Word on the street is that you love what we are doing over here at Spruce MD. We’re providing personalized medical care in a nontraditional space, spending lots of time with patients, performing advanced lab testing not often available in conventional practices, truly listening to patients health concerns, and communicating with patients directly. However, the hang-up for many is that we don’t accept insurance. Sticker shock? Perhaps, but I’m not convinced. Americans readily dish out money for  iPhones, all those things you don’t intend to buy at Target, prissy coffee drinks, rounds of golf, and meals out with friends. However, when it comes to paying out of pocket for medical care people are often reticent. 

Why should you want to pay cash for your healthcare? You already pay for health insurance (although let’s be honest, high deductible plans don’t get you  much these days), so why pay to see your doctor? Let me reverse that question and ask, “Why would you not pay for the upkeep of the most important thing you own?” The function of your body is ultimately your most valued possession. When it is not working properly it affects all areas of your life – work, school, family, sleep, and leisure. Many Americans are accustomed to paying a premium for health and wellness resources: expensive gym memberships, activity trackers, chiropractic care, aesthetics, supplements, subscription health apps, and organic foods. It seems logical to also pay for a medical provider who can help integrate all of these resources to maximize health. 

In fact, preventative care is probably where we should be putting the majority of our wellness dollars. In many ways, health insurance in the United States is a safety net for when you are sick. In contrast, most health insurance plans provide very little in terms of wellness and illness prevention. Below are three reasons why paying for healthcare makes sense, and can even save you money! 


Often, in an insurance driven practice, you will need to book an appointment with your physician weeks, perhaps months, in advance. When you arrive you’ll get to sit in a drab waiting room for one, possibly two, hours after which you will have a rushed, unsatisfying visit with your provider who likely spent the entire visit clacking away at the computer. Have a question after that appointment? Good luck. You will be funneled through an answering service and then wait a few days for the nurse to call you back. Ultimately, you will probably just be scheduled for another appointment the following month to get those questions answered.

Doctors in insurance-based practices are paid for seeing “X” number of patients in a day. As a result, visits are often hurried. There is no time to answer your questions, to look you in the eye, to make sure you understand the plan. This is a product of our broken healthcare system in which insurance companies pay physicians enough to justify 15 minute appointment slots. When you pay for a membership at Spruce MD, the experience is completely different. You and your provider are no longer constrained by the insurance companies arbitrary reimbursement. Initial appointments are upwards of an hour. Established patients can often make appointments within 48 hours and there is little to no down time in the waiting area (although you may wish it were longer because the coffee smells delicious and the furniture is oh so comfortable). You probably won’t have any questions afterwards because there is usually ample time to answer those in clinic, BUT if one pops up you can message your provider directly. 


Sometimes is can be hard to tell if you have good insurance. Insurance plans are notoriously difficult to decipher. Is it better to pay more for broader “in-network” coverage? Should you pay higher premiums for lower out of pocket maximums? Will your insurance company readily reimburse for treatment and procedures that you or your provider think are indicated?  Unfortunately, these questions can be difficult to answer and insurance companies can change “in-network” providers forcing you to switch physicians. You may go to your provider appointment and pay a co-pay only to find surprise medical bills keep showing up in the mail (they never all come at once). A fee here, a charge there, and before you know it your care has gotten very expensive. And you still feel crummy. 

With cash pay healthcare you know what you are paying for. There is a flat fee paid up front or on a monthly basis, traditional labs are often covered by insurance and specialty labs have a transparent sticker price. Better yet, you know you are paying to get well. Your provider has ample time during the appointment to listen to you and truly understand symptoms. No more getting blown off. Cash pay also gives providers time to research other care that might be applicable after the appointment to help identify the root cause of your medical issues. Actually, the hourly rate you pay for your physician’s time with cash pay  is very similar to traditional care. However, a visit to your primary provider’s office for a chronic complaint looks very different in an insurance versus cash pay model:

Traditional Model

After seeing your primary provider for a 10-15 minute appointment, you may be referred to a specialist to further investigate your chronic issue. You pay a $45 co-pay and see the physician for 12 minutes (paying $225/hr). The specialist recommends an expensive procedure that includes a large facility fee. In addition, your insurance company only covers 70% of the procedure. The cost of care can add up quickly.

Versus Spruce MD‘s Model

You visit Spruce MD where you pay a $500 assessment fee. Included in the assessment fee is one 60 minute initial appointment, 30-45 minutes of physician time creating a personalized health plan, a 20 minute phone call to review labs and tailor health plan, a 45 minute registered dietician appointment, and  20 minutes of the dietician’s time to write up a dietary plan. In addition, you are less likely to have expensive procedures recommended.

(Gosh, I should be charging more!!)


Every day we are reminded of the rapidly rising costs of healthcare in the US. From paying outlandish insurance premiums for high deductible plans, to exorbitant bills for procedures and imaging, everyone has felt the impact of this trend. While the average insurance premium has increased by more than 50% over the past 10 years, most do not feel that they are receiving 50% better care.  

In the US, it sometimes seems like quality, compassionate care is considered too expensive and inefficient. so health systems have negated its importance and pushed for a quantitative rather than qualitative system. Health systems insist physicians see more patients in less time, and only recently have they considered reimbursing based on quality and outcomes. Some health systems also pressure physicians to bill for higher services, book more procedures, and prescribe more medications. Providers accepting insurance often don’t get reimbursed unless they adhere to prescribing certain medications or performing certain procedures. The care they provide is often dictated by insurance companies’ protocols – not patients’ specific symptoms. And the insurance company’s decision of whether to cover a service is made by someone who has never met you, the patient. There is no personalized approach to care. According to the World Health Organization the United States’ healthcare system is ranked 37th in the world – coming in behind Dominica and Costa Rica with Cuba hot on our tails. We are well behind every other developed country in the world, yet spend more dollars per capita on healthcare. This insurance driven system is not making us well (often termed “sickcare”) and is the reason many providers are attempting to disrupt the system to provide better care for their patients. 

As if cash pay healthcare giving you better access to care, transparency and higher quality care weren’t enough, visits at Spruce MD are often covered by insurance or count towards your high deductible plan. While we don’t bill insurance directly at Spruce MD, when requested, we do provide Superbills to patients so that they can file with their insurance as they choose. Additionally, appointments, specialty lab testing and supplements can be paid for with pre-taxed HSA and FSA dollars. That works out to a big tax-free discount on all Spruce MD services.

Open enrollment is around the corner for many. When contemplating your healthcare needs over the next year you may want to consider a high deductible plan. You can use out of network care for a Spruce MD membership where Dr. Blankenship (mwah!) can function as your primary care physician. Additionally, HSA and FSA accounts are often employee benefit options or can be set up independently. Contributing to an HSA or FSA  account and then using that pre-tax money for your preferred (and cash pay) healthcare can save you money. 

By eliminating third-party payers such as insurance carriers, Spruce MD Integrative Medicine has the freedom to provide care in the best interest of our members. Our providers spend ample time with patients, answer messages/texts/emails and provide unmatched, personalized care to get and keep patients well.

Mary Brittain Blankenship, MD is the founder and physician at Spruce MD Integrative Medicine located in Greenville, SC.