People Will Pay You Cash

Many nurse practitioners that consider opening a business believe they have to accept insurance to create a successful practice. Nothing could be further from the truth. We are led to believe that insurance is a requirement for healthcare in this country. A majority of the adult population believe that they need to pay for and use their insurance…

Insurance premiums and deductibles continue to rise year after year… Many individuals have deductibles ranging from $1,500 to $10,000 a year! Most of these people are healthy individuals who will likely never pay their deductible fully to have their insurance kick in. Overall, insurance is a scam and a total money racket for the vast majority of the population. Yet, people continue to pay for it and think they need it…

Cash practices are a way around insurance companies including Medicare, Medicaid and private payers. When you take insurance, you invite a 3rd party into your business. When you accept Medicare or Medicaid, you invite federal regulation into your business. Does a plumber, barber, landscaper, electrician, and the majority of other service providers invite the federal government into their business? NO. Do these people rely on a 3rd party to pay them? NO. Why should you? Was this country not built on free market principles?

Private insurance companies, Medicare, and Medicaid bring in an enormous amount of regulation and red tape into your business. You must follow their bullshit rules, protocols, procedures, etc… It is an absolute headache. Talk to any person who owns a medical practice and they will speak unfavorably about Medicaid, Medicare and private insurance companies. It is an extra step and stressor in your life.


Cash affords you freedom. You practice as you want. You provide a service, and the patient pays you. It is that simple. Therefore, you should strive to open a cash practice.

Many people are afraid that a cash practice will not generate enough revenue to keep the doors open.

Many people do not believe there are enough cash paying patients in their region.

Many people believe they will have a low patient census with a cash only practice.

Well you know what? That is total bullshit. There are a PLETHORA of people in your area willing to pay you cold hard cash for services. Do not believe otherwise.

My men’s health clinic is in one of the poorest counties in the country and it is flourishing. We only accept cash.

You can make a side income of $10,000 a month CASH! You can do it!

When you work in healthcare for a long period of time, you begin to see the amount of individuals who utilize Medicare and Medicaid. You become accustomed to this. You begin to create this delusion that everyone has Medicare and Medicaid. Well, you are right to an extent. A large number of individuals that utilize the healthcare system do use Medicare and Medicaid. But guess what? There are a lot of people that make $80,000 or more year that have a disposable income to spend on services they derive value out of.

That is the KEY! You must provide VALUE to the patient. Sorry, some generic health coaching business or basic primary care visit does not provide that much value to a person. You must open a practice that has a niched service that people find valuable and difficult to obtain. Think outside the box.

People will pay you cash. People will drop $250 a month on what you can provide them. You would be amazed at what people are willing to spend to feel and look better. People are vain. People are self-conscious. People are afraid of getting old. People want to feel good and youthful. Hell, who doesn’t?!

Well…. that is outside of “medical necessity” as defined by the federal government and private insurance companies. Therefore, they will not pay for those services. The only option is to pay cash. End of story.

Do not be afraid of opening a cash practice. If you provide value to the patient, they will pay you over and over and over again without question. I have seen and experienced it. Pick the right idea, market the hell out of your practice, improve your patients quality of life and see the dollars pile up!

28 Responses

  1. Justin
    Can you please, go deeper into the various niches.
    Example, what is mens health, what does it take to start it. How is it marketed.
    Then, another niche, to the next, to the next.

    Will you be willing to coach for a fee?

    1. Daniel,
      Please see this post on niches. It is not totally inclusive but goes over common niches. I discuss how to find your niche in my book that I will be releasing in the next month. Here is a tip though: Figure out a need that a certain group of people need fulfilled. It can be difficult to find a niche some times. I plan on releasing an article about niches soon.

      In terms of men’s health, essentially you are treating male specific issues such as low testosterone, erectile dysfunction, and performance enhancement.

      I do consulting. I can assist you with building a practice from the ground up or with any other need you might have. Shoot me a message.

      1. Good morning,
        Please message me back.
        I need your help please. I don’t where to start.
        Thank you very much,

  2. Great tips. Thanks for sharing. There are different ways to market. What have you found to work for marketing your practice?

    1. Social media, billboards, and small niche advertisements such as in local publications. My men’s health clinic is advertised over bathroom urinals in bars and restaurants throughout town. It costs me $250 a month and I make thousands from them. The best ad I have! Experiment with a few different marketing channels and see what works.

      1. Excellent!! My practice is cash right now but I recently applied to take UHC, Aetna and CIGNA. Like you said I feel like I need to add insurances to make a profit. I’ve been open since September and right now my practice is paying the bills but that’s it. Right now my practice is all niche, I do weight loss, IV hydration and hormone replacement therapy. I really like men’s health, I need to delve more into that. I’d love an article on just had to open a men’s health clinic.

        1. Candi,

          Your practice has been open for 3 months. You have achieved autopilot status. You are on track to make a profit. Your business is still a baby. I say avoid insurance for now and give your business another 3-4 months. I promise, the money will come. Read this article about how long it takes to generate a profit. I will be releasing a course on how to start a men’s health clinic in the upcoming 2-3 months after I release my book. It is just way to much information to release in an article.

          1. I’m in process of starting a practice just like Candi’s. However, I’ve had conflicting information about offering services to Medicare Patients. Some have said if your office visit would normally be covered under Medicare, then you have to exclude these patients or bill medicare. Secondly, if I DO decide to bill medicare, do I need a practice NPI for my LLC OR use my individual NPI??

          2. Greetings Suzanne,

            Be sure to check out the Medicare article HERE.

            You cannot see Medicare patients for COVERED services if you are credentialed personally with Medicare. Are IV vitamin infusions covered? No, they are enhancement. So, you can see them but they need to sign an ABN. Just check out the article.

            In terms of NPI, you only need a group NPI (your LLC NPI) if it is going to be accepting insurance. If you are not, then you just function under your personal NPI. Check out the NPI article HERE.

      1. Shoot me a message through the consulting tab if you would like to brainstorm ideas. Night shift + hospitalist work = misery. That shit gets old really fast. I have been there…

  3. What do you use for an EMR and how do you get around the Patient info gap between your practice and the conglomerates?

    1. Paper charting during the start up phase. EMRs are regulatory requirements for insurance accepting practices. They are unnecessary. I only see an EMR being necessary until you have reached a patient census of 200. Then I would use a cheap one like simple practice or unicharts.

      If a large corporate practice needs info, they can call and we will be more than happy to fax it to them and vice versa.

  4. “My men’s health clinic is in one of the poorest counties in the country and it is flourishing. We only accept cash.”


  5. Thank You for this info! I’ve just launched my practice and have actually been stressed about the cash only aspect. I applied for Medicare provider but as you remind that’s a lot of oversight and regulations. I would love to speak with you more.

  6. Hi Justin! We are following your elite np model after taking your courses. We have decided to start a medical weight loss practice- cash only. We are having some trouble figuring out prices, and payment models. I found a few blogs: Payment models, and Automatic payment plans. Do you have more articles that would help us with this issue?

    1. Greetings C.,
      In terms of pricing, I assume you are referring to this post. Also with automatic payment plants, I assume this one. Be sure to check out this article about subscription vs time of service pricing.

      Follow the pricing recommendations in the courses. I personally like subscription models as it develops a solid stream of passive income. Essentially, call around other weight loss clinics in your area and determine the going rate of services, match or undercut them by 10%. This is an overall solid strategy!

    2. Hi there,
      I’m a FNP and interested in opening up a similar practice. Thinking cash pay as well. Have you started and how is it going?

  7. If you take insurance, can you still have a cash practice for services not covered? How do you bill/charge for this?

  8. How do you transition from insurance to cash in psychiatry? How long will it take to build revenue? I do have a lot of cash paying clients. Best simplistic affordable emr that supervising physician can send out controls from? Hoping that Texas will become independent to cut out the supervising fee cost. Going cash will help eliminate biller and insurance verification person!!

  9. What would be considered “saturated”? I live in a rural town of 10,000 pop. and there are 3 medical practices that offer IV hydration. Would this be considered saturated?

    1. In my opinion, yes that is saturated for IV infusion. So instead, offer something no one else is! Anyone doing HRT or weight loss?

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