Insurance or Self-Pay in 2026? What I Recommend for Private Practice
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[00:00:00] One of the most common questions ~that ~I hear from dietitians is, should I accept insurance or go cash pay? ~Now, ~this ~question has always come up, but in the last couple years, it's come up even more. Usually that ~question is loaded with ~a lot of ~fear. Fear of doing it wrong, ~and fear of ~not making enough and ~fear of ~being judged.
But the real issue isn't insurance versus cash pay. It's whether your business model actually supports the kind of clinician and human that you wanna be. So in today's episode, I'm walking you through how I think about insurance versus cash pay in 2026, ~and ~what actually matters when choosing a model and how to stop making this decision from panic or comparison.
~Which I know is so easy to do. Now, ~this isn't about trends. It's about alignment, sustainability, and long-term clinical excellence, which is what US dietitians ~really ~want ~to do. So ~you might be wondering, why does this decision feel ~so ~confusing? You've probably heard it mentioned before, among your peers or maybe online.
And it's because, as us dietitians are not taught business strategy. We're well [00:01:00] versed on clinical matters, but we haven't been taught marketing scale sales and operational skills, right? We're taught clinical precision, and that's the backbone of dietetics. So when it comes to choosing a practice model like how to operate, oftentimes dietitians will rely on social media opinions.
Because where else are you gonna go? And you'll look at what are other dietitians doing? More specifically, what are other dietitians doing in Texas where you might live? Or in California where there happens to be a high number of dietitians. Or maybe you'll look at worst case scenarios out of fear.
You'll say, ~oh ~dietitians don't charge a lot in my area, so I'm not gonna charge a lot. Does this sound familiar? This comes up ~so ~often, and I wanna say it's normal, ~right? ~We're human. ~I wanna name something important here. ~I've evolved my own mindset on ~a particular matter of ~insurance over the last specific.
Three years, ~especially ~post pandemic ~with how everything has evolved ~with expanded telehealth laws, shifting client access needs, and ~the realities of ~sustainability. My perspective has shifted and [00:02:00] I've ~actually openly ~discussed this ~on a video ~on YouTube called Why I Changed My Mind about taking insurance as a dietician.
I posted that several years ago where I talked through how and why this evolution has happened in real time. And I've talked about it on the podcast too, and it wasn't a sudden slip. It was really a strategic recalibration based on experience and data and what I saw happening both with clients and the clinicians ~at large ~and ~also in ~other fields like ~in ~therapy.
~So some people are told, ~some dietitians are told ~that ~insurance clients are harder and ~others here that ~cash pay is the only ethical way to go. Suddenly what should be strategic decisions just becomes an overall identity crisis. You just don't know what to choose. But here's the truth ~that there, ~there's no morally superior model.
It's ~only ~the model that best supports your capacity ~and your ~goals and ~your ~stage of business. What really matters more than the model is ~instead of ~asking ~insurance or cash pay, I want you to think and ask yourself this question. ~Can I sustain the model I'm choosing [00:03:00] financially?
Can I serve clients without burning out? Can I maintain clinical integrity? And does this allow me to grow or stabilize? ~Because ~a cash pay model is ~so much ~fun and I love ~it and I teach ~it, but if ~a cash pay model and what ~it ~comes with in terms of skillset ~stresses you out, ~then ~it's not ~a ~better ~model ~for you.
~You have to ~think about what you can sustain financially, how you can serve clients without burning out, and what you can do to maintain clinical integrity and what allows you to grow or stabilize. Additionally, you have to think about what skills are you willing to learn, because if you are leaning towards an insurance-based model, ~you're gonna have to ~work on your operational skills.
Even if you hire ~out ~a biller, you still have to understand the ins and outs of what the biller's doing. And if you have a cash pay model, you're gonna have to get better at sales. Both models, you're gonna have to know sales, but you're gonna have to be even more precise when it comes to cash pay. So these are questions you have to ask yourself.
What skills are you willing to learn? If an insurance [00:04:00] model forces you to rush sessions, ~then ~it's not ~a ~more compassionate ~model. ~Categorizing or grouping one model into a certain set of characteristics, although it's really common and easy to do that. So I want you to think about your nervous system, ~right?~
~And I want you to ~think about your energy and ~the ~standards ~that you have ~for your practice, ~because ~they ~do ~matter. ~So ~the reality of assurance and not the rumor. Is that insurance does offer accessibility. We can't deny that it helps more people have benefits they wouldn't otherwise have, and that is huge, especially when it comes to nutrition and nutritional science, because nutrition is still a topic that's really undervalued in the medical space, and so it matters.
If we can make our services more accessible, we can potentially become more known and that can ~help ~bring. People into care who wouldn't otherwise ~be able to ~afford it or know ~that ~they could get help. ~But when people say that there's ~administrative complexity, that phrase can be a little bit vague when it comes to insurance.
~And ~it's true, but let me help you translate it plainly ~in real life. What that can look like ~for insurance ~is that ~[00:05:00] you verify benefits before sessions. ~You ~manage prior authorizations, ~you ~stay compliant with documentation ~requirements. You ~track reimbursement timelines, and you have to handle denials and resubmission and navigate multiple payer portals.
So if this gives you a headache, let me just say that every business model you choose, whether cash pay or insurance, will have their pros and cons. When it comes to cash pay, you're gonna have to work on your sales skills. And in insurance, you're gonna have to work on navigating multiple payer portals.
And if you change your name, if you move, if you are a multi-state healthcare practice, there's gonna be even more complexity ~and some of that you can't control. And ~you might ~just ~end up relocating ~and ~have to re credential or ~have to ~submit demographic changes. There's a lot of complexity when it comes to administrative.
Changes and updates with navigating insurance. It's just part of the business and ~it ~doesn't necessarily make insurance wrong, but it can make insurance heavier, and that was the [00:06:00] biggest setback for me. The operational complexity was something I never wanted to deal with, ~right?~
But insurance does work best when you have systems in place, just like anything. So your boundaries are clear ~and your ~session quality ~is ~intentional and you can grow and enforce your boundaries with time, so this model should be chosen strategically, not resentfully. So really thinking it through.
And when it's structured poorly insurance can create a lot of pressure to rush ~things ~under document or emotionally disengage, which is not clinical excellence, but when it's structured well, you can offer consistency and accessibility and predictable care ~continuity, ~which is excellent, ~right?~
~You can ~focus on ~getting ~higher retention. Getting referrals from clients and from physicians and improving your clinical skills during session, your counseling skills those are all really important parts of navigating any business model. So when you think [00:07:00] about it, the difference is really how you hold your care more than the model.
It's about how you reflect on what you're willing to do and not do. ~So when it comes to cash pay ~I've long taught and supported cash pay models ~and I still do them ~and love them. There's real power in cash pay. Cash pay offers flexibility ~that you can't get with insurance and ~autonomy and the ability to create ~deeply ~individualized care structures, which is very attractive for us clinicians and it can support longer sessions and different types of care, premium positioning and ~really ~strong client commitment.
But over time, I've ~also ~seen. Cash pay can create friction ~mostly ~for dietitians and ~for some ~clients depending on the cost. So that means clients delay care because of cost, and then dietitians under price, usually out of guilt, and then they emotionally feel fatigued from the constant sales conversations.
That could just be a lack of training in terms of sales, because it's a skill that many dietitians don't [00:08:00] put enough energy and attention into. And the inconsistent outcome can create stress and urgency in a cash pay model. So dietitians might say, it doesn't work for me, when really there was this one skill that needed to be more developed.
Cash pay works really beautifully for many dietitians when it aligns with your values, your capacity, and your stage of business. So there's absolutely a place and time for it. ~And just ~like insurance, you ~will ~need to build ~on your ~skills and identify your strengths and weaknesses as a provider. But when cash pay is chosen as a reaction to fear of insurance rather than strategically aligning.
This business model, ~it ~can lead to overworking ~and ~overgiving and self-doubt, ~which can feel really wearing. ~So that's where ~this ~nuance matters. ~Want you to really ~line up. ~What ~your thoughts ~are ~and ~what your ~capacity ~is ~when you choose a business model ~or multiple business models. And then ~there's hybrid, and that's the model that I think a lot of dietitians are operating under, but I don't think it gets enough attention.
So in 2026, the most sustainable practices, I don't think will be strictly A or B, but ~they'll be intentionally ~both. [00:09:00] Insurance for accessibility and cash pay for flexibility ~in depth. And that allows you to ~diversify ~your ~revenue and stabilize your income and build on your skills with time. So you can scale thoughtfully.
And so what that might mean is that you do have packages, higher tiered options and more personalized care for cash pay. For folks that maybe have used up their benefits or that don't wanna use insurance ~or ~can't use ~their ~insurance, or you offer a membership model, or you have other digital products that you're offering your clients.
And it's not indecisive to offer both. It's really strategic range, and ~it ~will require. Some front loading especially if you're going to do both, but that's why you can add them on slowly. ~So you might ~start with one model and ~then decide you wanna ~incorporate another ~model ~later realizing ~that the ~skills come with it.
~So ~on a recent sales call, a dietician ~did tell me that she ~felt stuck choosing between insurance and self-pay, which again is such a normal conversation I have with our clients. [00:10:00] And what made this particular conversation more layered is that she had already followed a cash pay only framework for years, and a framework that I have taught and supported, and she believes in it deeply, and ~she had ~built her identity around it.
And so for a long time it really did serve her. To be a cash pay practitioner, but her life had shifted and she has more financial responsibility now, and less tolerance for income peaks and valleys. And the desire for steadiness felt really real ~in that moment. So when we spoke, ~the question wasn't, is self-pay bad?
~It was, ~is this still sustainable for who I am today? ~And ~for her, the answer wasn't abandoning. The cash pay model, it was just reframing the model entirely. And so we explored what that hybrid approach would look like, not as failure to her values, but an evolution to her structure. ~So ~she chose to credential with insurance and create a stable base of consistent clients and predictable income in addition to her cash pay model.
And that did [00:11:00] relieve the pressure that she felt to sell every ~single ~session. And it allowed her to have a bit of. Relaxation and a bit of managed anxiety with her nervous system. So when we layered the cash pay intentionally, we positioned it for clients who desire extended support ~and ~premium structure or specialized care.
Instead of feeling like every client decision carried ~a ~financial panic, ~right? ~She now has ~this ~choice and control. ~So rather than swinging from one extreme to another, ~this ~particular ~client built ~some ~range. ~And ~what changed wasn't her payment structure, it was ~just ~her ability to have trust in herself and build on her skills.
So insurance became a foundation to her and cash pay was an expansion of that foundation. And so together they created sustainability like not contradiction. So when a hybrid works without ~becoming ~overwhelming ~is ~when ~it's ~built in layers ~and ~not chaos. ~So ~a simple ~functional ~structure could be insurance, cash pay, ~could be ~weekly or biweekly sessions for ~maybe ~core care, and ~then ~optional cash pay packages for ~deeper ~extended [00:12:00] work.
~And then there's ~clear messaging around who each option is for. ~And that ~can prevent overwhelm because each stream has a distinct purpose. ~So ~let's say insurance is consistency and continuity, and cash pay is depth. And flexibility. ~That's just one example. There are many, and ~the mistake isn't choosing hybrid.
The mistake is building without clarity, ~right? ~Without thinking about your strategy. ~So ~when hybrid is framed as intentional and not reactive, it becomes one of the most stabilizing models for long-term practice growth that I've seen my clients have been able to build on evolution. That's really strengthened by your ability to reflect on your skills and layer with intention.
With multiple revenue streams. I hope you enjoyed today's episode. I look forward to seeing you next week.
