This page is scaffolding for a business model you have not committed to. None of it is launch-ready. A retainer or membership practice is a legal structure first and a web page second, and the structure has to be built with a healthcare attorney licensed where you practise before any of this is published.
Corporate practice of medicine. California, like most states, restricts non-physician entities from owning a medical practice, employing physicians, or influencing clinical decisions, and restricts fee-splitting. If membership would run through a management company, an MSO, or a third-party concierge platform, the whole arrangement — who owns the professional entity, who holds the patient relationship, how the platform is compensated — needs review before you price anything.
A retainer can be characterised as insurance. A flat fee paid in advance for an undefined quantity of future services can be treated by state insurance regulators as risk-shifting, which is the business of insurance and requires licensure you do not hold. States differ; some have direct-practice statutes that create a safe harbour, and what the fee actually buys (clinical services versus access and administrative conveniences) determines which side of the line you fall on. Ask counsel for a written opinion specific to your state, and keep it on file.
Medicare. If you will ever see a Medicare beneficiary, membership fees interact with Medicare rules — including whether you must formally opt out (affidavit plus written private contracts, on a renewable term) and what you may charge for services Medicare would otherwise cover. Federal enforcement guidance has addressed membership fees charged to beneficiaries for services already covered. Settle your Medicare status before you set a price, not after.
You need a written membership agreement, drafted by a healthcare attorney. Not a web page — a signed agreement that states exactly what the fee buys and what it does not, that it is not insurance and not prepayment for medical services, how it is billed, prorated and refunded, how either party ends it, and how you will meet continuity-of-care obligations so that termination is not patient abandonment. Everything on this page must then match that agreement word for word. State medical board advertising rules apply to every claim made here.
If you decide against it, delete the page rather than leave it unlinked. Remove concierge.html; then remove the Concierge Care entry from the Care dropdown in the shared header (_archive/SHELL.md section 2) and from the Practice list in the shared footer (_archive/SHELL.md section 3), so future pages do not reintroduce it; then remove both links from every page already carrying that shell — index.html, about.html, services.html, fees.html, research.html, resources.html, faq.html, contact.html, and every file under legal/ and resources/. Finally drop the /concierge.html entry from sitemap.xml. An unlinked file still ships: it is indexable and guessable.
Concierge membership
[NOT LAUNCH-READY — THIS STATEMENT STAYS VISIBLE IN ?clean PREVIEW ON PURPOSE. This page describes an arrangement the practice has not committed to and for which no written membership agreement exists. Nothing below may be presented to a patient as available until a healthcare attorney has drafted that agreement and you have signed it, and until every bracketed instruction on this page has been replaced with wording that matches it. Decide first whether membership will exist at all: if it will not, delete this file, its sitemap.xml entry, and the Concierge Care links in the shared header and footer; the internal note on this page lists every file to touch, and is visible when the page is viewed without ?clean. Do not remove this paragraph without replacing it with a true statement of what is actually offered.]
Most people do not need this. A standard outpatient arrangement — scheduled appointments and a defined way to reach the office between them — is the right structure for the large majority of psychiatric care, and choosing it does not mean receiving less careful treatment. [Decide and state plainly whether membership is something this practice offers, offers to a limited group, or does not offer at all. Treatment and service availability is one of the claims a medical board will read literally, so this page must not describe an arrangement that does not exist yet.]
A smaller group is genuinely poorly served by the standard structure: patients managing several interacting diagnoses or medications, patients under the care of more than one clinician where decisions have to be coordinated rather than relayed, patients in the middle of a difficult medication change who need to be heard from in days rather than weeks, and patients whose work makes conventional appointment times unworkable.
[Unapproved draft wording — every clause below is a service commitment, so publish only the ones the signed agreement actually contains and delete the rest: "What membership is intended to buy is time and access — longer appointments, a direct route to the physician, and the administrative work of keeping your other treaters aligned. It is not intended to buy a different clinical opinion, and it does not shorten the diagnostic process. The evaluation is the same evaluation."]
What a membership could include
[None of the five cards below is offered today — each is draft wording for an arrangement that does not exist yet, and each is a commitment about how the practice runs. Keep only the ones the signed agreement contains and that can be sustained every week, including weeks with research obligations; delete the others outright rather than softening them.]
Extended appointments
[Draft, not offered: "Visits scheduled with enough time to review the whole picture rather than the immediate problem — medication response and side effects, sleep, function at work and at home, and whatever has changed since the last visit."]
Direct access between visits
[Draft, not offered: "A way to reach the physician directly between appointments about a side effect, a dose question, or a change in symptoms — without routing through a general office line."]
Appointments when they are needed
[Draft, not offered: "Time protected in the schedule so that an urgent change in symptoms or a medication problem can be addressed promptly rather than at the next routine opening."]
Coordination with your other clinicians
[Draft, not offered: "Direct contact with your therapist, primary care physician, neurologist, or surgeon so that decisions are made from the same information rather than relayed through you."]
Annual comprehensive review
[Draft, not offered: "A longer appointment once a year to re-examine the diagnosis rather than continue it: the medication history end to end, what has worked and what has not, and whether the current plan is still the right one."]
What membership does not change
It does not change clinical judgement. An access arrangement changes scheduling and contact. It does not buy a particular diagnosis, a particular medication, or a conclusion arrived at in advance. The recommendation is the same recommendation you would receive without it.
It does not guarantee any treatment or prescription. No treatment is promised before an evaluation. This applies with particular force to controlled substances — stimulants, benzodiazepines, and similar agents — which are prescribed only where clinically indicated, under the same monitoring, documentation, and prescription-monitoring-programme requirements that apply to every patient, and are not prescribed where they are not indicated. [Write one or two sentences stating your actual controlled-substance policy — whether you initiate these prescriptions at all, what monitoring you require, and what you do with a transferring patient already on them. Membership pages attract exactly this enquiry, and a clear published policy prevents most of it.]
It does not include emergency or crisis care. This is an outpatient practice. Membership does not create a 24-hour service and does not substitute for emergency care. If you are in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), call 911, or go to your nearest emergency department.
It is not insurance. A membership fee is not a health plan, does not pay benefits, and does not cover the cost of medical services. [Insurance and billing: state whether the practice participates in any network, whether patients receive a superbill for out-of-network reimbursement, and your Medicare enrolment or opt-out status. Have counsel confirm the wording — a retainer described as covering future medical services is the phrasing most likely to be read as an unlicensed insurance product.]
It does not affect research participation. Dr. Pellionisz's neuromodulation work — low-intensity focused ultrasound, fMRI connectivity-guided TMS, and kTMP — is conducted under research protocols at academic centres. Membership confers no eligibility, no priority, and no place in any study. Eligibility is determined by protocol criteria and institutional review board rules and cannot be purchased. [Research/clinical firewall — state plainly, here and on /services.html, which treatments are available to a patient of this practice clinically, and which exist only as research protocols you take part in elsewhere. A reader who leaves this page believing that membership is a route to TMS or focused ultrasound has been misled, and that is the highest-risk misreading on the site.]
Membership and fees
[No fee has been set and no membership agreement exists, so nothing in this list is quotable to a patient yet. Every line below must match the signed agreement exactly before it is published; where the page and the agreement differ, the page is the one a patient will quote back.]
- Fee structure [State the structure and the amount — monthly, quarterly, or annual retainer, the exact figure, when it is billed, and whether the first payment falls due before or after the initial evaluation. Do not publish this page with the number missing: an unpriced membership page generates enquiries you then price inconsistently over the phone.]
- What the fee covers [List precisely which services the retainer includes and which are billed on top of it. This is the distinction patients dispute afterwards, and the one your attorney will want drawn most sharply — a retainer that reads as prepayment for medical care is the version most likely to be characterised as insurance.]
- Per-visit fees [Give the session charges that apply in addition to membership, with session lengths — or link to /fees.html and keep a single source of truth. The federal No Surprises Act requires a written Good Faith Estimate for self-pay patients, so these figures must match what you actually bill.]
- Insurance and Medicare [State network participation, superbill practice, and Medicare enrolment or opt-out status. If any Medicare beneficiary could enrol, confirm with counsel first whether a formal opt-out is required and what the retainer may lawfully cover for that patient.]
- Availability [Say whether membership is capped and, if so, at what number, or simply whether enrolment is currently open or closed. Do not imply scarcity you have not actually created — a published cap is a representation, and it has to be true and kept current.]
- How enrolment begins [Describe the real sequence — for example a brief introductory call, then an initial evaluation, then a decision by both parties — and state that membership begins only when the written agreement is signed. Name the contact route, and ask people not to include clinical detail in a first email.]
- Term, cancellation and refunds [State the term, the notice either side must give, whether unused fees are refunded or prorated, and what happens to continuity of care when membership ends. Your attorney should draft this; reproduce it here rather than paraphrasing it, and make sure the ending provisions do not leave you exposed to a patient-abandonment claim.]
Nothing on this page is an offer of treatment or a contract. A physician–patient relationship begins only after an evaluation and, where membership applies, a signed agreement.
Most patients are well served by the standard practice
A standard outpatient arrangement — scheduled appointments and a defined way to reach the office between them — is the right structure for the large majority of psychiatric care.
[Do not publish an invitation to enquire about membership until membership exists and the signed agreement defines it; an enquiry you cannot answer consistently is worse than no page. When it exists, replace this paragraph with the real first step. If it never exists, delete this page rather than leaving this band to collect enquiries.]