$598 is a real amount of money and paying it before you have met anyone is a legitimate reason to hesitate. Below is what the first charge covers and what it protects you from. We will not talk you out of the hesitation. The decision is yours.
- The $598 is one charge that covers the first two months of membership at $299 a month.
- It is held on your card at sign-up and charged only once a clinician accepts you into care.
- The first two months are charged and non-refundable once you are accepted and we say so plainly.
- After month two the membership is month to month at $299 and you can cancel anytime.
What the $598 actually buys
The first charge covers the first two months of the Cardiometabolic Optimization Membership. It is not two payments and it is not a deposit on top of the monthly fee. It is the first $598 of a $299-a-month membership, collected at once because the two-month start is the commitment the clinical model asks for.
Within those two months, three things happen that a single visit cannot deliver. First, your intake. A clinician licensed in your state reviews your history, your medications and what you have already tried, in more time than an eight-minute visit allows. Second, your first Biomarker Audit. A panel of nine biomarkers including Hs-CRP, Comprehensive Metabolic Panel, TSH With Reflex To Free T4, Fasting Insulin, Lipoprotein (A), Hemoglobin A1c (HbA1c), Lipid Panel, Standard, Apolipoprotein B (ApoB) and CBC (Includes Differential And Platelets), drawn at a Quest Diagnostics patient service center near you. Third, the protocol. The plan built from those results, explained to you, with every number in your hands.
The reason for the two-month shape is that the first panel and the first protocol take that long to prove themselves. A clinician who sees your labs once can guess. A clinician who is still working with you in week seven has ordered the follow-up, answered the message you sent on a Tuesday and adjusted the plan when the first read was incomplete. That is what the second month is for.
The hold, in both halves
This is the part we ask you to read twice, because half of it comforts and half of it does not.
The $598 is held on your card at sign-up. It is charged only once a clinician accepts you into care. If you cannot be accepted, the hold is released and you are never charged. Not everyone is accepted. The path is the eligibility check, the intake and then a clinician's review and some applications end there. If yours does, the money was never taken.
Once you are accepted, the first two months are charged and non-refundable. That is the other half. The two-month start is a commitment in both directions and we would rather lose the sale than pretend otherwise. Medication, when it is prescribed later, is billed by your pharmacy at the pharmacy's own price and follows that pharmacy's own return policy.
We are direct about this because a membership that hides its refund rule is a membership you will eventually resent. The number you were quoted is the number on the card.
Why two months instead of one
You could ask why the membership does not start as a simple month to month from day one. The honest answer is that month one alone produces a panel and a conversation and a panel and a conversation are exactly the kind of transactional medicine we built this to replace. The 90-day Biomarker Audit is designed to be repeated four times a year so that trends emerge. The first quarter is when you and your clinician find out whether the protocol is working and a clinical relationship that ends at day thirty never gets to that answer.
There is a second reason and it is about us rather than you. Our fee covers the clinician relationship, the quarterly panels, asynchronous messaging and video visits and it never rises with a prescription because medication is billed by your pharmacy separately with zero markup to us. A membership that front-loads its first two months and then runs month to month has no incentive to churn you quickly or to upsell a dose. The $598 is where our incentive to keep you ends and month-to-month is where yours begins.
If the math of the flat fee interests you, our guide to what $299 a month buys over 24 months works through the year-one and year-two figures in detail. The short version is $3,588 in year one, with four Biomarker Audits included and no change to the fee whatever is prescribed.
What it is not
The $598 is not a fee for the medication. It is not an initiation charge that recurs. It is not an insurance premium and it does not replace insurance for hospital care or emergencies. It replaces the primary-care relationship. It is also not refundable once you are accepted, which is why we ask the eligibility check to come first.
It is worth saying what it protects you from as well. The alternatives you have probably compared charge less at the start and more later. A program fee that climbs with the dose, a membership tier that gates the stronger pens, a lab add-on billed at each visit. Those models collect their real price in month seven. Ours collects it in month one and then stops moving. If you leave after month two, the two charges you made are the only ones we ever made.
The direct primary care model this membership is built on has a simple design principle. When the patient pays the practice directly, the practice's time belongs to the patient rather than to a throughput target. The American Academy of Family Physicians describes direct primary care as a model built on a flat periodic fee for defined clinical services, with no fee-for-service billing. That design is why our clinicians have time to explain a panel rather than flag it.
Who should wait
If $598 would strain your budget this month, wait. A membership you cannot pay for comfortably is a membership you will cancel in month three and the clinical model only works across quarters. If your employer covers a concierge practice you already like, take that first. And if you are looking for a single prescription with no labs and no follow-up, the two-month structure will feel heavy for what you want and a prescription-only service fits better.
If the fit is real, start with the eligibility check. It takes a few minutes, it asks about your history and your state and a clinician reviews every application. If you cannot be accepted into care, the hold is released and you are never charged.
A membership you cannot pay for comfortably is a membership you will cancel in month three. The clinical model only works across quarters, which is why the two-month start exists.
Frequently Asked Questions
Is the $598 charged at sign-up?
It is held on your card at sign-up and charged only once a clinician accepts you into care. If you cannot be accepted, the hold is released and you are never charged.
What does the $598 cover?
It covers your first two months of membership. That includes the clinical intake, your first comprehensive Biomarker Audit, the protocol built from it, messaging with the care team and video visits. From month three the membership is $299 a month, month to month.
Can I get a refund on the first two months?
No. Once a clinician accepts you into care, the first two months are charged and non-refundable. Medication follows the pharmacy's own return policy. We say this plainly rather than softly because it is the term that matters.
Why not just offer a one-month trial?
Because the clinical model is quarterly. The first Biomarker Audit and the protocol need the full two months to show whether they are working and a thirty-day trial measures nothing.
Does the fee ever rise with my dose?
No. The membership fee is the same whatever medication is indicated and whatever the dose. There is no molecule upcharge and no dose upcharge, because medication is billed by your pharmacy separately at that pharmacy's own price.
What if I want to cancel after month two?
You can, anytime, with no penalty. The membership is month to month after the first two months and a cancellation takes effect at the end of your billing period.
Is the fee HSA or FSA eligible?
We do not promise it is. Your account administrator decides, so check with them before using those funds on the membership fee.
What happens if you change your mind
Because the non-refundable rule is the part people read twice, the paths after sign-up deserve their own plain description.
Before acceptance, everything reverses. The eligibility check costs nothing, the intake costs nothing and the $598 sits as a hold on your card rather than a charge. If a clinician reviews your application and cannot accept you into care, the hold is released and you are never charged. Nobody calls to retain you, because nobody was paid.
After acceptance, the first two months belong to the commitment. If you decide in week three that the model is not for you, you can say so, stop the membership at the end of month two and owe nothing further. The panels you have already received stay yours and so does the protocol your clinician built from them. Medication you have already collected follows your pharmacy's own return policy, which we do not control and will not pretend to.
Month two is the honest boundary. It is long enough for the first Biomarker Audit, the results conversation and at least one adjustment to the protocol and short enough that a mismatch costs you one month beyond the commitment rather than a year. A member who leaves in month three leaves for a reason we respect. A prescription faster than a diagnosis is not what we do.
There is also the path nobody advertises, which is staying. The quarterly rhythm is where the model earns its fee because the second audit is the first one with a trend line behind it. If you are still with us in month nine, the panels have drawn a picture of your cardiometabolic health that no single visit could produce and the fee has not moved once, whatever was prescribed.
One last thing
Before you pay anything, put the $598 against the number it would replace. A concierge practice in your zip code can quote up to $20,000 a year and a program that raises its monthly fee as the prescription climbs costs more each time the dose does. Our number is the largest single charge of a year and it happens once. That comparison, dated and in your own budget, is the only one that counts.
Related Guides
- What $299 a month buys over 24 months
- Cardiometabolic Optimization: the definitive guide
- Who the membership is and is not for
References
- Tirzepatide Once Weekly for the Treatment of Obesity (SURMOUNT-1). 2022. pubmed.ncbi.nlm.nih.gov/35658024/
- Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1). 2021. pubmed.ncbi.nlm.nih.gov/33567185/