One flat fee.
No surprises.

Yes, and most members do. The membership covers what happens in primary care: visits, messaging, medication management, lifestyle and chronic-condition work, and the time it takes to do those well. It doesn't cover hospital stays, ER visits, urgent care, specialists, imaging, surgery, pathology, or the cost of the labs themselves (though we pass lab pricing through at wholesale where available). For all of that, you'll still want insurance. Most members pair direct primary care with a high-deductible health plan or catastrophic coverage to handle the rare big events. The two work well together: the membership for the everyday care, insurance for the things that happen elsewhere.

Insurance billing dictates how primary care has been run for decades: short visits, high volume, coded encounters, layers of administration. By stepping outside the insurance billing model, we can spend the time the visit actually needs and keep the price predictable. The membership replaces the per-visit fee structure entirely.

Direct primary care isn't a Medicare or Medicaid plan, and by federal and state rules, neither program can be billed for our services. If you're enrolled in Medicaid, North Carolina law doesn't allow non-participating providers like us to see Medicaid patients, so the practice can't accept you. We wish it worked differently.

If you're a Medicare beneficiary, the standard membership doesn't apply, but we can talk about our separate Medicare Agreement, which lets eligible patients continue receiving care while keeping Medicare for everything outside primary care. If you become eligible for Medicare during your membership, just let us know; we'll move you onto the Medicare Agreement or refund any unearned fees, your choice.

The IRS treats direct primary care membership fees variably; many members use HSA or FSA funds for membership and lab fees. We recommend checking with your tax professional about your specific plan and circumstances.

Sarah is a board-certified Adult Nurse Practitioner (ANP-C) with more than twenty years caring for adults. Nurse Practitioners are licensed to diagnose, prescribe, order labs and imaging, and manage chronic conditions. In North Carolina, NPs work with a collaborating physician, and Sarah does. For day-to-day adult primary care, the work is the same. For anything outside primary-care scope, we coordinate with specialists, same as any practice would.

Sarah prescribes as part of your care, and the prescription itself goes to whichever pharmacy you prefer. The membership doesn't include the cost of the medication, but we'll help you find the lowest-cost options through generic alternatives, GoodRx, Mark Cuban Cost Plus, or your insurance formulary.

As a general policy, the practice doesn't manage chronic controlled substances (long-term opioids, stimulants, benzodiazepines for ongoing use); those situations are usually better served by a specialist. If you have an existing situation, we'll talk it through case-by-case.

For non-urgent questions: typically same-day or next-business-day by message, often faster. For something more pressing, you can call or schedule a quick video. We're a small practice on purpose, which is what makes that level of access possible.

Direct primary care is built for the steady work of primary care: chronic conditions, the small concerns before they become big, the questions between visits. For an emergency (chest pain, severe injury, sudden change in mental status, signs of stroke), call 911 or head to the nearest emergency department. After the emergency, Sarah is here to coordinate the follow-up and make sure nothing falls through the cracks.

Sarah is licensed in Virginia, North Carolina, South Carolina, and Florida. If you move within those four states, your care continues uninterrupted. If you move elsewhere, we'll help you transition records to a new provider and pause or cancel your membership.

Membership is month-to-month, with thirty days' written notice if you decide to cancel. The final month gets prorated so you only pay for the days you were actually a member. We recommend giving the model a few months to settle in; the value compounds as Sarah gets to know your story.

One small note: if you cancel and later want to re-enroll, the practice may ask for a re-enrollment fee covering the months you were away (capped at twelve). Short gaps are usually no issue.

A free fifteen-minute consult call. We'll talk through what you're looking for, answer questions, and figure out whether direct primary care fits. If it does, you can enroll on the call or take time to decide. No card on file until you join.