Beyond Billing Codes: How to Thrive Without Insurance

1What happens when insurance won’t cover your services? In this episode, we explore how building a practice independent of insurance can actually give you more freedom, stability, and impact.

 Many healthcare professionals worry they can’t run a successful practice without billing insurance. But what if the opposite is true? In this episode, Dr. Tamar Lawful breaks down why shifting to a cash-pay or direct-pay model can protect your business and serve your clients better. From the history of health insurance to real stories of delayed payments, she explains why relying on insurance can leave both practitioners and patients frustrated. You’ll also hear practical steps to test a cash-pay option in your own practice without overhauling everything overnight.

What You’ll Learn in This Episode:

• Why the U.S. insurance system was never designed to support personalized or preventative care.
• How delayed payments and denials can put providers at financial risk.
• Answers to common concerns: losing clients, legality, credibility, and more.

Chapters

• 0:00 Reimagining Healthcare Beyond Medications
• 1:37 The History of Health Insurance
• 4:30 A Therapist's Insurance Nightmare
• 6:30 Common Questions About Direct Pay Models
• 9:43 Two Challenges for Practitioners
• 11:09 Next Episode Preview

Transcript

Speaker 1: 0:02

medications certainly have their place, but what if there was a way to support your body naturally by working with your genetics?

Speaker 2: 0:10

we are a pill for an ill society.

Speaker 1: 0:13

We take 18 pills per person per american per day it was so hard to find somebody who took my insurance and for me to get well, it took thousands of dollars and and I thought, what do regular people do? This is not right.

Speaker 2: 0:25

Despite my best efforts, I wasn't actually reversing disease and helping people to heal in the way that I thought I would.

Speaker 1: 0:32

We want to empower yourselves to take care of this root cause. We don't just want to cover it up. If you're ready to break free from outdated, one-size-fits-all health care, you're in the right place. Welcome to Raise the Script with Nutrigenomics, brought to you by InHer Glow® , by LYFE Balance. Here's a literature from we are all unique, right down to our DNA, so it's no wonder we respond differently to the same medications, foods and environments. How do you discover what your body needs? Which medications, foods, supplements? How do you discover what your body needs, which medications, foods, supplements or exercises are right for you? How can you manage chronic conditions without piling on more prescriptions? That's what we're here to explore. I'm your host, Dr. Tamar Lawful, doctor of pharmacy, nutrigenomics specialist, and your partner in reimagining how we personalize care for better outcomes. Whether you're a patient or a practitioner, let's raise the script and bring healthcare to higher levels together, because the future of health is personal. Welcome to Raise the Script with Nutrigenomics. I am Dr. Tamar Lawful, doctor of pharmacy, nutritional genomic specialist, and your partner in reimagining health. So it works for both you and your clients.

Speaker 1: 1:52

Today, we're talking about something that can make healthcare professionals a little nervous. Running a practice without billing insurance Now, before you think, but Tamar, that's impossible. Billing insurance Now? Before you think, but Samar, that's impossible. I want you to imagine this it's Monday morning and you open your inbox to see an email saying insurance will no longer cover 60% of what you do. No warning, no transition period just gone. Would your business still stand or would you be scrambling to keep the lights on? That's why today, we're going to break down why building a model independent of insurance can be one of the smartest moves you ever make and how you can still serve your clients without them feeling left in the cold. So let's start with a little history, because I really feel like it's important to understand how we got here and why this conversation about insurance even matters in the first place. So history lesson okay.

Speaker 1: 3:01

Health insurance in the United States really took off in the 1940s and 50s, tied to employer benefits as a way to attract workers during wage freezes. So at first it was pretty straightforward Insurance paid their doctor directly and people paid small copays. But as the decades rolled on, the system became more complex. Layers of billing codes, prior authorizations, provider networks and compliance requirements crept in. And here's the key part. The entire structure was built around illness care. It was never intended to cover long, in-depth consultations or preventative lifestyle services. Even now, according to the Kaiser Family Foundation, only about 3% of national healthcare spending goes toward preventative services. The other 97% goes toward treating existing illness. So if you're delivering anything truly personalized, like genomic-based coaching using pharmacogenomics or nutrigenomics, nutrition plans or long-term behavior change programs, it often doesn't fit neatly into an insurance-approved box, and if it doesn't fit the box, it doesn't get paid. I've seen firsthand how that can hurt both the provider and the client.

Speaker 1: 4:30

One of my health coaching clients was a therapist with her own practice. She was fantastic at what she did, highly sought after, loved by her clients. But here's the problem it was May and she still hadn't been paid for services she provided the previous October. Think about that for a second. Seven months without payment for work she had already done. And she's not alone. In 2022, the American Medical Association reported that one in five claims are either delayed or denied by insurers, and appealing them can take weeks or months. In the meantime, she still had to pay rent for her office, she had employees counting on their paychecks and she had her own bills, her own life but no income coming in from months of hard work. Her business was struggling. She was stressed and she told me I feel like I'm running on a hamster wheel, doing the work but not getting anywhere. That's when she started to consider shifting her business model. She began offering direct pay options for clients who wanted to bypass insurance entirely, and they said yes. Some used their HSA or FSA, some paid out of pocket, but within a few months her cash flow improved. She was able to pay her staff on time and she had consistent income for herself again. That's the difference a non-insurance model can make.

Speaker 1: 6:03

So I have two challenges for you this week. The first challenge is to take five minutes to pull up your current service list. Highlight everything that isn't covered by insurance or is often denied. That list is the foundation of a potential direct pay offer. Just knowing exactly where insurance fails to cover your expertise can change how you design and price your services. Now I know you probably have questions about this and maybe even some hesitations, so let's go into a Q&A format and address a few of the most common concerns I hear. Let's start with question one Won't.

Speaker 2: 6:45

I lose clients if I don't take insurance.

Speaker 1: 6:48

Maybe but not always. People pay for what they value. Friend, if they understand the results you can help them achieve and you give them clear options for payment, like HSA, fsa or payment plans, many will still say yes. In fact, health Affairs reported that 78% of consumers with HSAs or FSAs want to use these funds for more preventative and wellness services, which means the demand is already there. As a matter of fact, when I first launched my Life Balance 90-Day Health Coaching Program, my first client used her HSA to pay for the program. So they will use it if it's available and it's an option.

Speaker 2: 7:35

Question two Is it even legal to not bill insurance?

Speaker 1: 7:40

Yes, it is legal, as long as you follow your state regulations and your professional licensing requirements. Many independent providers, from dieticians to physical therapists to mental health professionals, operate cash pay models legally and successfully.

Speaker 2: 7:57

Question three. But don't clients prefer the safety of insurance Sometimes?

Speaker 1: 8:03

but here's what's also true the safety of insurance Sometimes, but here's what's also true Clients hate waiting months for approval, hate surprise denials and hate being told they can't get the service they actually need because it's not covered. If you can deliver what they need without that headache, you might be surprised at how many see it as a relief. Direct primary care is a great example. As of mid-2023, there were over 2,100 practices across 48 states operating successfully without billing insurance.

Speaker 2: 8:33

Question four what about credibility? Won't people take me less seriously if I'm not in network?

Speaker 1: 8:40

Being in network is not the same as being credible. Your credibility comes from your expertise, your results and your client relationships. In fact, many people associate direct pay with higher quality because they know you're not rushing them out the door to meet insurance quotas.

Speaker 2: 8:58

And our final question what if I try this and it doesn't work?

Speaker 1: 9:03

What you can do is start small friend. Offer one service as cash pay, maybe a premium package or a specialized program. See how clients respond. You don't have to overhaul everything overnight. You can test and adjust. Okay, so that was our listener.

Speaker 1: 9:22

Challenge number one and to recap, that is to take some time to look at your current service list and highlight what isn't covered by your insurance or is often denied. Use that list as a foundation for a potential direct pay offer so you can adjust your prices and maybe redesign your services. Now let's go to challenge number two. The second challenge I have for you is to pick one service or package you already offer and run the numbers. How much faster would you be paid if you charged directly instead of billing insurance? Compare that with how much time you'd save in adding the work. The math might surprise you and it could be the push you need to test a cash pay option.

Speaker 1: 10:10

Friend, when you step away from the insurance model, you're stepping toward freedom Freedom to create the services you know will get results, freedom to control your income and freedom to build a business that isn't at the mercy of policy changes. If you're curious about how this could look in your practice, start with that audit from challenge number one and the math from challenge number two. These two actions alone can give you the clarity to take your first step. That's all I have for you today, friend. If this episode made you rethink your relationship with insurance or gave you ideas for building more freedom into your practice, hit follow so you don't miss what's next. On, raise the Script with Nutrigenomics and share it with a colleague who's feeling boxed in by coverage rules. You might just help them see a new path forward.

Speaker 1: 10:59

Next week on the show. We're talking about how to stop feeling drained and start thriving so you can power through your day with focus and vitality, without relying on caffeine or sheer willpower. Talk to you next Friday. Until then, always remember to raise the script on health, because together we can bring healthcare to higher levels.

Speaker 2: 11:19

Raise the Script with. Nutrigenomics is a production of by LYFE Balance.