Guide
Direct Primary Care vs. Concierge Pediatrics: What's the Difference?
Both models promise more time with your pediatrician. But how they bill, whether they use insurance, and what "membership" really covers are very different. Here's a plain-English comparison for families weighing their options.
The short version
Direct Primary Care (DPC) pediatricians charge families a flat monthly membership and do not bill insurance for the care they provide. The membership is the payment for the pediatrician's time, communication, and visits.
Concierge pediatricians also charge a membership (often called a retainer or access fee), but they still bill your insurance for visits on top of that fee. The membership pays for enhanced access — same-day appointments, direct phone or text access, longer visits — while the medical care itself continues to flow through insurance.
Side-by-side
| Direct Primary Care | Concierge | |
|---|---|---|
| Monthly membership | Yes — this is the fee for care | Yes — an access fee, in addition to insurance |
| Bills insurance | No | Yes, typically |
| Visit copays / coinsurance | None from the practice | Standard insurance cost-sharing still applies |
| Panel size (patients per doctor) | Small — usually a few hundred | Small to moderate |
| Direct access to your pediatrician | Yes — phone, text, email | Yes |
| Best for | Families who want transparent pricing and an unhurried relationship | Families who want to keep insurance-billed care but with more access |
Billing: where the two models really diverge
The billing structure is the practical difference most families feel. In a DPC pediatric practice, the monthly membership covers visits, messaging, and the pediatrician's time — there is no claim sent to insurance for those services. Families still carry insurance for things like specialists, labs, imaging, ER visits, and hospitalizations, but the day-to-day pediatric care runs outside the insurance system.
In a concierge model, the retainer buys access — a direct line to your pediatrician, faster appointments, longer visits — but the underlying visits are still billed to your insurance. That means you can end up paying twice for the relationship: once as a membership, and again as a copay or coinsurance per visit.
Why DPC pediatricians opt out of insurance
Insurance-based pediatrics rewards volume. To make the numbers work, a typical practice sees many patients each day and spends significant time on documentation aimed at billing codes rather than the family in the room. DPC removes that machinery, which is what makes small panels and longer visits financially possible.
What families actually experience
- Time. Both DPC and concierge visits are longer than a standard 10–15 minute pediatric appointment. In DPC, 30–60 minute visits are the norm rather than the exception.
- Access. Both models offer direct access to your pediatrician, not a nurse line or portal queue. Texting your doctor about a rash on a Saturday is normal in both.
- Predictability. DPC is the more predictable of the two financially — you know the monthly cost and there are no surprise per-visit charges. Concierge families still navigate deductibles, copays, and coinsurance for each visit.
- Insurance. Keep it in both cases. DPC families typically pair a membership with a higher-deductible plan for the things insurance is genuinely good at: hospitalization, surgery, and specialty care.
How Poppy Pediatrics fits in
Poppy Pediatrics is a Direct Primary Care pediatric practice in San Luis Obispo. That means one monthly membership, no insurance billing on our end, and a small panel so that Dr. Landsman actually knows your child. The model is built around the relationship first — unhurried visits, direct access, and transparent pricing — not around what an insurer will or won't reimburse.
If you're comparing options for private pediatric care in SLO, the practical question isn't just "how much is the membership" — it's whether you'd rather have your pediatrician's time paid for directly (DPC) or layered on top of insurance-billed visits (concierge).
Common questions
Do I still need health insurance with a DPC pediatrician?
Yes. DPC covers the pediatrician-provided care — visits, communication, well-child checks, most in-office needs. Insurance is still important for specialists, labs, imaging, ER, and hospital care. A DPC membership pairs well with a higher-deductible or HMO/PPO plan used for those situations.
Is DPC more expensive than a concierge practice?
Usually the opposite. Concierge families pay the retainer plus insurance cost-sharing per visit; DPC families pay only the membership for the care the practice provides. The total-cost comparison depends on how often your child actually needs to be seen.
Can I switch to a DPC pediatrician if my child sees specialists?
Yes. Your DPC pediatrician coordinates specialty referrals, and specialists bill your insurance as they normally would.