Step by step
You enroll and share your history
Membership starts with a clinical intake: current medications, conditions, allergies, surgeries, family history and what you want from care. At Presence this is a one-time $49 clinical onboarding and medical history review completed before your first in-person visit, so your provider is not meeting you cold.
You get a way to reach care that does not involve a queue
This is the part people notice first. Instead of calling a front desk to request an appointment slot, you contact the practice directly. Presence members can reach a licensed provider by phone or video 24/7, and virtual visits included in the membership carry no copay.
Visits are longer than the industry norm
Because the practice is not paid per encounter, appointments are not compressed to fit a billing target. A first visit commonly runs longer than a follow-up, and the aim is to finish the conversation rather than to finish on schedule.
Labs, imaging and medications are quoted in advance
Membership practices typically negotiate cash rates with labs, imaging centers and pharmacies. You are told the price before the order is placed, which is the opposite of the usual sequence. Savings vary by service and facility, and Presence quotes them case by case rather than advertising a fixed discount.
Anything beyond primary care is referred out
If you need a cardiologist, an MRI read, surgery or hospital care, your provider coordinates and refers. Those services are billed by the specialist or facility. Your membership does not pay for them.
What a normal year looks like
For most members the year is unremarkable and that is the point. A sinus infection in February handled in a nine-minute video call. A blood-pressure medication adjusted in April after a home reading trend. Labs in June with the price known in advance. A preventive visit in the fall. Two or three quick questions in between that never became appointments because they did not need to.
The value shows up as friction removed rather than as a dramatic event. That is also why the model suits people who currently delay care because of cost or scheduling: a visit that costs nothing extra at the moment of need gets used at the moment of need.
Where in-person care fits
Virtual care handles a large share of primary care well, but not all of it. Anything that requires a hands-on exam, an in-office procedure, or a physical assessment belongs in a room. Presence offers in-person primary care at its practice in North Richland Hills for ages 13 and older. On the $19.99 household plan those visits are $129 each; the $29.99 plan includes two a year and then $99 each; Unlimited plans include local visits with no per-visit charge. Details are on local primary care.
| Situation | Usually handled virtually | Usually needs in-person |
|---|---|---|
| Cold, cough, sinus symptoms | Yes | If symptoms worsen or a lung exam is needed |
| Rash you can photograph | Often | If diagnosis is unclear or a biopsy is considered |
| Blood pressure follow-up | Yes, with home readings | Periodically, for a physical assessment |
| Annual preventive visit | Partly | Yes, for the exam component |
| Chest pain, trouble breathing | No | Emergency care immediately |
Never wait on a virtual visit for symptoms that could be an emergency. Call 911 for chest pain, trouble breathing, stroke symptoms, severe bleeding or sudden severe symptoms.
What happens if you also have insurance
Nothing breaks. A membership sits alongside a plan; the practice simply does not bill it for included care. Labs, imaging, prescriptions and specialist care can still run through your insurance if that is cheaper for you, and sometimes it is. The detail on this is in can you use direct primary care with insurance.