimbursement, when it happens, runs through superbills the patient submits themselves.
The bigger reason this matters: ADHD care depends on continuity, follow-up, and pharmacy support. Those things suffer when an insurance contract dictates how often the doctor can see you and what the visit is allowed to cover. Direct-pay care lets the practice keep those parts of care visible and accountable to the patient, not to a plan.
This post originally ran on the practice site in 2018. The model NorCal ADHD operates on today still leans on the same principles described above. Current pricing, insurance posture, and what the practice covers are documented on the pricing and how-it-works pages.