Your Doctor Has Never Shown You This Math. Here's What It Actually Says.

By Suzy Wraines | Army veteran, former healthcare professional, and founder of the Centered Care Directory, a curated national directory connecting patients with cash-based and hybrid practitioners across the United States.

You picked a plan during open enrollment. You paid attention to the monthly premium. You thought you were covered.

Then you needed a doctor.

And somewhere between the explanation of benefits and the billing statement, you realized the coverage you have been paying for all year does not kick in until you spend thousands more out of pocket.

If that moment has happened to you, you are not alone, and you are not stuck.

There is a conversation happening in cash-based primary care clinics across the country that most patients have never had with a doctor.

It starts when a patient walks in and says, "I have insurance."

Chad Stencel, a cash-based family nurse practitioner in Minnesota, asks the same follow-up question every time.

"What is your deductible? What do you have to pay before your insurance actually kicks in?"

The answers he gets have changed dramatically in recent years. Patients are reporting deductibles of $10,000, $15,000, and sometimes $25,000, even before their insurance covers a single dollar of care.

Here is what that means in practice.

A primary care visit in Chad's clinic costs $250. No insurance required. No billing. No surprise statement three weeks later.

At a $25,000 deductible, a patient could see Chad 100 times before they spent what their insurance requires them to pay first.

Most patients have never seen that math written out. Once they do, the conversation about cash-based care changes completely.

This is not about telling anyone to drop their insurance. Emergency coverage matters for:

For the everyday care most people actually use a doctor for, the insurance model is often the more expensive option.

Cash-based primary care exists specifically to fill that gap. A practitioner who answers to you instead of the billing department.

Chad sees patients of all ages, children through the elderly, for everything from sore throats and back pain to chronic conditions and wellness visits. His practice is built around time and outcomes, not billing codes.

One of the most striking things Chad shared in our conversation was something called pharmacogenomics, a test that has been available for more than 20 years and that most people have never heard of.

Here is what it does.

Every person metabolizes medications differently. Some people process a medication too slowly and build up toxic levels in their system. Others process it too fast and never get the therapeutic benefit. The same prescription, two very different outcomes, and your doctor has no way of knowing which category you fall into without this test.

The pharmacogenomics test is a simple cheek swab. It gives your provider a complete picture of how your body processes medications across every major category

It also screens for an MTHFR gene mutation linked to a range of neurological and chronic conditions, which an estimated 70 to 80 percent of the population carries without knowing it.

You take the test once. You own the results forever.

If you are currently on any medications or about to start one, it is worth asking your primary care provider whether they offer pharmacogenomics testing or can refer you to someone who does. It is the kind of personalized information that changes how your care is managed from then on.

The average American with employer-sponsored insurance pays over $1,400 per year in premiums, and that is before a single dollar of care is covered. For marketplace plans, that number is often significantly higher.

Cash-based primary care visits typically range from $100 to $300.

The insurance model was designed for catastrophic protection. Somewhere along the way, it became the default delivery system for everyday care, and the costs have followed.

Cash-based primary care providers exist in more states than most people realize. They offer the kind of time and attention that a 10-minute insurance-model appointment cannot.

If you are in the Minneapolis, MN area or anywhere in Minnesota, you can search for Chad Stencel directly. If you are looking for cash-based primary care near you in another state, search by location and specialty at how.healthcare, every practitioner listed has been reviewed and approved.

Watch the full conversation with Chad on the Centered Care Directory YouTube channel.

Then search for a cash-based primary care provider in your area at how.healthcare.

Suzy Wraines is the founder of the Centered Care Directory and host of the Health Over Wealth in the US newsletter. A U.S. Army veteran with decades of combined experience in human and veterinary healthcare, she writes from lived experience navigating the traditional healthcare system, and from personal experience building a healthcare approach centered on outcomes, not insurance requirements.

For educational purposes only. Not medical or financial advice. Always consult a qualified healthcare professional for your specific situation.