For about ten years, the advice has not changed. Eat less, move more and come back next year. You followed it more often than anyone gave you credit for. The weight came back anyway. With it came a conclusion you have probably never said aloud, which is that the problem is you.
Now, the budget allows a different kind of doctor. The kind people mention at dinner charges $20,000 a year. It is fair to ask whether you need a concierge doctor for insulin resistance nobody ever tested. This piece answers for one situation: a decade of the same advice, a fasting glucose called normal and a fasting insulin that was never drawn. It sets both sides' year-one costs next to each other with the date of every price. The short version is that GoodLife Health sits between the $20,000 concierge practice and the $99 app, with quarterly labs and a clinician who stays. It measures fasting insulin before glucose turns abnormal, which is the test a history like yours is missing.
- A decade of advice with no fasting insulin drawn is advice nobody could check.
- What this situation lacks is a measurement and a clinician who follows it over time.
- Ultra-premium concierge retainers ran $4,000 to $25,000+ a year as of September 2026, with insurance on top.
- GoodLife Health is $299 a month ($3,588 a year) with four cardiometabolic panels a year in the fee.
- Medication, when indicated, is billed by your own pharmacy at its own price with nothing taken on it.
- If you want house calls and private urgent care, the concierge retainer is the better purchase.
Ten years of the same advice
The visit is familiar to most people who have lived this. The appointment is short and the panel is basic. The clinician looks at the fasting glucose and says the word you have heard every year: “Normal.” Then comes the advice, delivered kindly and with no numbers attached. Eat a little better. Walk more. We will look again next year.
None of this makes your clinician careless. In insurance-based primary care, a visit runs between eight and 18 minutes, according to the figures in our guide to the real ROI of a $299 membership. That leaves room to screen and very little room to follow anything up. The advice you were given is the advice that fits in the time available.
So you took it home and worked at it. You counted, walked, cut bread and tried the plans colleagues swore by. Some years the scale moved. Most years it drifted back. Each drift landed like a verdict. After enough of them, you stopped raising the subject at all.
That is a lonely place to arrive, especially for someone used to solving problems. People who run budgets, teams and households expect effort to produce results. When it does not, the obvious suspect is the person doing the work.
Now ask a different question about those ten years. Did anyone draw a fasting insulin? Did anyone repeat a test three months after you changed something, so you could see whether the change worked? If your history looks like this one, the honest answer to both is probably no. Fasting glucose was checked. Fasting insulin, the marker that can move before glucose turns abnormal, was not.
Our cost guide describes the price of doing nothing in exactly these terms. It names untreated insulin resistance and weight gain that compound for a decade before anyone gives them a name. That is a description of a measurement gap. It is a long way from a verdict on your character. You were asked to fix a number nobody had measured.
You were asked to fix a number nobody had measured.
What was missing was a number and someone to read it
Advice you cannot measure is advice nobody can adjust. If nobody knows your fasting insulin, nobody can tell you whether a change in how you eat, sleep or train is moving it. Your effort may have been doing more than the scale showed. It may have been doing less. Nobody could say, because nobody was reading the number.
One reading is a snapshot. A fasting insulin drawn once and read beside A1C gives a clinician something to interpret. The same markers drawn again 90 days later show direction, which is the one thing a decade of annual visits never gave you. A line of readings turns advice into an experiment you can check.
This is where medicine is heading for people in your position. The direction is testing before treating, with fasting insulin and ApoB read where fasting glucose and LDL once stood alone. The economics are moving too. By September 2026, the makers of Wegovy and Zepbound were publishing their own self-pay prices for patients who buy direct. Care can now be priced as a relationship, with the medicine bought separately at a price anyone can look up.
That is the lens to put on the concierge question. Ask what each fee buys toward the measurement you were missing.
What a concierge retainer buys
As of September 2026, ultra-premium concierge practices published retainers from $4,000 to more than $25,000 a year. A $20,000 retainer sits well inside that range. The published model buys private urgent care, house calls and a physician who caps the practice at about 50 families. Separate insurance is still required. Specialty care is still billed.
Mid-tier networks such as MDVIP, SignatureMD and PartnerMD published retainers of $1,500 to $5,000 a year in the same month. That fee lets a local physician shrink a panel of roughly 2,500 patients to between 300 and 600. It buys 30- to 60-minute appointments, direct phone access and an annual wellness exam. Visits are still billed to insurance. Ongoing labs vary by physician.
Concierge medicine sells time and access. Both are real and both are worth paying for if they are what you need. Neither one guarantees the test your history is missing. A concierge physician with an hour to spend may order a fasting insulin the first time you ask. Another may spend the hour on the advice you already have, delivered more warmly. The retainer buys the conversation. What happens in it depends on the physician.
If you are weighing a practice, ask four questions before you sign. Is fasting insulin drawn routinely or only on request? How often are labs repeated? Who pays for each draw? Will the same physician read every result? The answers matter more than the size of the retainer. For someone who has spent ten years being told to try harder, the useful purchase is a number read every quarter by a clinician who remembers the last one.
Fasting insulin is in the panel because it can move before glucose turns abnormal. A normal fasting glucose, read alone, leaves the question of insulin resistance open.
What $299 a month does about it
GoodLife Health is a clinician-led, flat-fee membership at $299 a month, available in all fifty states. It is precision direct primary care for cardiometabolic optimization, which means diagnosis first, then treatment, then the long haul. For your situation, the line that matters most is the panel. Four cardiometabolic panels a year are part of the fee. Each one measures fasting insulin and reads it beside A1C, so a change can show before glucose turns abnormal. The same draw includes Apolipoprotein B (ApoB), Lipoprotein (A) and Hs-CRP for cardiovascular risk. It also includes TSH With Reflex To Free T4 for the thyroid. Every result is in your hands as a number.
The clinician who reads your first panel reads the fourth. Between video visits, the care team answers by message. That continuity turns four blood draws into a line you can follow. It is the part a decade of short visits could not provide.
What the membership returns is specific. If the numbers point to insulin resistance, you leave with a diagnosis that has a name and a value attached. Whatever you change next, the panel 90 days later shows whether it moved. You do not repeat the eight-minute visit, because the clinician is working from your results over time.
Treatment comes second. If a clinician judges medication indicated, it is a branded, FDA-approved medication prescribed to the pharmacy you choose at that pharmacy's own price. GoodLife Health sets nothing, sees nothing and takes nothing on it. We call this Medication-Neutral Pricing. The fee is the same whatever medication is indicated and whatever the dose.
For reference, here are the manufacturers' own self-pay prices as published in September 2026. Through NovoCare, Wegovy pens were $199 a month for the first two fills (an introductory offer for new patients through December 2026) and $349 a month after that. The Wegovy pill started at $149 a month at lower doses. Through LillyDirect, Zepbound vials were $299 to $449 a month depending on dose. If no medication is indicated, your membership fee for the year is $3,588.
The membership has limits worth knowing before you compare. It does not replace insurance. It pairs with your plan, which stays in place for specialists, imaging and the hospital. It is not full-scope primary care. House calls and private urgent care are what the concierge retainer buys. This membership is delivered by video visits and messages. Nobody is accepted automatically. The path is the eligibility check, the intake, the checkout and then a clinician's review. No result is promised, whether weight loss, remission or a cure.
Set side by side for year one, with the date of every price, the two choices look like this.
Year one, both sides, every price dated
| Option | Annual fee | What the fee buys | Billed on top | Year one |
|---|---|---|---|---|
| GoodLife Health membership (current price) | $3,588 ($299 a month) | A clinician who stays, four cardiometabolic panels a year with fasting insulin, messaging and video visits | Any medication, billed by your pharmacy at its own price. Insurance for specialists and the hospital | $3,588 plus any medication and your insurance |
| The $20,000 concierge practice (ultra-premium range of $4,000 to $25,000+, September 2026) | $20,000 | Private urgent care, house calls, a physician capped at about 50 families | Separate insurance required. Specialty care billed | $20,000 plus your full insurance cost |
| Mid-tier concierge (September 2026) | $1,500 to $5,000 | A smaller panel, longer visits, direct phone access, an annual wellness exam | Visits billed to insurance. Ongoing labs vary by physician | The retainer plus your full insurance cost |
Both totals sit on top of your insurance, because neither choice replaces it. For scale, the KFF 2025 Employer Health Benefits Survey puts the average employee's premium contribution at $1,440 a year and the average deductible at $1,886. Those costs apply whichever way you go. What should decide it is which fee builds the reading you never had into the price.
How to decide and what to do this week
Start with something you can do whether or not you join anyone. At your next appointment, ask your current clinician to add a fasting insulin to the fasting glucose and A1C. Ask whether your plan covers it and what it costs if not. When the result comes back, ask for the number itself. The word normal describes a population range. Your number describes you.
Then write the decade down. List the years, the weights you remember and the plans you tried. It takes an evening. It turns ten years of private guilt into a history a clinician can read.
Then decide what you are buying. If you want house calls, private urgent care and a physician capped at about 50 families, a concierge retainer is a sound purchase. Ask the four questions first. If what you need is the measurement and a clinician who follows it, you do not need to spend $20,000 a year to get it.
Timing matters here more than it seems. You have already given this ten years. Each quarter without a reading is another quarter of guessing. The first panel is the baseline every later reading is measured against.
Who this is not for
This membership is the wrong purchase for several kinds of reader. If you are healthy, see a doctor twice a year and take no medication, you will not recoup $3,588. Keep the care you have.
If you want house calls and private urgent care, buy the concierge retainer. That is what its price pays for.
If you want a prescription by the end of the week without a blood draw, a low-fee app will suit you better. How a company is paid shapes what its clinicians are rewarded for, as our whitepaper on how GLP-1 telehealth companies make money explains. A company that earns a margin on the medicine is rewarded for the prescription. We earn the same fee at every dose and whether or not anything is prescribed, which is why the first step is a blood draw. We prescribe branded, FDA-approved medication only. Compounded GLP-1 is not part of the model.
If you want to drop your insurance, this does not replace it. If you want one practice for every complaint, look for a general practice. If you live outside the United States, we cannot care for you, because we serve residents of the fifty states only. If you want a promised result, we cannot offer one.
What it costs and why now
The membership is $299 a month. At sign-up, $598 is held on your card for the first two months. It is charged only once a clinician accepts you into care. If the clinician cannot accept you, the hold is released and you are never charged. Once you are accepted, the first two months are charged and are non-refundable. From month three, the membership is month to month. Medication billed by a pharmacy follows that pharmacy's own return and refund policy. The fee buys four cardiometabolic panels a year with fasting insulin in each, every result in your hands and a clinician who stays. Any medication is prescribed to your pharmacy at that pharmacy's price with nothing taken on it. In return, you get what a decade of visits never produced: a diagnosis when the numbers support one, markers followed every 90 days and an end to the eight-minute visit. The difference is that we test first, treat second and sell neither the drug nor the dose. You have spent ten years guessing. A first panel gives you the baseline the next ten years can be measured against.
Related Reading
- The Real ROI of a $299/Month Health Membership: Every Alternative, Priced Honestly
- How GLP-1 Telehealth Companies Make Money: A Plain-Language Whitepaper
References
- MDVIP — membership overview and fees. 2026. www.mdvip.com/
- NovoCare Pharmacy — Wegovy self-pay pricing (Novo Nordisk). 2026. www.novocare.com/pharmacy/wegovy.html
- Zepbound Self Pay Journey Program — LillyDirect vial pricing (Eli Lilly). 2026. zepbound.lilly.com/savings
- 2025 Employer Health Benefits Survey — Kaiser Family Foundation. 2025. www.kff.org/health-costs/2025-employer-health-benefits-survey/