Some California patients are running into a new cost: annual fees to keep their doctor. Maya Mackrandilal got an email in 2021 saying her primary care doctor planned a $250 yearly fee, on top of insurance. With her husband also a patient, that meant $500 a year, so she found a new doctor in Los Angeles. These fees are spreading in major metros, with no standard for what they cover, creating a "wild west" for patients. Doctors point to low insurance reimbursements, administrative burdens and burnout. Telehealth and portal messaging added unpaid work, they said. California law does not prohibit these fees, but says they can cover administrative tasks only, not anything billable to insurance.