Why I Don't Take Insurance (And Why That Might Actually Be Good News for You)

Accidentally going down the fence

If you've poked around this website at all, you've probably noticed something a little unusual: I don't bill insurance. No co-pays, no prior authorizations, no explanation of benefits forms showing up six weeks after your visit with a number that makes no sense. Just a straightforward price, paid directly. That's it.

I know that probably raises some questions. Let me explain what this model actually is, why more and more doctors and patients are choosing it, and why even if you have insurance, it might be worth your time to keep reading.

The System Is Broken. We All Know It.

I've spent 20 years in emergency medicine. I've watched patients avoid their doctor for months because of cost or hassle, then show up in my ER in crisis. I've seen physicians so buried in documentation, billing codes, and insurance requirements that the actual medicine becomes almost secondary. The average primary care physician in a traditional practice carries a panel of 2,000 or more patients. That works out to roughly 15-minute visits, packed schedules, and a whole lot of "we'll send a refill request to your pharmacy" without ever really getting to know someone.

That's not anyone's fault exactly. It's the math of a system built around billing insurance, not around caring for people.

What Is Direct Primary and Specialty Care?

Direct Primary Care — DPC — is a membership-based model of medicine. Instead of billing your insurance company for every visit, your doctor charges a flat monthly fee, and in return you get actual access to them. Same-day or next-day appointments. Phone calls and texts that get answered. Visits that last as long as they need to. A physician who actually knows you.

DPC practices intentionally keep their patient panels small. Instead of 2,000 patients, a DPC doctor might care for 300 to 600. That changes everything about how the relationship works. There's time to think, to listen, to follow up, to catch things early. It's primary care the way it was probably always supposed to work.

Direct Specialty Care follows the same philosophy, applied to specialist medicine. A growing number of specialists, including physicians in fields like cardiology, dermatology, orthopedics, and yes, obesity and metabolic medicine, are stepping out of the insurance system entirely and building practices around direct relationships with patients. The number of physicians practicing this way is still small, but it is growing, and the patients who find them tend to be very glad they did. At PresenceMD, being part of this network means I have access to a community of like-minded specialists who approach medicine the way I do — with time, intention, and a genuine commitment to knowing the patient in front of them.

The Direct Primary Care Alliance describes the model this way: longer, unhurried appointments with a smaller patient panel, direct access by phone, email, and video, and care focused on prevention and whole-person health rather than reacting to emergencies after they happen. Having practiced emergency medicine for two decades, that last part hits close to home for me.

Why Cash Pay Keeps Costs Low

Here's something that might surprise you: billing insurance is expensive. Not just in time and frustration, but in real dollars. A traditional practice employs billing staff, coding specialists, and administrative teams just to navigate insurance claims. Those costs get built into the price of everything. When a practice removes insurance billing from the equation entirely, overhead drops dramatically, and that savings gets passed directly to patients.

At PresenceMD, cash pay pricing also applies to labs and imaging. Self-pay rates at many labs and imaging centers are often dramatically lower than what gets billed through insurance, sometimes by 50 to 90 percent. A basic metabolic panel that might carry a $200 insurance-billed price can cost $10 to $15 cash. A lipid panel, a thyroid check, and even many imaging studies follow the same pattern. When you're not routing everything through an insurer, you can shop for the best price and pass it along.

You Have Insurance. Does This Still Make Sense?

It actually makes more sense than you think. First, the important clarification: I don't bill your insurance, but that doesn't mean you can't use it. If you want to submit a visit to your insurance company yourself for potential reimbursement, especially if you have a health savings account or a high-deductible plan, you can absolutely do that. We can provide you with the documentation you need. You're just handling that part, not us.

Second, think about what you actually use insurance for. Catastrophic coverage — hospitalizations, surgeries, major emergencies — that's what insurance is genuinely good at. Routine primary and specialty care is where the system gets expensive and inefficient fast. Many patients find that pairing a DPC membership with a lower-premium, higher-deductible catastrophic plan actually costs them less overall, while giving them far better access to day-to-day care.

Even if you already have a primary care physician you see through insurance, there are reasons patients add a direct care practice. Maybe your regular doctor has a six-week wait for appointments. Maybe you want a physician who will actually call you back and spend real time on your questions. Maybe you're managing something specific like metabolic health or weight, and you want a dedicated provider who knows your case deeply.

Why Physicians Are Leaving Traditional Practice

The physician side of this matters too, because it directly affects the care you receive. Burnout among primary care and specialty physicians is at a crisis level. The administrative burden of insurance billing, prior authorizations, and documentation requirements eats up hours of every working day. Many doctors went into medicine to help people and find themselves spending more time fighting with insurance companies than actually practicing medicine.

Direct care lets physicians be doctors again. Smaller panels, no billing bureaucracy, direct relationships with patients. The physicians who choose this model tend to be the ones who got fed up with the system and decided to build something better. That self-selection matters. These are people who cared enough to completely rebuild their careers because they wanted medicine to feel like medicine again.

That's why I'm here. The DPC and direct specialty care model makes it possible to catch things early, know patients well, and actually change outcomes in a way that traditional practice simply doesn't allow.

If you want to understand more about whether this might be a good fit for you, take a look at our services or reach out directly. You'll get an answer from me, because I don't have any staff. There are no gatekeepers here.