Some cash upfront can get you to the head of the line. By Anne Kates Smith, Executive Editor May 1, 2010 Peter Carvara says he’s far from wealthy. But when his doctor, internist Alexander Davis switched his busy Overland Park, Kansas practice to concierge service last year, the 58-year-old marketing manager shelled out $1,500 to join. The fee covers a comprehensive physical plus follow-ups; Carvara’s health insurance with his employer, Hostess Brands, picks up most of the cost of sick visits and appointments with specialists.As part of the the national MDVIP network, which limits the number of patients to 600 per doctor—down from some 3,000 in the case of Carvara's physician—Carvara enjoys leisurely office visits and same- or next-day appointments. He has his doctor’s cell-phone number and carries his medical records on a wallet-size CD. The cost of the preferred treatment is roughly equal to a dinner out per week, says Carvara, “and it’s a better investment.” Also called retainer, boutique, direct or private medicine, the number of such alternative practices in the U.S. has grown to more than 5,000. Practice models run the gamut. While MDVIP’s service wraps around traditional insurance, the No Insurance Club, based in Arizona, charges $35 a month ($60 for a family) after an $80-a-year sign-up fee for 12 doctor visits a year, including in-office tests and services such as immunizations and blood work. Other doctors simply charge for their time. You can use your flexible spending or health savings account to reimburse concierge fees, if the money is spent on medical services and not simply to reserve future care.