Why We Don’t Take Insurance: How to Explain Cash-Only to Your Patients

Naturopathic practices are different by nature. As a doctor, you take more time to get to know your patients, consider the whole picture to diagnose problems, and do your best to recommend the best treatments even if they don’t fit within the conventional framework. Because you operate in this unique space, you also have to take a unique approach to your finances.

Many naturopathic clinics choose to operate as cash-only instead of working with insurance companies. This can come with some pushback from patients, though. They might not understand why you don’t take their health insurance or feel like you’re not a “real” health practitioner unless you bill insurance companies. If you’re concerned these objections might cost you clients, you’re not alone.

The key for naturopathic doctors who choose this approach is to explain it to patients in a way they can understand. Most patients are so used to the traditional billing process that they don’t realize there’s another way to do things. In this article, we’ll show you some ways to respond to common objections by explaining how it benefits you and your patient.

Why Don’t You Take Insurance?

A cash-only medical practice is likely a foreign concept to most of your patients. They’re used to walking in, handing over their insurance card, and waiting patiently for a bill to come through the mail. So when you mention you’re cash-only, they might be confused or even upset.

To alleviate their concerns, explain that working with insurance companies—even if you’re just billing them—comes with some restrictions. You want to help your patients find relief now instead of waiting to see if their insurance will cover a treatment. Keeping your practice cash-only allows you to help patients without having to worry about insurance approval.   

How Does Cash-only Affect My Treatment?

stack of money

Some patients might think that because you don’t bill their insurance, you can’t offer services other doctors would. This is your opportunity to point out that you can actually offer more! Explain that having a cash-only practice means you’re able to spend more time with each patient so they receive the best quality care. You have more time to listen to their story and work with them to find potential solutions.

You can add that by keeping insurance companies out of your practice, you maintain a certain flexibility that conventional doctors just don’t have. Insurance companies work in a lock-step format, meaning to treat someone for a specific condition they have to display specific symptoms. Sometimes, doctors are even required to attempt alternative methods before they can prescribe what they know will help. 

A cash-only practice allows you to not only prescribe what you think will work best, but it also gives you the opportunity to explore different diagnoses and treatments. Odds are your patients came to you because conventional doctors couldn’t find a way to help them. Explain that a cash-only practice means you aren’t confined to the same rules as conventional doctors, which means you have a better chance of figuring out their true cause of illness.

How Do I Pay?

Woman paying with credit card

As I mentioned before, people are conditioned to pay for medical services through their insurance companies. So changing the game can come as a shock. I know how difficult it can be to explain a new approach to money. (Profit First isn’t exactly conventional.) But I’ve found that keeping it simple is often the best path to help people understand how things work.

Cash-only might be misleading for some. They might think they need a $20 bill every time they visit your office. So first and foremost, explain that “cash-only” just means you don’t bill to insurance. You can take cash, checks, credit cards, HSA funds, or whatever you accept at your practice. Knowing they have payment options often puts patients at ease.

Next, you want to make sure they understand how payment works. By that, I mean explain what you expect from them at each visit. Some practices opt for a monthly fee that covers routine services. If this is you, then you can tell clients they pay one flat rate for access to you and your staff. Other practices require payment at the time of service. For this model, you can tell people about what charges to expect for each type of visit and remind them they’ll need to pay before they leave the office.

While having this conversation, you can always remind them how cash-only makes things easier for them. No worrying about a large medical bill coming in the mail or keeping up with payments. Your patients always know they’re paid in full and that you’re there whenever they need you.

What’s In It For Me?

This question is a hallmark of human nature. Some patients might not see the value in choosing a cash-only practice or might need a little convincing. There are three main points to mention when telling patients why a cash-only practice is in their best interest.

  1. A dedicated doctor. Refer to the conversation about how cash-only affects treatment. Explain to patients that your business model allows you to operate with less patients on the books, which means you can spend more time with each person. You can pay more attention to their specific complaints and work through problems together until you find a solution.
  2. Simple billing. We all know how frustrating it is to sit on the phone with an insurance company to debate a claim or even ask a simple question. Draw on this experience with patients to show them you’re the solution to that frustration. By billing directly from your office and requiring payment at each visit, you eliminate any complicated insurance problems that might require them to talk in circles with a company representative on their lunch break.
  3. Cost savings. Few patients realize just how much insurance companies can take out of their doctor’s pocket. That’s why it’s sometimes helpful to explain that you can often charge less for services because you’re not sharing profits with a third party. Also, if you operate on monthly fees instead of per-visit charges, you can show how clients save money over time.

3 Tips for Communicating Cash-Only Policies

Doctor accepting cash

Because cash-only operates differently from what people are used to, it’s key to communicate your process and expectations from day one. This can help you avoid problems with payments or confusion with new patients. 

There are three ways you can easily explain your policies to new and existing patients:

  1. Create a written policy. Having a separate financial agreement that your patients sign before their first visit is an easy way to make sure everyone is on the same page. This is the document where you can note that you are a cash-only business and expect payment at the time of service. If you have conditions for special circumstances or other client billing procedures, you can list them here as well. When your new patient signs the form, they are acknowledging your policy and agreeing to adhere to it at each visit.
  2. Have a simple billing process. This works twofold for your staff and patients. A simple billing process will take less time for your staff to complete and is easier for patients to understand. The easiest way to approach this is to require payment at every visit, regardless of the total amount. It relieves your staff of having to worry about printing invoices and collecting money after the fact, and ensures your patients are always caught up on their payments.
  3. Post reminders. It always helps to remind people that you do things a little differently. Posting a sign at your front desk that says something like “payment required at each visit” can ensure people remember how your billing process works. You can also add information about what types of payment you accept. Additionally, it can help to have people sign the financial agreement form once a year as a refresher on the finer points of your payment policy.
  4. Train your staff. When you operate a little differently, you’re going to get some questions. It’s important to train your staff on how to communicate your policies with new and potential patients. Give them a list of some key points and training on how to position their explanations. Remember to always show patients how cash-only is in their best interest too.


Running a cash-only practice might give patients pause before they choose you as their doctor. Using these suggestions for explaining the benefits of an insurance-free practice and how it operates will help to put patients’ minds at ease and reassure them you’re a legitimate medical office. 

If you’re interested in implementing a cash-only structure in your business or need help with the one you already have, schedule a call with us! We’d love to help you make the most of your naturopathic medical practice.

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