The alternative to traditional healthcare is the cash-based medical model of Direct Care or Direct Primary Care.
Welcome to the Healthy Aging Newsletter, a free publication translating trustworthy medical research into simple habits to age well, free of chronic disease. I’m Dr. Ashori, a family medicine doctor turned health coach.
Cash-based healthcare, also called direct care, is when patients pay doctors directly instead of using insurance. Here’s what it costs, why it’s important, and where to find services.
Imagine having your doctor on speed dial. You can text them for a same-day appointment without having to pay anything extra. The appointments are 30-60 minutes long, and you never feel rushed or dismissed. That’s the new modern primary care model.
Why Consider Cash-Pay Healthcare
Having options is one of the greatest luxuries of modern living. I would love for every American to have their health insurance for big, unexpected health events while having options to pay for cash-pay services to fill in the gaps left by traditional health insurance.
1. More Control Over Your Health
In the self-pay world, transparency is king & queen – you know whom you’ll see, when you’ll see them, what they’ll deliver, and how. That’s because for cash-pay doctors like myself to compete in this system, we must define how we stand apart from mainstream healthcare.
2. Transparent Clinical Care Pricing
Paying your doctor directly means that you’ll be offered an exact breakdown of the cost upfront. You can negotiate which services are necessary and which you can put off. It’s a patient-doctor discussion that takes your health and pocketbook into account.
A cash-pay doctor will never send you a surprise bill. Transparency is what they pride themselves in.
3. Faster Clinical Access
Doctors allow for more time in their cash-pay healthcare models because it’s the one thing the health insurance companies are deprioritizing. Unfortunately, Faster clinical visits lead to more prescribing and testing, resulting in data dumps that lead to unnecessary interventions.
4. Better Quality of Care
When you have more time with your doctor, you get to tease out the nuances. Both the patient and the doctor identify their biases through ongoing discussions to focus on what matters most – the patient’s overall health.
5. Protection From Overbilling
When you pay cash, clinicians have no incentive to inflate prices or run unnecessary tests because the health insurance system highly reimburses them.
How Much Does A Visit Really Cost?
Most Americans don’t have a good barometer for the cost of the clinical services and procedures they receive. Unlike an oil change or timing belt replacement, where we have well-established guidelines, healthcare remains a bit unchecked.
The Cost of Primary Care Services
Direct Primary Care doctors like myself have been fortunate in having a high demand for our cash-based services. They believe it’s important for the primary care doctor to get to know their patients over a long time, so they charge them an ongoing monthly subscription – around $100/month.
One-off visits might cost around $75-110. Remember, these are often at least 30-minute-long appointments.
Lab & Imaging Costs
Direct-to-consumer lab testing can be had through LabCorp, Quest, and Rupa. You might pay around $100 for the average blood panel if you purchase these directly from the laboratory centers. If you get them through your DPC, it’s often much cheaper because they negotiate bulk pricing which they pass on to their patients.
RadNet, American Health Imaging, and Green Imaging are just a few examples of radiology networks and centers that offer cash-pay options. A good strategy is to search for an imaging center near you, call them, tell them that you’d like to pay cash for an MRI or CT scan, and inquire about the cost. You’ll find that many are quite ready to negotiate prices with you.
My hand MRI, which was initially quoted at $700, was completed for $365. I drove to the location, had the study done, got the MRI read by the radiologist, and had the report and images emailed to me.
Specialist Visits & Procedures
You can call different institutions near you, such as teaching hospitals, university affiliated hospital networks, and various specialty groups, to ask about the cost of seeing an cardiology, orthopedic surgeon, dermatologist, oncologist, or gynecologist for an IUD placement.
I did that for a sports orthopedist and was quoted anywhere from $1,200 for single visit to as little as $140. I paid $90 for a hand surgeon working at a prestigious hospital group in one city over. He reviewed my MRIs, discussed surgical options with me, told me when to follow up, and was relatively easy to communicate with. And he was a traditional in-network surgeon, not even cash-based.
Prescription Medication Costs
We have lots of pharmacy options available for patients who prefer to pay cash for their medications. CostPlus pharmacy is a popular one. Others include Blink and Honeybee.
Some medications may not be available or might still be quite unaffordable. There are ways still to get access to such medicines through cash-pay options but it’s more complicated and may require a patient navigator to help you through that process.
Surgery Center & Infusion Costs
Many fear the cost of an unexpected surgery. Fortunately, most surgeries are elective and only a few are true emergencies. When they are done in a hospital, it’s possible to negotiate prices. A great resource on this topic is the book Never Pay The First Bill.
There are several surgery centers in the US that are cash-based. A favorite pick for my patients is Surgery Center of Oklahoma. There is also Texas Free Market Surgery and Pacific Surgical Center in WA.
I won’t mention international options, often referred to as medical tourism. But due to the lack of malpractice scene overseas, surgical care is often much cheaper with similar outcomes as what we enjoy here in the US.
When it comes to getting specialized infusions such as chemotherapy or medications for autoimmune diseases, there are many infusion centers that aren’t hospital-affiliated. They will have cash-pay options and are much cheaper than what you’d pay if you were in the inpatient setting.
Common Myths About Cash-Pay Healthcare
“It’s Only For The Wealthy”
Cash-pay services are often more affordable than the out-of-pocket expenses associated with health insurance. The MRI that would cost $2K with your PPO plan would be $500 if you pay cash.
The surgery that would cost you $12K out of pocket with your health insurance would cost zero with your cash-based surgeon because they would might advise you not to have the surgery in the first place. I know, this one is a bit unfair but I see it enough that it’s worth mentioning.
“It’s Impossible to Find a Doctor”
Cash-pay options have been around for a long time and are growing. True, most of these services don’t spend too much time marketing or advertising but if you know where to look, they aren’t hard to find.
Companies like Sedera and Crowd Health, which offer an alternative to health insurance, are often a good resource for such cash-pay options.
“I Already Have Insurance, It’s Not Worth It”
Health insurance isn’t guaranteed to every American, but fortunately, many states are offering more and more affordable options. A time may come when it will be tough for you to afford certain care which is why having access to cash-based doctors who may not even accept health insurance may pay off.
“It’s Risky”
With the right planning and research, cash-pay healthcare might be just as good, if not better, than your high-deductible health insurance plan. It might even save you from unnecessary medications, surgery, testing, and interventions.
My Thoughts On The Direct Pay Model
As a family medicine physician, the health insurance-based system rarely allowed me to do what was best for my patient. There were too many financial incentives, so I decided to open my own Direct Primary Care practice, forgoing the conflicts of health insurance.
As a patient, I have my own DPC doctor who handles all of my medical care virtually. I’m fortunate that I can afford it at $99/month. But she doesn’t replace health insurance, which I only use for serious, catastrophic health events, should that some day arise.
When I need to take medication, I shop for them the same way I shop for something online. When I need a specialist, I search for and refer my own patients to cash-based doctors. And when a patient needs an MRI, I help them shop for the most affordable options which end up much cheaper than what they pay through their health insurance.
In the end, it’s always the doctor that matters and not the brand or medical group. It’s that individual human being who cares about you, is proactive, and can take the guessing out of your healthcare journey. Build that patient-doctor relationship with someone who has the least amount of conflict of interest.
Curious if Direct Primary Care (cash-based care) would actually make your life easier, or if it’s just hype?
In a Fit Call, I’ll help you decide what to keep with insurance, what to pay cash for, and how to build a simple “healthcare stack” that saves time, reduces surprise bills, and gives you faster access when you need it.
- Figure out if DPC fits your goals, budget, and health needs
- Build a plan for labs, imaging, meds, and referrals with transparent pricing
- Learn how to shop for cash-pay MRI/CT and specialists without getting overbilled
- Walk away with a clear next-step checklist you can use immediately
Bring your situation (high-deductible plan, frequent urgent care visits, confusing bills, chronic condition management, lab questions). I’ll help you map the simplest, lowest-conflict path forward.
