Private Physician Sarasota

The question we hear most from people researching a Private Physician Sarasota membership isn’t “is it good care” — it’s “how does the money actually work?” That’s fair, because it’s a genuinely different system than what most people are used to, and vague marketing language doesn’t help anyone decide if it fits their situation. Here’s the mechanical breakdown, not the pitch.

If you’ve already decided the care model is right for you and just need the financial mechanics explained, this page is for you. If you’re still deciding whether a private physician relationship is the right fit at all, our overview of what a concierge doctor actually does is a better starting point before getting into billing specifics.

How Membership Billing Actually Works

In traditional primary care, your insurance is billed per visit and per procedure using specific billing codes — what you owe depends on your plan’s copay, deductible, and how the visit is coded. In a PPS membership, you pay a recurring membership fee that covers direct access to your private physician; that fee is not billed to insurance and doesn’t generate a claim.

You still keep your existing health insurance for everything outside our practice — hospitalizations, specialist visits, imaging, prescriptions. The membership fee specifically covers your relationship with your PPS physician: appointments, direct communication, and the extra time that comes with a smaller patient panel.

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Benefits Compared with Traditional Insurance Billing

Insurance billing rewards volume: a practice generates revenue by seeing as many patients as possible, as often as billing codes allow — which is precisely why traditional visits are short and appointments are hard to get quickly. A membership model removes that incentive entirely: physician income isn’t tied to visit count, which is what allows the patient panel to stay small.

This distinction matters most for two groups: people without employer-sponsored insurance, and people already on a high-deductible plan who were effectively paying out of pocket for primary care anyway. Membership fees are typically billed on a recurring schedule (monthly or annually), rather than as a one-time payment — understanding that cadence upfront is part of making an informed decision.

Benefits Compared with Traditional Primary Care

Membership Fee vs. Insurance Billing

Category	Insurance-Billed Visit	PPS Membership
Billing structure	Per-visit, per-procedure codes	Recurring flat membership fee
What it covers	The specific coded visit only	Ongoing access, communication, longer visits
Claims filed	Yes, to your insurer	No — not submitted as a claim
Outside care (hospital, specialists, imaging)	Billed to insurance	Still billed to your existing insurance
Physician incentive	Tied to visit volume	Not tied to visit count

Why This Structure Is Trustworthy

This membership model is the same structure Dr. Carlos Caballero built PPS around when he founded the practice in 2001, and Dr. Jose Santana applies with his own patient panel — neither physician’s income depends on how many patients they see in a day, which is the financial mechanism behind every other benefit described on this site. Full credentials are on our physician credentials page.

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The Local Detail That Matters Here

Sarasota has a large population of retirees on Medicare and self-employed residents on high-deductible plans — two groups for whom this distinction actually changes the math of what care costs in a given year. Self-employed Sarasota residents specifically often find the direct primary care framing more useful — our direct primary care page covers that specific math in more depth.

PPS is based in Sarasota and serves the Gulf Coast, including Siesta Key, Lakewood Ranch, Longboat Key, Palmer Ranch, Lido Key, and Venice.

By the Numbers

According to CMS (Centers for Medicare & Medicaid Services) guidance, Medicare does not reimburse concierge or direct-pay membership fees, since they aren’t billed as covered services — which is why PPS members retain their existing Medicare or commercial insurance for care outside the practice.

Frequently Asked Questions

What exactly does the membership fee cover?

It covers your ongoing relationship with your PPS physician — appointments, direct access, and coordination of your care. Contact our office for current fee amounts.

Will my insurance reimburse me for the membership fee?

Typically no — the membership fee is separate from insurance and isn’t submitted as a claim. Ask your insurer directly if you have questions about your specific plan.

Can I use HSA or FSA funds toward membership?

Rules vary by plan and change periodically — ask our office about current guidance, and confirm with your HSA/FSA administrator.

If I have Medicare, do I still need a PPS membership?

Medicare covers many services but doesn’t include concierge-style access; you’d keep your Medicare coverage for those services and add PPS membership for the direct physician relationship.

Is the membership fee the same for everyone, or does it vary by age or health status?

Contact our office for current pricing structure and whether it varies by individual circumstances.

Do I pay the membership fee in addition to my regular insurance premium?

Yes — the membership fee is separate from and in addition to whatever health insurance premium you’re already paying for coverage outside our practice.