In this interview, host Matthew Gillogly talks with Dr. Ash Goyal, DO, and his wife Nikki about the evolution of their Scottsdale, Arizona practice, Integrated Spine Pain and Wellness. Dr. Goyal outlines his medical background in anesthesiology and interventional spine, and explains the practice’s original 98% insurance‑based model, which generated high patient volume but minimal profit, leading to long work hours and financial strain. The conversation shifts to their transition to a cash‑pay focus on orthobiologics and PRP, detailing how they initially charged $1,000‑$1,200 per joint and later increased prices to $3,000‑$4,000 based on complexity. Joining Matthew’s Business Mastery Fellowship sparked a mindset shift, boosting confidence and prompting them to double prices, which drove cash‑pay revenue from $5‑$12 k per month to $84 k in a single month. They also began dropping major insurance contracts (Cigna, Blue Cross Blue Shield) to thin schedules and prioritize patients willing to pay out‑of‑pocket. Nikki highlights the program’s intensive, twice‑weekly mastermind format, operational coaching, and cultural focus as differentiators from other consultants. Throughout, the interview emphasizes the financial, operational, and personal transformations achieved by moving away from insurance dependence toward a high‑value, cash‑pay model.
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All right, everybody.
I am here with Dr. Ash Goyal and his lovely wife, Nikki. She is the brains of the organization, without a doubt. So, Ash, why don't you tell everybody the name of your practice and where you're located?
The name of our practice is Integrated Spine Pain and Wellness, and we're located in Scottsdale, Arizona. I'm a DO. I went to medical school at Ohio University, and then I trained in anesthesiology. So I did my anesthesia residency at Cleveland Clinic. And then I elected to do a 1-year advanced fellowship in interventional spine and pain management, also at Cleveland Clinic. So my practice focuses heavily on treating people with any kind of spine pain. So back pain, neck pain, mid-back pain, as well as musculoskeletal and joint pain. So knee pain, hip pain, shoulder pain. And so I come at this from more of a holistic approach. We focus on helping people benefit through diet, exercise, mindset, movement. And then we have a heavy emphasis on orthobiologics and PRP.
And so the practice until we met was 100% insurance, correct?
Well, for the most, I would say it was 98% insurance, 2% out of pocket.
98%.
Okay.
Yeah. Right.
So that was a good setup, right? That was working out really well for you guys, the 98% insurance and— I'm kidding.
Uh, not so much. Yeah.
What was life like? When it was just a straight insurance practice?
Incredibly busy, incredibly frustrating. I mean, I'm still seeing a lot of patients now, but then, I mean, I was seeing a lot of patients every day in the clinic, doing a lot more procedures when I was, well, primarily insurance-based than I am now, but not making any money. All the money that was coming in was going out. We were having to take out additional loans to make payroll, to cover our overhead. Despite the 80 hours a week I was putting into this place, the return was very little.
Nikki, I wanna ask you, because from a spouse standpoint, what was Ash's work schedule like?
Typical day is waking up early in the morning, out the door by 6:30, at the office by 7, working until probably 7, getting home 7:30, and then doing notes from 7:30 until like 10, and then going to bed and doing it all over again. And that was every single week. 5 days a week. So then weekends, anything that he didn't get caught up on during the week, it was Saturday at the office for probably majority of the day after he would try and get at least one workout in for the week. And then on Sundays, same thing, getting ready for the week, calling patients back. No dinners at night together, no vacations. Everything just is focused or was focused around our practice.
So, and Ash, you had tried— you, you had started doing orthobiologics how long ago? When did you start getting trained in orthobiologics?
Uh, 2017 for a few years. And then, um, but that was, I was at a different practice then and I knew my organization, the PRP kits that we're buying were suboptimal. And so I was really very reluctant to do PRP and orthobiologics in that practice. So I did a few cases that I knew were going to be slam dunks. And then I avoided more of the complicated cases until I started my own practice. And I had the ability to invest in, you know, top-of-the-line equipment and really focus on equipment that was going to bring patient outcomes.
What were you charging for a cash— for an orthobiologics procedure?
$1,000 to $1,200. Per procedure. That was for a single joint.
Yeah.
Sometimes I would throw in a second joint, no additional charge. Oh my God.
I just got heartburn. Like, I swear to God, I think I just had arrhythmia. So what are you charging? What are you charging now?
For a single joint, anywhere from $3,000 to $4,000, depending on how complicated the pathology is. And if I'm going to be injecting all the ligaments and tendons associated with that joint. And that's for one joint.
Nikki, what was Asha's response when we would start saying you need to charge more? What was that process like?
It took a while. I think there was a little bit of a hesitation, and there was definitely some mindset components that were there. And, you know, it wasn't like, okay, tomorrow I'm gonna start charging more. It, you know, you guys really had to Like work with us and really teach us how to do it.
What would you say has been the biggest transformation since joining our program and joining Business Mastery Fellowship?
Confidence and mindset. Being in this community that you've created and connecting with like-minded physicians, some of who are incredibly successful, hearing their stories and seeing how they were doing things really was eye-opening for me. It's like, well, okay, these guys are doing this and they're stellar physicians and people are paying for this and they're getting great outcomes. So why can't I do that? And that was a mindset part of it, right? Because I mean, we are our own worst enemies. We create mental roadblocks. And I think the initial biggest transformation when, you know, we became part of your team was overcoming those roadblocks. And a lot of that was through the camaraderie and connection that we had. With the other physicians in the practice. That was the biggest part, was just really realizing, okay, I am worth it, right? And I'm doing this—
Absolutely.
Like no one else is doing this. I really care about my patients and I'm invested in their outcome just as much as I want them to be invested in their own outcome. And so at the end of the day, it's money, right? And it's money that they're gonna blow other places. Why not invest it in themselves? And that was one thing that you really helped us You know, hone in on was the fact that people are going to spend money. You want them to spend it on themselves, or they should want to spend it on themselves so they can improve their health and overall quality of life.
And you just finished a really great month. Tell everybody, let's walk through like a 3 to 4 month, you know, when you really started grasping the concept of the pricing and the packages. Walk us through just kind of how that worked, because really what we started— you You did what we talked about, just start talking to your existing patients, right? That's all you did.
Exactly.
And so walk us through, like, how did that go along? Like, from the standpoint, from a revenue standpoint, what, where did you begin and where are you today?
So when we first met you in February and going into March, I mean, Nikki was on all the calls. I mean, my schedule was, was nutty. So she was on all the calls and she was like, hey, listen, you really need to jump on these calls. Like, what these guys are doing is tremendous and this is what you need. Like, this will get you out of the situation you're in. And I think I came on one call sometime in March, and that was my first call with you guys because I had an ultimatum. If I wasn't on the call, something bad was going to happen to me. So, so I, so I jumped on the call.
This is why I love— this is why I love Nikki. She's a great wife for you.
She is for sure. But that one—
no, that was your ultimatum.
Oh, that was my ultimatum. All right, I thought maybe, you know, you were using leverage, but that's all right. Whatever it takes.
No, I think that was you and Shaktar threatening me. So, but it was that one call I jumped on. Like, it just, it was so eye-opening that I was like, okay, I'm going to double my prices. And that's the first thing I did. And so we went from collecting anywhere from like $5,000 to $12,000 a month in cash pay services to doubling that the first month. I think we did $25,000 the next month. And then for the next several months, we kind of held steady between $25,000 to $45,000 with an average of about $30,000 in cash pay services per month. Fast forward to last month, we did $84,000 in cash pay.
Wow.
Yeah.
Wow.
Tremendous.
You fired some of your insurance providers, right? Didn't you send— didn't you— aren't you jettisoning them now?
Yes. So we dropped Cigna last year. I mean, my private rate insurance contracts are terrible. So we dropped Cigna last year and we just gave notice to Blue Cross Blue Shield. So we'll be dropping them June 1st. And we have a list of other insurance companies we're going to be dropping along the way. And so what that will ideally do is thin out the schedule and allow patients who really want to be seen by our practice and what we do here, it'll give them the time and availability to come in at a, in a more convenient fashion than having to wait a week or two for an appointment because insurance patients are taking up all our time.
What has made Our program, Business Mastery Fellowship, what has made it different from other coaches or consultants or programs that you have been through?
We have consultants that we work with, have worked with. We've done— I've done some masterminds. I would say your mastermind is completely different because you continue to go above and beyond what you're offering. You are really focused on teaching us the operational side of the business as well, creating a good culture, culture, showing us how to get our mindset different. I mean, you go into all areas focusing on our team, and you just— and we're meeting twice a week, which most masterminds, you're lucky if you get one call a month.
So how do you feel about your investment in the program?
Priceless.
You guys are just all there on a regular basis to help Give us all the tools that we need, answer all of our questions, support us in any way that we can to show us that this is possible. And that's what is so nice. And just there, you can't put a value on that.
Yeah. And your team exudes authenticity and integrity, Matt. That's really what's attractive.
It does.
And I think that you and your team have done a very good job of making the whole process Come from a place of compassion, also from you know an entrepreneur perspective. You know building something financially sound. Well, great.
Well, thank you for that. I appreciate you all taking the time. I for the folks in the audience, hopefully they were able to get something from this as well. So keep up the great work, Ash. I'm proud of you.
Thanks.
I know it's been a big transformation, and I know Nikki and I have been, and Shactor as well, have been over there kicking in your butt. But It's kind of fun. So to move you along. So I can't wait to see what the next 12 months hold for you. I can't wait for you to send that last letter out to the insurance company and be insurance-free. So thanks for joining us today. I appreciate it.
