Part 2: Functional and Integrative Medicine: Should You Accept Insurance or Cash?
How to accept BOTH insurance and cash-pay and supplement your income if you accept insurance.
Picture: Waiting to present at the NWI Consortium in Westville, IN on August 23, 2025.
Last week we talked about if you should accept insurance as a functional/integrative med provider. I think this brews up some interesting discussions!
Some providers are very dedicated to staying in network with insurance or are just not ready to make a move, and that’s okay! So here is what you CAN do to optimize your income and get paid for the hard work and expertise you provide.
If you are committed to staying in-network with insurance panels, here's what I suggest:
Segment your services. Keep your foundational visits under insurance (basic evals, med management) but create separate, cash-based packages for functional labs (such as urine organic acid testing-not covered by insurance), protocols, and other services that insurance does not cover (such as courses.) Be crystal clear with your clients from the beginning on what is billable and what is not.
Document everything. This system is built on audit risk. You will need airtight charting and a solid understanding of how to code what you can bill for—without crossing into services that aren’t covered.
Cap your insurance volume. Don’t build your entire model around in-network clients. Blend your practice so that cash-pay services can subsidize the time and effort insurance doesn’t compensate you for. Be careful with this though because insurance contracts obligate you to see their clients. Do not expect to be “in network” with United Healthcare and ask the client to pay cash unless the client wants to skip using their insurance. It can be EASY to fill up your practice - especially in primary care or psychiatry settings- by accepting insurance. But will that really fulfill your personal and professional needs? What you may want to do is..
Have two practices. Now I know that can sound like a lot-I get it. I have had two practices at a time from my third month in private practice (always had psychiatry and weight loss practices). I now have an insurance practice that I am slowly moving away from and I also have a separate functional med/HRT clinic that I am building. I have been prioritizing speaking engagements, content creation, and family time so the cash pay clinic is slow going. Fortunately, that is genuinely how I want it to be right now.
I will probably always have more than one business. I currently have 4 but only two are patient-facing. My insurance practice allows my long-standing clients to stay on board without facing great financial stress but also allows me to limit how much insurance I take by seeing clients at my other practice. These are COMPLETELY separate entities-this is important to do if you truly want to be able to accept insurance and cash simultaneously.
Negotiate if you can—but don’t wait around for miracles. Some insurers will adjust your rates after recredentialing or if you show strong patient outcomes. Most won’t. Don’t count on it but I have been successful a couple times with smaller plans.
Build an exit ramp now. Even if you’re not ready to go fully cash-pay, build the system like you might one day. Use intake forms, consents, and workflows that are future-proof. Because once you're deep in the insurance game, it's harder to climb out.
Supplements. This is a bit controversial but I think it is wise to consider. There are companies such as Fullscript that allow you to order and establish individualized supplementation plans for your clients with reputable supplement companies such as Pure Encapsulations and Designs for Health, two of my favorite companies to work with due to their high quality and affordability. Fullscript allows you to either pass on savings to clients and keep a percent for yourself. You can choose to keep a percent for yourself because so many of us spend HOURS looking for the right supplements and combinations for our clients. I spend hours weekly doing this because I want to ensure that my clients can afford their regimen but also take the most that they need with the least amount of pills. This is time that insurance will NEVER pay me for yet it is a lot to do outside of visits.
You deserve whatever it is that gives you joy or peace of mind even if it means seeing fewer clients which ideal for a lot of providers. You deserve to be able to practice how and when you want. There are always options.
Let that be your north star.
Additional Updates:
There are only 8 more CE seats left on our cruise! Now only $99 for the next two attendees! Do not miss out. Email me for the special rate before they are gone. info@npecb.com
With Gratitude,
Stacey
