In this solo podcast episode, Kelly Alhooie urges clinicians and practice owners to abandon the insurance‑based reimbursement model and transition to an all‑cash practice. She outlines five concrete signs that indicate a practice is ready for the switch—overwhelming patient volume, excessive time spent on administrative tasks, unreliable and low margins, limited treatment scope, and stagnant reimbursements. Kelly compares insurance versus cash on client volume, time commitment, cash flow predictability, and the ability to treat the whole patient rather than just manage symptoms. She highlights the financial strain of low insurance payouts (e.g., $125 per visit) against rising therapist salary expectations, and stresses that the barrier to cash is often a missing skill: convincing patients to pay cash for services. Kelly offers a PDF guide and personal coaching to teach this sales skill, advises practitioners to drop all insurance contracts to avoid confusing patients and identity conflicts, and positions the cash model as a path to better outcomes, higher profit, and sustainable business growth.
Chapters
5 signs you're ready to stop billing the insurance company and go cash. Guys, I can't tell you how many people I talked to that are in the insurance-based model and are trying to go cash, but they are terrified. And I even did a comparison and analysis for them. We even have a full-on guide. So if you guys want it, um, cash versus insurance, I will lay out specifically line by line why this is so important. So number one, you will see literally double the clients you will in an insurance-based model than you will in a cash. So what does that lead to? Burnout, overwhelm, exhaustion, and profit not to be what you want it to be. And it will take— the biggest thing here is it will take all of your time. Comparatively, cash will take half of your time. That's the first thing. Okay, so you're gonna see double the patients. Do you guys want that? No. Do you want double your time taken up? No, that's the second thing. You don't want double your time taken up. Number 3, your margins are always way off because you may never get paid for that visit. Or you may get paid 6 weeks later for that visit and you don't know if you're gonna get money in the door today or not. Comparatively, cash, they have to pay for the service before the service is administered. Which means that your books, meaning your profit, is very consistent because you always have something coming in. That's key. If you're also insurance, the problem is you can only treat one body part. So the clients actually get their problems solved? No, you are basically doing symptom management. You really are. You're doing symptom management. Comparatively, in a cash, you can treat the entire body, and so you're actually gonna be able to solve the problem. So which one do you wanna be? Symptom management or actually solve the problem? I wanna be a problem solver, and I wanna be a result changer, and I wanna change people's lives. So guess what? Cash is my thing, okay? I can't tell you enough. And if you're scared that no one's gonna come to you, all you're basically just saying if you go cash is that you don't have the skills yet to then get people to understand why they should pay cash for your service. And all that's stopping you from this is bridging the gap and learning a new skill of why people should pay you and why you are different. That's it. And if you want to learn that skill, I'd be happy to teach you because I coach many people on this, on how to communicate the effectiveness of why they should come to you and pay you cash. So if you're stuck in a situation where you're taking insurance and you want to go cash, let's chat. Because we all know that the insurance-based model, the reimbursement goes lower and lower. The max, the max that I've ever seen get paid from the top insurance people is like $125 a visit. Guys, you cannot pay a therapist's salary and, and overhead on rent, and also pay you, and pay admin. It just doesn't work with $125 max. Conversely, you're also getting $60 from some other insurances a visit. The math doesn't math. And by the way, not to mention, anyone coming out of school now wants to start out at $90,000 to $95,000. So how are you going to keep up with salaries increasing because there's not as many people coming into the field? And how— and then when the insurance company keeps denying or saying, "We're not covering that because you didn't code it right," how does the math math? And all I need you guys to do is realize that if you're willing to learn a new skill, You can literally bridge the gap from insurance to cash, and you can turn your insurance-based practice into a cash-based practice. And if you are feeling— here's the signs— if you are feeling overwhelmed and overworked and your bank account is not showing that, wow, this is worth it, that's your sign. If you're feeling burnt out because you've got to cross the T's and dot the I's with all the notes, guess what? That's another sign. If you are saying, man, I am getting less and less things reimbursed, that's another sign. Okay, if the patients are still not getting to the max result that they are looking for, that's another sign. All these are signs, guys, that it's time to make the jump and learn a new skill. And, and so we've got to make sure that we continuously push and keep learning, not clinical but business skills, so that we can move not only us but our people that work with us, our patients. Our patients deserves more. And so drop the insurance company. If you want to have a conversation, or if you want my PDF, I'd be happy to give it to you to show you exactly what that you need to be doing to move from an insurance-based to a, a more cash-based realm. And by the way, because I get this question too, please just don't drop like a couple insurances. I need you to drop all insurances and go full-on cash. And I say that because if you are insurance some and cash some, you now confuse the crap out of the patient. Number one, they're going to get so mad that you don't take their insurance and they're not going to pay you cash. So then you're not going to believe that they will pay you cash. And then it's also, you can't talk bad about the insurance company because you basically take some of the insurance companies. And so you have an identity problem yourself. Your company does because you don't know what you stand for. Are you for the insurance companies? Are you not? And so it's like us versus the insurance companies and you can't really go heavy on anti-insurance because you take some because you're just scared. And so I coach people to literally get rid of all insurances and go cash and firmly stand in that so that you can make statements that are actually true. Against insurance that literally will solve people's problems. So why wouldn't we want better outcomes for our patients, more profit so that we can pay our people what, what we deserve and also have profit for the business so we can stay in business, treat the client completely, not just treating one issue at a time. Okay. And then actually getting results faster with less time, Less copays and all things. Why would we not want that? So if you guys are scared, if you're on the fence, if you're like, Kelly, I don't know how to do this, that's why I'm here. I'm here to help solve the problem. So if you guys want more of that, please reach out. We have a PDF on this, like I said, and I'd be happy to chat with you as well. So reach out soon. Stop staying stuck. Let's get you unscared so that you can move forward and make your business all cash. Let's go.
