I just came across this today for the first time. I've heard of concierge practices where patients pay a monthly fee for premium service in addition to the charges for office visits, etc. though I never knew one could enroll if you were on Medicare (although I couldn't afford it anyways) However, today I discovered a practice that has 2 doctors: one has something called a "hybrid insurance subscription practice" where you pay $150 month subscription fee - it's a concierge practice, like the concierge practices, but the other doctor has something called a "hybrid insurance surcharge" practice. There is no monthly fee for this one, but you are charged something called a "holistic surcharge fee" - so for a doctor visit less than 20 minutes, you pay $75 + Medicare or insurance copays and for extended visits, the charge is $150 plus any copays. Ordinarily to see a doctor like this would cost around $500 + for the initial visit. It's an integrative/functional medicine practice, they're both D.O.s and do regular medical care as well as nutritional IVs and other things. I'm seriously considering making an appointment with the insurance surcharge doctor. I would like to get more testing done and have been unable to find a doctor who takes Medicare who knows anything about ME/CFS. I think it's a pretty creative solution. I rarely go see doctors - so I'm thinking I could handle just a few visits a year with this practice.