All fees are deducted monthly from a Credit Card (there is a 5% reduction in the fee if pre-paid for 1 year). There is no additional out-of-pocket expense besides the monthly fee for any services rendered by Dr. Serbin- no co-pays, co-insurance, deductible, etc. Although we do not participate with insurance plans, we accept as payment in full any insurance reimbursement for covered services, such as hospital newborn care. Of course, the member's health insurance continues to cover all specialist referrals, labs, x-rays, hospitalizations, etc. in the usual fashion.