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Fees & Membership

Metro Medical Direct is a private, limited-panel concierge medical practice serving medically and psychiatrically complex older adults in Manhattan. The fee structure below is transparent so families, trustees, and professional partners understand the scope before we speak.

A Two-Step Model

All new patients begin with a comprehensive evaluation. Ongoing care is available through concierge membership. Each step is clearly structured—and each stands on its own.

Step 1 — For All New Patients

Comprehensive Evaluation

$6,000 · standalone · no obligation to continue

All new patients begin with a structured three-visit evaluation. This is a thorough clinical reset designed to establish medical and psychiatric baselines, clarify drivers of instability, and provide meaningful decision support. The evaluation is a complete, standalone service.

Visit 1 — Comprehensive Medical & Psychiatric Assessment

An extended in-person visit reviewing:
  • Full medical and psychiatric history
  • Hospitalizations and specialist records
  • Medication reconciliation and polypharmacy analysis
  • Cognitive screening and functional assessment
  • Mood and behavioral evaluation
  • Fall risk and safety review
  • Current living supports and caregiver strain

When clinically indicated, this visit includes structured assessment of decision-making capacity related to medical treatment, financial management, estate planning decisions, and appointment of fiduciaries.


Visit 2 — Focused Clinical Review & Testing

Clarification of findings, targeted examination, and when appropriate, pharmacogenomic testing to support safer prescribing and reduce medication-related complications.

 

Visit 3 — Clinical Summary & Strategy Conference

A structured meeting with adult children, trustees, care managers, or legal counsel when appropriate. Deliverables include:
  • Verbal clinical synthesis
  • Written summary outlining diagnoses, risk factors, and recommendations
  • Clear differentiation between medical, psychiatric, and environmental contributors
  • Identification of areas requiring specialist referral
  • Documentation relevant to decision-making capacity when assessed

Laboratory & Imaging: Laboratory testing and imaging are ordered through preferred vendors when indicated and billed separately by those entities. Evaluation fee is non-refundable.

Many families and attorneys find that this evaluation alone brings clarity to previously unstable or ambiguous situations.

Step 2 — After the Evaluation

Concierge Membership

$24,000 / year · annual, semi-annual, or quarterly

If, after the comprehensive evaluation, we mutually determine that ongoing oversight is appropriate, the elder may enroll in concierge membership. This model prioritizes stability, clarity, and anticipatory planning rather than episodic urgent care.

Ongoing House Calls & Telehealth
Scheduled and as-needed visits for management of medical conditions, psychiatric symptoms, medication changes, and evolving safety concerns.

Clinical Leadership
One clinician responsible for integrating cardiology, neurology, psychiatry, hospital teams, assisted living staff, and home care into a coherent plan.

Structured Documentation
Ongoing documentation reflecting cognitive trends, medication adjustments, risk factors, and functional changes.
 
 
 
Decision-Specific Capacity Evaluations
When appropriate, structured, task-specific assessments for:
  • Consent to medical treatment
  • Ability to manage personal or financial affairs
  • Appointment of health care proxy or power of attorney
  • Amendment of estate planning documents
  • Participation in guardianship-related decisions

 

Professional Collaboration
Scheduled conferences with elder law attorneys, trustees, fiduciaries, and care managers when appropriate.
 
Risk Mitigation
Proactive attention to medication burden, fall risk, behavioral changes, and emerging instability to reduce preventable ER visits and hospitalizations.

If the Evaluation Is Not Followed by Membership

The comprehensive evaluation stands on its own.

  • You receive a written and verbal clinical summary
  • You leave with structured recommendations that can be shared with existing physicians, care managers, or legal advisors.
  • There is no obligation to continue

The evaluation fee is not refundable. For some families and attorneys, this level of clarity is sufficient without ongoing membership.

What Is Not Included

Emergency Care

Metro Medical Direct is not an emergency response service and does not replace 911. In emergencies, call 911.

Hospital & Facility Services

Hospitalizations, rehabilitation stays, skilled nursing, assisted living fees, and emergency room charges are billed separately by those facilities.

Outside Services

Laboratory testing, imaging, durable medical equipment, and home health services are billed directly by those providers.

Insurance Billing

I am opted-out Medicare non-participating with private insurance. Documentation may be provided upon request. Reimbursement is handled directly between the family and insurer.

Forensic Litigation Services

Court testimony, contested expert witness services, or formal forensic reports for litigation are not included in standard evaluation or membership and require separate agreement.

Is This the Right Level of Care for Your Family?

This model is designed for situations where medical complexity intersects with legal, fiduciary, and family decision-making. If you are an adult child, trustee, or elder law attorney seeking clarity regarding a medically complex elder in Manhattan, you may request a brief introductory call.

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Not for emergencies. If you believe your parent is in immediate danger, call 911 or go to the nearest emergency room.