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Why My Psychiatry Practice Doesn't Accept Health Insurance

By Dr. Brian Dixon

|Oct 16, 2018

Physician burnout is frighteningly common. There are more reasons for this burnout than I could begin to capture in this article. Suffice it to say, there’s a lot of overworking and unnecessary bureaucracy behind the scenes at your average hospital.

As one case among many, I experienced burnout after just three years working for major hospitals.

Nurses and doctors find different ways to cope with their burnout. For me, I had to completely reset by getting out of the system that caused it. I left my last hospital position in 2014 to launch my private psychiatry practice, Progressive Psychiatry.

Launching a private practice requires making many hard decisions. One thing I knew: to avoid any more burnout, I had to increase my time doing actual patient care. This required reducing the number of hours I spent pushing papers.

Among my decisions, I had to choose whether or not to accept health insurance at my own practice. As the title of this article suggests, I chose not to accept insurance (and haven’t regretted that decision yet).

Since my choice is a little controversial and unusual, it bears explaining. Here’s why I’ve chosen not to accept health insurance at my psychiatry practice:

Insurance Companies Take More than They Give

Insurance companies are businesses. We can’t blame them for trying to make money. But it’s important to distinguish their role in a patient’s wellbeing. Priority #1 for insurance companies is paying their shareholders, plain and simple. Their interest in customer wellbeing comes second at best.

In a free-market society, the health insurance company that cares the least for its patients loses the most customers. So there’s overlapping interests here, but only insofar as the insurance company can retain customers while spending the least amount of money on their customers’ healthcare needs.

Also, this might come as a surprise: doctors don’t make money by contracting with health insurance companies. Health insurance companies do, however, maintain an exorbitant level of control over how their contracted physicians manage their medical practices.

In other words, the expertise I gained throughout ten years of medical school suddenly must be sifted carefully by a business whose financial interests may be opposed to my understanding of the best possible care that can be given to my patients.

I prefer autonomy because, well, I went to school for this.

Accepting Insurance Raises the Prices Charged for Non-Insured Payers

Biz Accounting 101: Income must exceed expenditures.

When a business takes on a new expense, it must ensure the additional cost is still exceeded by money flowing into the business. Sometimes that means cutting other expenses or raising the price of a good or service.

I’m not allowed to raise my rates for one party (the insurance company) and keep costs down for someone else (a non-insured payer). If I choose to keep my prices lower so that non-insured patients can afford my services, I must also eat the cost of the insurance fee.

In order to keep my costs low for non-insured patients and keep the bills paid, I don’t accept insurance.

Insurance Locks You In or Out

While there are some laws against insurance companies withholding care from patients with preexisting conditions, it doesn’t entirely stop that discrimination from happening. Insurance companies maintain the ability to approve or deny you insurance coverage.

Insurances companies are private networks with exacting criteria. They can lock people out who need a certain type of care by finding loopholes through obfuscation. In other words: they are intentionally vague about their criteria for coverage.

Instead of jumping through all the hoops and confusing financial mess to determine what services are or are not covered under someone’s insurance plan, I post my prices online.

By avoiding insurance companies in my practice, I can be transparent about pricing, collaborative with patients, and straightforward about what’s possible. Working direct with a physician eliminates the discriminatory hoops insurance companies make patients jump through.

Insurance is a Bet Against Yourself

Fear of the what if’s is one of the biggest reasons people buy insurance, despite our collective health being better than any time in history. But the thought of disasters still scare many of us, and buying insurance is a bet against our own propensity for healthy living.

My advice: plan for emergencies, take greater responsibility for your health by eating better and exercising, and invest in FDA and CDC approved preventative medicine (read: get your vaccines).

I’m a huge advocate for taking responsibility for one’s own health. Ownership and self-care will save you more money and more doctor visits than any medicine, in most cases.

I Believe There’s a More Straightforward, Affordable Approach to U.S. Healthcare

As I mentioned at the top of the article, I’m not a lone-physician trying to venture against standard industry practices. In fact, there’s a free-market healthcare movement with strong wind in its sails. The future of healthcare stems from the financial choices of everyday people. The most democratic decision you can make in healthcare is deciding where to spend your money when it’s time to visit a physician.

I believe healthcare is strongest when I can work directly with patients, without a third-party insurance business trying to control who I see, what I prescribe, or how much I charge my patients. So when my patients visit me, or visit any other private-practice physician, they are also investing in a more transparent, cost-effective healthcare experience.

There’s another way to do things, is all I’m saying.


Want to learn more? I wrote a book about healthcare in America. It will answer almost every question you’ve asked (or never thought to ask) about our healthcare system. I also throw out a few ideas about how we can make the healthcare industry more innovative, cost effective, and practical for everyone. Learn more here.

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About the author

Dr. Brian J. Dixon

With accolades spanning my career as a child psychiatrist, entrepreneur, writer, and public speaker, I advocate for a more sensible U.S. healthcare solution that appeals across all party lines. I am a Texan, born and raised. My psychiatry practice, Progressive Psychiatry, is based in Fort Worth.

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