Direct Primary Care · Fort Worth & DFW
Direct primary care, explained without the sales pitch
Direct primary care removes insurance billing from the exam room. You pay a flat monthly membership, your provider answers to you instead of to a coding department, and every price is visible before you agree to it.
Memberships from $19.99/month · Transparent pricing · Not insurance
The short answer
Direct primary care at Presence means a membership relationship with one board-certified Adult-Gerontology Primary Care Nurse Practitioner instead of a different face each visit. Unlimited plans include 24/7 virtual access, longer appointments and medically appropriate local visits without a per-visit charge. Dues are a private fee and are never billed to a plan.
- Who it is for
- People in the Dallas–Fort Worth area, aged 13+, who want one provider who knows their history and enough time in each visit.
- When it may not fit
- Anyone wanting a specialist, hospital care or an insurance substitute, and anyone outside the metro for in-person visits.
- What it costs
- From $19.99 a month; local visits are $129 each on Virtual Family Care, two included annually then $99 each on Virtual + Local In-Office Care, and included without a per-visit charge on Unlimited plans; one-time $49 clinical onboarding before the first in-office visit.
- What to do next
- Join, or meet the provider first.
In an emergency call 911 or go to the nearest emergency department.
Prices and material terms
- Member in-person visit$99In the Dallas–Fort Worth area, on Virtual plans.
- One-time clinical onboarding$49Medical history review before a first in-person visit.
- Without a membership$149A single in-person visit, no commitment.
Local in-person care is for ages 13 and older. Unlimited plans include medically appropriate local visits with no per-visit charge. Membership is not insurance and does not cover hospital, surgical, specialist or emergency care.
Caring for older adults is a privilege and an honor.
Every season of life brings a different story and different needs. Presence makes room for unhurried care, ongoing support and the time each stage deserves—given gladly, with dignity and respect.
What direct primary care actually is
In a traditional practice, the visit is a billable event. Revenue depends on volume, so appointments compress to whatever the schedule allows and your access is mediated by a front desk, a portal and a claims process. Direct primary care (DPC) changes the economics: members pay a flat monthly fee directly to the practice, the practice does not bill insurance for that care, and there is no incentive to convert your questions into separate appointments.
The practical result is fewer patients per provider, longer visits, and direct access — you can ask a question without booking anything. That is the entire idea. Everything else, including how Presence adds 24/7 virtual care on top, is implementation.
Flat monthly membership
One predictable price covers the primary care included in your plan. No copays for included care, no surprise statement six weeks later.
Direct access to care
Reach a provider by phone or video, 24/7/365, without a per-visit charge for included virtual care.
Prices you can see
The $99 member visit rate, the one-time $49 onboarding, member pricing on labs and imaging — all published rather than quoted after the fact.
DPC vs concierge vs insurance-based primary care
These three get blurred in marketing copy, so here is the honest separation. Concierge practices typically charge a high annual retainer and still bill your insurance. Traditional practices bill insurance for everything. DPC charges a modest monthly membership and does not bill insurance for member care.
| Insurance-based practice | Concierge practice | Direct primary care (Presence) | |
|---|---|---|---|
| Typical cost | Copays, deductibles, billed visits | Often $1,500-$5,000+ per year, plus insurance billing | $19.99-$219 per month depending on plan |
| Bills insurance for your primary care | Yes | Usually yes | No |
| Visit length | Often short and tightly scheduled | Long | Unhurried, with a smaller panel per provider |
| After-hours access | Answering service or urgent care | Varies by practice | Unlimited 24/7/365 virtual care included |
| Price transparency | Usually unknown until billed | Retainer known, care costs vary | Published membership and member rates |
Cost ranges for other models are general market descriptions, not quotes for any specific practice, and vary widely. Presence prices are our own and are listed on pricing. A fuller side-by-side is on compare options.
What DPC does not do
This part matters more than the benefits, because people get burned by assuming otherwise. A direct primary care membership is not health insurance. It does not pay for hospitalization, surgery, emergency care, specialist fees or catastrophic events. Most Presence members keep some form of coverage for those costs and use membership for the care they actually touch every year.
DPC membership covers
- Primary care visits included in your plan
- Unlimited 24/7 virtual care with no per-visit charge
- Preventive planning, chronic condition follow-up and medication management
- Member pricing on labs, imaging and many medications
- Referrals and coordination when you need specialty care
DPC membership does not cover
- Hospital stays, surgery or emergency room care
- Specialist visits and their fees
- Imaging or labs beyond the member-priced options offered
- Anything a health insurance plan would pay for — this is not insurance
- Controlled-substance prescriptions via virtual visits
How joining works at Presence
Pick a plan
Virtual Family Care at $19.99/month; Individual Unlimited at $79 for ages 19–44, $89 for ages 45–64 or $109 for ages 65+; Virtual + Local In-Office Care at $29.99; or Family Unlimited at $219 for up to five, plus $29 per additional child after five — full details on pricing.
Complete clinical onboarding
A one-time $49 medical history review before your first in-person visit, so the first appointment isn't spent on data entry.
Use 24/7 virtual care immediately
Unlimited, from anywhere, with no per-visit fee for included virtual care.
Build the local relationship
In-person visits happen at the North Richland Hills practice with the same provider — see local primary care, or call 817-900-6368.
Explore membership primary care
Whatever brought you here — no insurance, appointments you cannot get, visits that feel rushed, or a parent whose care nobody is coordinating — start with the answer that fits.
Start Here
What membership primary care is, and how the monthly model works.
Time & Relationship
Longer visits, and one provider who carries your history forward.
Paying Without Insurance
Self-pay prices, what membership covers, and what it does not.
Older Adults
Unhurried care for people managing several conditions at once.
Families & Caregivers
Coordinating care for a parent, or for a whole household.
Labs, Imaging & Follow-Up
Blood work and imaging at member pricing, with results explained.
Local & Virtual Care
In-person primary care in DFW, plus virtual care across Texas.
Learn
Plain-English answers, including the comparisons people ask about.
Direct primary care questions
Is direct primary care worth it if I already have insurance?
For many people, yes — because insurance rarely fixes access. Membership gives you 24/7 reachability and unhurried primary care, while your coverage stays in place for hospital, emergency and specialty costs.
Can I use my insurance at Presence?
Presence does not bill insurance for membership care. Labs, imaging, medications and referred specialty care may still be billed to your plan by those providers depending on where you go.
Can I use an HSA or FSA?
Rules for membership fees vary and change. Ask your plan administrator or tax advisor before assuming a membership fee is eligible — we cannot give tax advice.
How is Presence different from other DPC practices in Fort Worth?
Most DPC practices are in-person only, with after-hours access limited to whatever your provider can personally answer. Presence pairs local direct primary care with unlimited 24/7 virtual care through a participating clinician network, at membership prices starting well below typical DPC rates. See compare options.
Is there a contract?
Membership is a 12-month commitment billed monthly, then continues month to month. Material terms are shown next to every price.
Who is my provider?
Local care at Presence is provided by Melissa Presence, a board-certified Adult-Gerontology Primary Care Nurse Practitioner. Her background is on the provider page.
About this information
Written by the Presence care team for patients considering care with us. Presence care is delivered by licensed providers, including a board-certified Adult-Gerontology Primary Care Nurse Practitioner — not by a physician, and not by software. Meet your provider.
This page explains how our service works. It is general information, not a diagnosis, and it is not a substitute for an evaluation of your own situation. Whether testing, treatment or a prescription is appropriate is decided during a visit.
If this is an emergency — chest pain, trouble breathing, stroke symptoms, severe bleeding, or thoughts of harming yourself — call 911 or go to the nearest emergency department. See our emergency care notice.
Primary care without the billing machine
Join Presence direct primary care, or call and we'll answer the questions this page didn't.