Sept. 12, 2025
Beyond Billing Codes: How to Thrive Without Insurance
Send us a text 1What happens when insurance won’t cover your services? In this episode, we explore how building a practice independent of insurance can actually give you more freedom, stability, and impact. Many healthcare professionals worry they can’t run a successful practice without billing insurance. But what if the opposite is true? In this episode, Dr. Tamar Lawful breaks down why shifting to a cash-pay or direct-pay model can protect your business and serve your clients better....
1What happens when insurance won’t cover your services? In this episode, we explore how building a practice independent of insurance can actually give you more freedom, stability, and impact.
Many healthcare professionals worry they can’t run a successful practice without billing insurance. But what if the opposite is true? In this episode, Dr. Tamar Lawful breaks down why shifting to a cash-pay or direct-pay model can protect your business and serve your clients better. From the history of health insurance to real stories of delayed payments, she explains why relying on insurance can leave both practitioners and patients frustrated. You’ll also hear practical steps to test a cash-pay option in your own practice without overhauling everything overnight.
What You’ll Learn in This Episode:
- Why the U.S. insurance system was never designed to support personalized or preventative care.
- How delayed payments and denials can put providers at financial risk.
- Answers to common concerns: losing clients, legality, credibility, and more.
✨ Ready to take today’s insights and put them into action?
WANT AN ELEVATED APPROACH TO YOUR HEALTH?
- Precision Wellness Consult – Discover how your DNA unlocks energy & vitality [Apply Here].
- Preview A Genomic Report – See a sample [Preview Here].
- Join Our Inner Circle – Connect with high-achieving women [Join Here].
FOR PRACTITIONERS & HEALTH PROFESSIONALS
- Unlock the Blueprint Masterclass – Learn to tailor wellness [Register Here].
- Refer With Confidence – Explore partnership opportunities [Schedule Here].
FOLLOW DR. TAMAR LAWFUL
[Instagram] | [LinkedIn] | [TikTok]
ENJOYED THIS EPISODE?
Share with a friend & leave a 5-star Apple Review Here or [Here].
00:00 - Reimagining Healthcare Beyond Medications
01:37 - The History of Health Insurance
04:30 - A Therapist's Insurance Nightmare
06:30 - Common Questions About Direct Pay Models
09:43 - Two Challenges for Practitioners
11:09 - Next Episode Preview
WEBVTT
00:00:02.745 --> 00:00:10.365
medications certainly have their place, but what if there was a way to support your body naturally by working with your genetics?
00:00:10.625 --> 00:00:13.371
we are a pill for an ill society.
00:00:13.672 --> 00:00:24.589
We take 18 pills per person per american per day it was so hard to find somebody who took my insurance and for me to get well, it took thousands of dollars and and I thought, what do regular people do?
00:00:24.589 --> 00:00:25.693
This is not right.
00:00:25.879 --> 00:00:32.109
Despite my best efforts, I wasn't actually reversing disease and helping people to heal in the way that I thought I would.
00:00:32.320 --> 00:00:35.691
We want to empower yourselves to take care of this root cause.
00:00:35.691 --> 00:00:37.146
We don't just want to cover it up.
00:00:37.146 --> 00:00:44.890
If you're ready to break free from outdated, one-size-fits-all health care, you're in the right place.
00:00:44.890 --> 00:00:51.933
Welcome to Raise the Script with Nutrigenomics, brought to you by InHer Glow® , by LYFE Balance.
00:00:51.933 --> 00:01:02.073
Here's a literature from we are all unique, right down to our DNA, so it's no wonder we respond differently to the same medications, foods and environments.
00:01:02.073 --> 00:01:04.867
How do you discover what your body needs?
00:01:04.867 --> 00:01:07.555
Which medications, foods, supplements?
00:01:07.555 --> 00:01:13.424
How do you discover what your body needs, which medications, foods, supplements or exercises are right for you?
00:01:13.424 --> 00:01:15.049
How can you manage chronic conditions without piling on more prescriptions?
00:01:15.049 --> 00:01:16.453
That's what we're here to explore.
00:01:16.453 --> 00:01:18.141
I'm your host, Dr.
00:01:18.141 --> 00:01:26.861
Tamar Lawful, doctor of pharmacy, nutrigenomics specialist, and your partner in reimagining how we personalize care for better outcomes.
00:01:26.861 --> 00:01:37.412
Whether you're a patient or a practitioner, let's raise the script and bring healthcare to higher levels together, because the future of health is personal.
00:01:37.412 --> 00:01:41.167
Welcome to Raise the Script with Nutrigenomics.
00:01:41.167 --> 00:01:44.370
I am Dr.
00:01:44.370 --> 00:01:48.725
Tamar Lawful, doctor of pharmacy, nutritional genomic specialist, and your partner in reimagining health.
00:01:48.725 --> 00:01:51.891
So it works for both you and your clients.
00:01:52.433 --> 00:01:56.850
Today, we're talking about something that can make healthcare professionals a little nervous.
00:01:56.850 --> 00:02:04.813
Running a practice without billing insurance Now, before you think, but Tamar, that's impossible.
00:02:04.813 --> 00:02:06.861
Billing insurance Now?
00:02:06.861 --> 00:02:07.905
Before you think, but Samar, that's impossible.
00:02:07.905 --> 00:02:16.044
I want you to imagine this it's Monday morning and you open your inbox to see an email saying insurance will no longer cover 60% of what you do.
00:02:16.044 --> 00:02:20.592
No warning, no transition period just gone.
00:02:20.592 --> 00:02:25.750
Would your business still stand or would you be scrambling to keep the lights on?
00:02:25.750 --> 00:02:40.402
That's why today, we're going to break down why building a model independent of insurance can be one of the smartest moves you ever make and how you can still serve your clients without them feeling left in the cold.
00:02:40.402 --> 00:02:58.401
So let's start with a little history, because I really feel like it's important to understand how we got here and why this conversation about insurance even matters in the first place.
00:02:58.401 --> 00:03:00.323
So history lesson okay.
00:03:01.204 --> 00:03:11.697
Health insurance in the United States really took off in the 1940s and 50s, tied to employer benefits as a way to attract workers during wage freezes.
00:03:11.697 --> 00:03:18.984
So at first it was pretty straightforward Insurance paid their doctor directly and people paid small copays.
00:03:18.984 --> 00:03:24.287
But as the decades rolled on, the system became more complex.
00:03:24.287 --> 00:03:31.510
Layers of billing codes, prior authorizations, provider networks and compliance requirements crept in.
00:03:31.510 --> 00:03:33.472
And here's the key part.
00:03:33.472 --> 00:03:37.774
The entire structure was built around illness care.
00:03:37.774 --> 00:03:44.918
It was never intended to cover long, in-depth consultations or preventative lifestyle services.
00:03:44.918 --> 00:03:54.387
Even now, according to the Kaiser Family Foundation, only about 3% of national healthcare spending goes toward preventative services.
00:03:54.387 --> 00:03:59.588
The other 97% goes toward treating existing illness.
00:03:59.588 --> 00:04:23.401
So if you're delivering anything truly personalized, like genomic-based coaching using pharmacogenomics or nutrigenomics, nutrition plans or long-term behavior change programs, it often doesn't fit neatly into an insurance-approved box, and if it doesn't fit the box, it doesn't get paid.
00:04:23.401 --> 00:04:29.512
I've seen firsthand how that can hurt both the provider and the client.
00:04:30.194 --> 00:04:33.141
One of my health coaching clients was a therapist with her own practice.
00:04:33.141 --> 00:04:38.740
She was fantastic at what she did, highly sought after, loved by her clients.
00:04:38.740 --> 00:04:46.644
But here's the problem it was May and she still hadn't been paid for services she provided the previous October.
00:04:46.644 --> 00:04:49.197
Think about that for a second.
00:04:49.197 --> 00:04:55.081
Seven months without payment for work she had already done.
00:04:55.081 --> 00:04:57.115
And she's not alone.
00:04:57.115 --> 00:05:08.394
In 2022, the American Medical Association reported that one in five claims are either delayed or denied by insurers, and appealing them can take weeks or months.
00:05:08.394 --> 00:05:23.057
In the meantime, she still had to pay rent for her office, she had employees counting on their paychecks and she had her own bills, her own life but no income coming in from months of hard work.
00:05:23.057 --> 00:05:25.139
Her business was struggling.
00:05:25.139 --> 00:05:33.129
She was stressed and she told me I feel like I'm running on a hamster wheel, doing the work but not getting anywhere.
00:05:33.129 --> 00:05:37.416
That's when she started to consider shifting her business model.
00:05:37.416 --> 00:05:44.396
She began offering direct pay options for clients who wanted to bypass insurance entirely, and they said yes.
00:05:44.396 --> 00:05:52.158
Some used their HSA or FSA, some paid out of pocket, but within a few months her cash flow improved.
00:05:52.158 --> 00:05:57.579
She was able to pay her staff on time and she had consistent income for herself again.
00:05:57.579 --> 00:06:01.732
That's the difference a non-insurance model can make.
00:06:03.415 --> 00:06:06.163
So I have two challenges for you this week.
00:06:06.163 --> 00:06:12.057
The first challenge is to take five minutes to pull up your current service list.
00:06:12.057 --> 00:06:16.677
Highlight everything that isn't covered by insurance or is often denied.
00:06:16.677 --> 00:06:20.821
That list is the foundation of a potential direct pay offer.
00:06:20.821 --> 00:06:29.317
Just knowing exactly where insurance fails to cover your expertise can change how you design and price your services.
00:06:29.317 --> 00:06:42.033
Now I know you probably have questions about this and maybe even some hesitations, so let's go into a Q&A format and address a few of the most common concerns I hear.
00:06:42.033 --> 00:06:45.560
Let's start with question one Won't.
00:06:45.620 --> 00:06:47.783
I lose clients if I don't take insurance.
00:06:48.589 --> 00:06:50.233
Maybe but not always.
00:06:50.233 --> 00:06:52.117
People pay for what they value.
00:06:52.117 --> 00:07:03.834
Friend, if they understand the results you can help them achieve and you give them clear options for payment, like HSA, fsa or payment plans, many will still say yes.
00:07:03.834 --> 00:07:16.853
In fact, health Affairs reported that 78% of consumers with HSAs or FSAs want to use these funds for more preventative and wellness services, which means the demand is already there.
00:07:16.853 --> 00:07:30.024
As a matter of fact, when I first launched my Life Balance 90-Day Health Coaching Program, my first client used her HSA to pay for the program.
00:07:30.024 --> 00:07:34.076
So they will use it if it's available and it's an option.
00:07:35.439 --> 00:07:39.211
Question two Is it even legal to not bill insurance?
00:07:40.072 --> 00:07:46.425
Yes, it is legal, as long as you follow your state regulations and your professional licensing requirements.
00:07:46.425 --> 00:07:55.985
Many independent providers, from dieticians to physical therapists to mental health professionals, operate cash pay models legally and successfully.
00:07:57.029 --> 00:07:58.315
Question three.
00:07:58.315 --> 00:08:03.132
But don't clients prefer the safety of insurance Sometimes?
00:08:03.613 --> 00:08:13.173
but here's what's also true the safety of insurance Sometimes, but here's what's also true Clients hate waiting months for approval, hate surprise denials and hate being told they can't get the service they actually need because it's not covered.
00:08:13.173 --> 00:08:20.012
If you can deliver what they need without that headache, you might be surprised at how many see it as a relief.
00:08:20.012 --> 00:08:22.735
Direct primary care is a great example.
00:08:22.735 --> 00:08:32.423
As of mid-2023, there were over 2,100 practices across 48 states operating successfully without billing insurance.
00:08:33.384 --> 00:08:36.147
Question four what about credibility?
00:08:36.147 --> 00:08:39.879
Won't people take me less seriously if I'm not in network?
00:08:40.909 --> 00:08:43.129
Being in network is not the same as being credible.
00:08:43.129 --> 00:08:48.899
Your credibility comes from your expertise, your results and your client relationships.
00:08:48.899 --> 00:08:57.638
In fact, many people associate direct pay with higher quality because they know you're not rushing them out the door to meet insurance quotas.
00:08:58.801 --> 00:09:02.991
And our final question what if I try this and it doesn't work?
00:09:03.879 --> 00:09:05.626
What you can do is start small friend.
00:09:05.626 --> 00:09:11.472
Offer one service as cash pay, maybe a premium package or a specialized program.
00:09:11.472 --> 00:09:13.806
See how clients respond.
00:09:13.806 --> 00:09:16.749
You don't have to overhaul everything overnight.
00:09:16.749 --> 00:09:19.027
You can test and adjust.
00:09:19.027 --> 00:09:22.585
Okay, so that was our listener.
00:09:22.745 --> 00:09:33.682
Challenge number one and to recap, that is to take some time to look at your current service list and highlight what isn't covered by your insurance or is often denied.
00:09:33.682 --> 00:09:43.748
Use that list as a foundation for a potential direct pay offer so you can adjust your prices and maybe redesign your services.
00:09:43.748 --> 00:09:46.461
Now let's go to challenge number two.
00:09:46.461 --> 00:09:52.605
The second challenge I have for you is to pick one service or package you already offer and run the numbers.
00:09:52.605 --> 00:09:57.721
How much faster would you be paid if you charged directly instead of billing insurance?
00:09:57.721 --> 00:10:03.105
Compare that with how much time you'd save in adding the work.
00:10:03.105 --> 00:10:09.551
The math might surprise you and it could be the push you need to test a cash pay option.
00:10:10.410 --> 00:10:23.403
Friend, when you step away from the insurance model, you're stepping toward freedom Freedom to create the services you know will get results, freedom to control your income and freedom to build a business that isn't at the mercy of policy changes.
00:10:23.403 --> 00:10:32.322
If you're curious about how this could look in your practice, start with that audit from challenge number one and the math from challenge number two.
00:10:32.322 --> 00:10:37.181
These two actions alone can give you the clarity to take your first step.
00:10:37.181 --> 00:10:40.102
That's all I have for you today, friend.
00:10:40.102 --> 00:10:50.464
If this episode made you rethink your relationship with insurance or gave you ideas for building more freedom into your practice, hit follow so you don't miss what's next.
00:10:50.464 --> 00:10:56.182
On, raise the Script with Nutrigenomics and share it with a colleague who's feeling boxed in by coverage rules.
00:10:56.182 --> 00:10:59.202
You might just help them see a new path forward.
00:10:59.744 --> 00:11:00.485
Next week on the show.
00:11:00.485 --> 00:11:09.023
We're talking about how to stop feeling drained and start thriving so you can power through your day with focus and vitality, without relying on caffeine or sheer willpower.
00:11:09.023 --> 00:11:10.427
Talk to you next Friday.
00:11:10.427 --> 00:11:17.424
Until then, always remember to raise the script on health, because together we can bring healthcare to higher levels.
00:11:19.235 --> 00:11:20.220
Raise the Script with.
00:11:20.220 --> 00:11:23.823
Nutrigenomics is a production of by LYFE Balance.
00:00:02.745 --> 00:00:10.365
00:00:10.625 --> 00:00:13.371
00:00:13.672 --> 00:00:24.589
00:00:24.589 --> 00:00:25.693
00:00:25.879 --> 00:00:32.109
00:00:32.320 --> 00:00:35.691
00:00:35.691 --> 00:00:37.146
00:00:37.146 --> 00:00:44.890
00:00:44.890 --> 00:00:51.933
00:00:51.933 --> 00:01:02.073
00:01:02.073 --> 00:01:04.867
00:01:04.867 --> 00:01:07.555
00:01:07.555 --> 00:01:13.424
00:01:13.424 --> 00:01:15.049
00:01:15.049 --> 00:01:16.453
00:01:16.453 --> 00:01:18.141
00:01:18.141 --> 00:01:26.861
00:01:26.861 --> 00:01:37.412
00:01:37.412 --> 00:01:41.167
00:01:41.167 --> 00:01:44.370
00:01:44.370 --> 00:01:48.725
00:01:48.725 --> 00:01:51.891
00:01:52.433 --> 00:01:56.850
00:01:56.850 --> 00:02:04.813
00:02:04.813 --> 00:02:06.861
00:02:06.861 --> 00:02:07.905
00:02:07.905 --> 00:02:16.044
00:02:16.044 --> 00:02:20.592
00:02:20.592 --> 00:02:25.750
00:02:25.750 --> 00:02:40.402
00:02:40.402 --> 00:02:58.401
00:02:58.401 --> 00:03:00.323
00:03:01.204 --> 00:03:11.697
00:03:11.697 --> 00:03:18.984
00:03:18.984 --> 00:03:24.287
00:03:24.287 --> 00:03:31.510
00:03:31.510 --> 00:03:33.472
00:03:33.472 --> 00:03:37.774
00:03:37.774 --> 00:03:44.918
00:03:44.918 --> 00:03:54.387
00:03:54.387 --> 00:03:59.588
00:03:59.588 --> 00:04:23.401
00:04:23.401 --> 00:04:29.512
00:04:30.194 --> 00:04:33.141
00:04:33.141 --> 00:04:38.740
00:04:38.740 --> 00:04:46.644
00:04:46.644 --> 00:04:49.197
00:04:49.197 --> 00:04:55.081
00:04:55.081 --> 00:04:57.115
00:04:57.115 --> 00:05:08.394
00:05:08.394 --> 00:05:23.057
00:05:23.057 --> 00:05:25.139
00:05:25.139 --> 00:05:33.129
00:05:33.129 --> 00:05:37.416
00:05:37.416 --> 00:05:44.396
00:05:44.396 --> 00:05:52.158
00:05:52.158 --> 00:05:57.579
00:05:57.579 --> 00:06:01.732
00:06:03.415 --> 00:06:06.163
00:06:06.163 --> 00:06:12.057
00:06:12.057 --> 00:06:16.677
00:06:16.677 --> 00:06:20.821
00:06:20.821 --> 00:06:29.317
00:06:29.317 --> 00:06:42.033
00:06:42.033 --> 00:06:45.560
00:06:45.620 --> 00:06:47.783
00:06:48.589 --> 00:06:50.233
00:06:50.233 --> 00:06:52.117
00:06:52.117 --> 00:07:03.834
00:07:03.834 --> 00:07:16.853
00:07:16.853 --> 00:07:30.024
00:07:30.024 --> 00:07:34.076
00:07:35.439 --> 00:07:39.211
00:07:40.072 --> 00:07:46.425
00:07:46.425 --> 00:07:55.985
00:07:57.029 --> 00:07:58.315
00:07:58.315 --> 00:08:03.132
00:08:03.613 --> 00:08:13.173
00:08:13.173 --> 00:08:20.012
00:08:20.012 --> 00:08:22.735
00:08:22.735 --> 00:08:32.423
00:08:33.384 --> 00:08:36.147
00:08:36.147 --> 00:08:39.879
00:08:40.909 --> 00:08:43.129
00:08:43.129 --> 00:08:48.899
00:08:48.899 --> 00:08:57.638
00:08:58.801 --> 00:09:02.991
00:09:03.879 --> 00:09:05.626
00:09:05.626 --> 00:09:11.472
00:09:11.472 --> 00:09:13.806
00:09:13.806 --> 00:09:16.749
00:09:16.749 --> 00:09:19.027
00:09:19.027 --> 00:09:22.585
00:09:22.745 --> 00:09:33.682
00:09:33.682 --> 00:09:43.748
00:09:43.748 --> 00:09:46.461
00:09:46.461 --> 00:09:52.605
00:09:52.605 --> 00:09:57.721
00:09:57.721 --> 00:10:03.105
00:10:03.105 --> 00:10:09.551
00:10:10.410 --> 00:10:23.403
00:10:23.403 --> 00:10:32.322
00:10:32.322 --> 00:10:37.181
00:10:37.181 --> 00:10:40.102
00:10:40.102 --> 00:10:50.464
00:10:50.464 --> 00:10:56.182
00:10:56.182 --> 00:10:59.202
00:10:59.744 --> 00:11:00.485
00:11:00.485 --> 00:11:09.023
00:11:09.023 --> 00:11:10.427
00:11:10.427 --> 00:11:17.424
00:11:19.235 --> 00:11:20.220
00:11:20.220 --> 00:11:23.823
