For us at Rejuvenate and countless other physicians across America, the breaking point came not from a single dramatic event, but from the accumulated weight of thousands of insurance denials, prior authorizations, and administrative battles that stood between them and their ability to practice medicine. Physicians complete an average of 39 prior authorizations weekly, spending 13 hours on the process, time that could be spent actually caring for patients.

The solution? An increasing number of physicians are choosing to opt out of the insurance system entirely, building thriving practices based on transparent pricing, direct patient relationships, and freedom from administrative burden. This isn't just a fringe movement—it's a fundamental restructuring of how medicine can be practiced in America.

The True Cost of Insurance-Based Medicine

The statistics paint a devastating picture of what insurance requirements are doing to medical practices:

On average, practices complete 39 prior authorization requests per physician, per week, with physicians and their staff spending an average of 13 hours completing those requests each week. Even more troubling, 40% of physicians have staff who work exclusively on prior authorizations, representing enormous overhead costs that provide zero value to patient care.

The burden extends far beyond time and money. Over 90% of physicians say prior authorization delays care, while 82% report that prior authorization sometimes leads to patients abandoning treatment. When the very system designed to facilitate healthcare actively prevents it, physicians are increasingly asking: why participate at all?

The Direct Primary Care Revolution

Direct Primary Care (DPC) represents a radical departure from traditional insurance-based practice. DPC allows family physicians to care for the whole person while reducing the overhead and negative incentives associated with fee-for-service third-party-payer billing.

The model is elegantly simple:

• Patients pay a monthly membership fee (typically $50-$150)

• All primary care services are included

• No insurance billing for routine care

• Transparent pricing for additional services

• Direct access to physicians via phone, email, and extended visits

The average DPC practice patient panel size is 413 patients, compared to 2,000-3,000 in traditional practices. This dramatic reduction allows for 30-60 minute appointments instead of the standard 7-15 minute insurance-driven encounters.

The Financial Reality: It Actually Works

Critics often dismiss cash-based practice as financially unviable, but the numbers tell a different story. DPC offers stable revenue through subscription fees, eliminating routine insurance claims and enhancing patient access.

The economics are compelling:

Traditional Practice Overhead:

• 40-60% of revenue goes to administrative costs

• Multiple staff members dedicated to billing and prior authorizations

• Significant bad debt and collection costs

• Delayed payments from insurance (60-90 days typical)

Cash-Based Practice Advantages:
"When you're not billing through insurance, you don't need 10 people doing coding and billing for you", notes one physician who made the transition. This dramatic reduction in overhead means physicians can actually earn more while charging patients less.

The pay-first model improves cash flow by collecting patient payments upfront, reducing manual collections and bad-debt write-offs. This predictable revenue stream allows for better business planning and eliminates the uncertainty of insurance reimbursements.

Breaking Free from Prior Authorization Hell

The prior authorization burden has reached crisis levels. Seventy-two percent of physicians said UnitedHealthcare has a "high" or "extremely high" prior authorization burden, with other major insurers close behind. Even more concerning, 61% of physicians fear that payers' use of unregulated AI is increasing prior authorization denials.

In cash-based practices, these problems simply don't exist. There are no prior authorizations because there's no third party to seek approval from. Physicians make clinical decisions with their patients, period. Treatment plans are based on medical necessity and patient preference, not insurance formularies and coverage limitations.

The Legislative Landscape: Growing Support

The movement toward insurance-free practice is gaining legislative support. As of 2025, 34 states have enacted laws and regulations generally defining DPC as a medical service outside of state insurance regulations. This regulatory clarity has been crucial for practice growth.

Furthermore, bipartisan legislation clarifies that DPC is not health insurance for the purpose of HSA rules in the tax code, pre-tax HSA funds may be used to pay for DPC fees, and DPC arrangements under $150 per month will properly be treated as a medical service. This allows patients to use tax-advantaged healthcare dollars for DPC memberships, making the model more accessible.

Building Your Insurance-Free Practice: Practical Steps

For physicians considering this transition, the path forward requires careful planning but is increasingly well-documented:

1. Choose Your Model

Direct Primary Care: Monthly membership model for comprehensive primary care
Cash-Based Specialty Practice: Fee-for-service without insurance billing
Hybrid Approach: Accept insurance for complex procedures, cash for routine care
Concierge Medicine: Higher-fee membership with enhanced services

2. Understand the Economics

Using data on work RVUs generated by PCPs in physician-owned outpatient practices, a single PCP can accumulate 9,063 work RVUs annually. Understanding your current productivity helps in setting appropriate cash prices that maintain or improve income while reducing administrative burden.

3. Establish Transparent Pricing

Most DPC practices have established relationships with local laboratories and radiology centers, meaning patients can get blood tests, pathology screens, X-rays, MRIs, and more for low cash prices. This transparency extends to all services, eliminating surprise bills and building trust.

4. Leverage Technology Wisely

Without the need for complex billing systems, practices can focus on technology that actually improves patient care—telemedicine platforms, patient communication tools, and clinical decision support rather than coding optimization software.

The Patient Perspective: Better Care at Lower Cost

Paradoxically, eliminating insurance from the equation often results in lower costs for patients. Most DPC practices dispense medications in-house at near-wholesale prices, so patients can both save money and avoid extra trips to the pharmacy. Combined with the elimination of copays, deductibles, and surprise bills, many patients find their total healthcare costs decrease significantly.

Patients report receiving better care, with testimonials highlighting the transformative nature of having genuine access to their physician. The ability to reach their doctor directly, spend meaningful time during appointments, and receive personalized care plans creates a healthcare experience that many thought was no longer possible.

Addressing Common Concerns

"But what about emergencies and hospitalizations?"

Cash-based practices typically recommend patients maintain high-deductible catastrophic insurance for major medical events. DPC handles the 80-90% of healthcare needs that occur in primary care, while insurance covers true emergencies and hospitalizations.

"Can this work in lower-income areas?"

DPC practices serve a diverse group of patients of all ages with coverage from Medicare, Medicaid, employer-based insurance, health sharing communities, and patients who are 100% cash pay. Many practices offer sliding scale fees or payment plans to ensure accessibility.

"What about complex chronic conditions?"

For practices like Rejuvenate that specialize in complex conditions, the extended time available in cash-based practice actually improves outcomes. Without insurance time constraints, physicians can properly address multifaceted health issues that require comprehensive evaluation and treatment.

The Rejuvenate Model: A Case Study in Success

Dr. James Dill's Rejuvenate practice demonstrates how specialty services can thrive outside insurance constraints. By focusing on treatments that insurance rarely covers adequately—IV therapy, ketamine protocols, and functional medicine—the practice eliminated the futility of fighting for approvals that would likely never come.

The results speak for themselves:

• Physicians report greater professional satisfaction

• Patients receive the treatments they need without delays

• The practice maintains financial stability without insurance dependence

• Expansion through franchising becomes possible without insurance contract complications

The Future of Insurance-Free Medicine

More than half of physicians (56%) report concern about their organization's financial health under traditional insurance models. As administrative burdens increase and reimbursements decline, the economic case for insurance-free practice becomes increasingly compelling.

The trend is accelerating. Young physicians who entered medicine to help patients, not fight insurance companies, are increasingly choosing direct care models from the start. Established physicians, burned out from decades of administrative warfare, are finding renewed purpose in insurance-free practice.

Making the Transition: It's Not All or Nothing

For many physicians, the transition away from insurance doesn't happen overnight. It may be in your best interest to "moonlight" part-time in a DPC onsite clinic and then have your own DPC practice as well. This gradual approach allows physicians to build their cash practice while maintaining income stability.

Some practical transition strategies:

1. Start with cash-only services that insurance doesn't cover well

2. Gradually reduce insurance contracts while building membership base

3. Partner with other cash-based practitioners for referrals

4. Develop relationships with self-insured employers seeking alternatives

The Bottom Line: Freedom to Practice Medicine

The movement away from insurance-based medicine isn't just about escaping paperwork—it's about reclaiming the fundamental ability to practice medicine as it was intended. 89% of physicians say prior authorization somewhat or significantly increases physician burnout. By eliminating insurance from the equation, physicians can focus on what matters: patient care.

For Dr. James Dill and the growing number of physicians choosing this path, the decision to build a practice without insurance constraints isn't just a business model—it's a return to the core values of medicine. No prior authorizations, no denied claims, no fighting for what patients need. Just medicine, practiced the way it should be.

The insurance-industrial complex may still dominate American healthcare, but for those brave enough to step outside it, a different kind of practice is not only possible—it's thriving. As more physicians discover this freedom and more patients experience the benefits, what started as a rebellion against insurance bureaucracy is becoming a revolution in how healthcare can be delivered.

The message to physicians drowning in insurance requirements is clear: there is another way. And increasingly, they're choosing to take it.