What Is Direct Primary Care for Children, and How Does a Pediatric Membership Work?

Mother and child playing in waiting room

Wondering how direct primary care works for children? Dr. Sean Park of Lighthouse Pediatrics in Issaquah explains what a pediatric membership includes and how it fits with insurance.

When your child is sick and the next available appointment is days away, it is natural to wonder whether there is a different way to get care. Nearly every parent I talk with has a version of that experience, and it usually says more about how pediatric practices are organized than about the people working in them. Direct primary care organizes care differently, and this article explains how it works for children, what care looks like day to day, and how it fits alongside your insurance, so you can decide whether it suits your family.

What Direct Primary Care Means for a Pediatric Practice

In a direct primary care practice, families pay a flat monthly membership that covers their pediatrician's care, and the practice does not bill insurance for those services. That means no copays, no charges per visit for services included in the membership, and no surprise bills from our office. Many direct primary care practices do not have a billing department at all, which is part of why the model tends to feel simpler to families.

Direct primary care is a way of paying for pediatric primary care, and it works alongside health insurance rather than replacing it. You may also hear this kind of practice called concierge pediatrics. The terms are used loosely and practices vary, but concierge practices often charge a membership fee in addition to billing insurance for visits, while direct primary care replaces insurance billing with a flat monthly membership. I care for families across Issaquah, Sammamish, Bellevue, and the broader Eastside, and every member sees me, so the relationship stays with one pediatrician instead of changing from visit to visit.

Why Getting an Appointment Is So Hard, and What Changes in This Model

In a practice that bills insurance, the payment for each visit is set by the insurer, and the structure of the schedule follows from that. Practices generally need to see many children each day to cover their costs, which leaves little room for same-day openings or longer appointments. Having worked in insurance-based practice myself, I know how much of the day is shaped by how visits are paid for rather than by anyone's preference. When an appointment feels hard to get, it reflects how the system is built, not anything you did.

Because members pay a monthly membership instead of a fee for each visit, my schedule does not have to be built around fitting in as many visits as possible. I care for a smaller number of families, which leaves room for same-day and next-day sick visits, longer appointments, and follow-up between visits. I wrote more about why same-day access is so limited in Why It's So Hard to Get a Same-Day Pediatric Appointment.

What Care Looks Like Day to Day for a Member Family

Membership covers the everyday care most children need, and you see the same pediatrician each time. Members typically use it in a few ways:

Sick visits offered the same day or the next day, with extended time when a concern needs it
Well visits and routine vaccinations as part of the membership
Telehealth visits, along with phone, text, and email access for questions between visits
In-office lab testing and school, camp, and sports forms, without copays or separate bills
Follow-up on each concern, including developmental and behavioral questions

Having all of this in one place means a question that comes up between visits can be answered by someone who already knows your child. I go into why timely visits matter in Why Same-Day and Next-Day Visits Matter More Than Parents Realize.

Reaching Your Pediatrician After Hours

Children's health questions do not always arrive during office hours. Members can reach me by phone, text, or email after hours, and the main purpose of those conversations is triage: deciding whether what you are describing needs urgent care or the emergency room right away, or whether it can wait until I am next available. My role in those moments is to help you decide where your child should be seen and how soon, so you have someone who knows your child to talk it through with.

After-hours contact is not a substitute for emergency care. If your child has trouble breathing, is very hard to wake, or you believe it is an emergency, call 911 or go to the nearest emergency room. When you are unsure whether to go to urgent care or call your pediatrician first, Should I Take My Child to Urgent Care or Call the Pediatrician First? walks through how to think about it.

How Membership Works Alongside Your Insurance

A membership is not insurance, and I strongly recommend that families keep their health coverage. Insurance remains important for the care a primary care practice does not provide, including:

Emergency room care and hospital stays
Visits with specialists, including any referrals I make
Imaging studies and laboratory tests done outside our office
Unexpected or high-cost medical needs

I think of the two as working together. Having worked in insurance-based practice, I understand how coverage tends to work, and I help families think through out-of-pocket costs when a specialist referral, imaging study, or outside lab comes up. I can also provide the billing codes for the test or service being ordered, which a billing department uses to give you an accurate estimate, so you know what to expect before your child has it done.

If you are deciding whether to change your coverage, an insurance agent or financial advisor is the right person to talk to, since the best choice depends on your plan. I explain more about how the two fit together in Does Direct Primary Care Replace Health Insurance for Kids?.

What Membership Includes and Where to Find Current Pricing

The monthly fee covers the care described above, with no copays or separate charges for those services, and visits are covered regardless of how many your child needs in a month. Because fees can change over time, our membership page is the best place to see current pricing. For a closer look at what is covered and what is not, see What a Pediatric Membership Includes and What It Doesn't Cover.

Who This Model Tends to Fit

Membership tends to be a good fit for families who want a sick visit with their own pediatrician instead of urgent care, who would rather not manage copays and unexpected bills, or who want more time to talk through development, behavior, or mental health with someone who knows their child. Many also value having one pediatrician who follows their child over the years, which I describe in What It Means for a Pediatrician to Know Your Child Over Time. I look more closely at who tends to benefit, and who may prefer a traditional practice, in Is a Pediatric Membership Right for Your Family?.

It is not the right choice for every family. If you are happy with your current pediatrician and can usually get in when you need to, there is no reason to change, and the right fit is the one that works for your family.

How to Get Started

The first step is a free introductory meeting, offered virtually or in person, and booking one carries no obligation. It is a chance to ask how membership would work for your family, what it would cost, and whether it feels like the right fit. If you are wondering what the first few weeks look like, What to Expect When You Join: The Intro Meeting, Records, and the First Visit walks through it, and you can schedule through our free consultation page whenever you are ready.

About the Author

Dr. Sean Park is a board-certified pediatrician and founder of Lighthouse Pediatrics in Issaquah, Washington. His practice focuses on thoughtful, relationship-based care for children and families across Issaquah, Sammamish, Bellevue, and the broader Eastside.

Lighthouse Pediatrics is a direct primary care practice, where families pay a monthly membership instead of billing insurance for visits. Dr. Sean works with families to understand how that model fits alongside their insurance and what care looks like day to day, beginning with a free introductory meeting.