Sanctuary Functional Medicine, an insurance-free practice in Tennessee

Self-pay patients in the area south of Nashville, Tennessee have what looks to be at least one terrific option when they need a doctor’s office prepared to cater to their needs. Sanctuary Functional Medicine, founded by Dr. Eric Potter, has an office in Spring Hill, which appears to be about half an hour south of Nashville (depending on traffic, of course). Another office will be opening next week in Franklin, also south of Nashville.

Potter and the practice’s other doctor, Theron Hutton, offer what they call “functional medicine,” which their web site describes this way:

Functional medicine is a modern approach to healthcare that seeks to address the underlying causes of disease, rather than just treating acute symptoms. Practitioners of functional medicine take a more patient-centric approach to your care by viewing you as a whole person—with an integrated body—as opposed to just an isolated set of symptoms.

One of the benefits of this approach, and one that is fairly typical of most cash-only practices, is that they are able to spend a lot of time with their patients:

As a functional medicine practice, we spend at least 90 minutes with each of our patients on their initial visits. The average visit after that is 30-60 minutes. We take the time to ask thorough questions and to listen in order to gain an in-depth understanding of the root causes of your body’s dysfunction.

They also try to incorporate approaches to health care beyond standard Western medicine:

Unfortunately, many of today’s patients are often forced to choose between traditional Western medicine and alternative, holistic approaches to healthcare when evaluating their care. We believe both have value and can play in important role in treating a patient. In addition to prescribing medicine, we may also prescribe a new nutrition program or fitness regime. In some cases, a botanical supplement, or counseling, can serve as an effective, much safer alternative to taking a pharmaceutical drug. Each patient is unique and deserves to have the best science-based care from both Western medicine and holistic care.

Dr. Potter’s story of why he founded Sanctuary is one that will sound familiar:

After spending several years trying to care for patients in multiple conventional medical settings, Dr. Eric Potter realized the clock was ticking faster and faster: either see more patients in a day (spending less time with each one) or get off the hamster wheel and provide real care. Once he discovered the Direct Pay Care business model, the pieces fell into place that enabled him to found and open Sanctuary Medical Care and Consulting in 2014.

And his explanation for why he doesn’t accept insurance will not surprise anyone either:

Paying at the time of service means that you are not paying for bureaucracy, nor for administration, but for your health. It means that you and your physician decide your care, rather than third parties whose interest may not coincide with your own best interest. Moreover, your physician can spend more time caring for you, rather than filling out paperwork.

One of the under-appreciated benefits of the services offered by Sanctuary is that it has its own pharmacy, and bill patients at cost for the medicines it sells. I spoke with Dr. Potter yesterday and he said they keep about 40 commonly prescribed medicines in stock, typically at savings up to 80 percent. He specifically noted that a prednisone prescription that normally runs $20 at a pharmacy is available to his patients for around $5 (I neglected to ask what the dose/quantity was). Sanctuary can also order in specific medicines for patients that it doesn’t routinely stock, offering more savings. Lab tests performed in-house are free, while patients only pay the practice’s cost of labs that are sent out.

Sanctuary is a direct primary care practice, meaning a relatively modest monthly fee covers all routine visits and treatments, which typically can be scheduled for the same or the next day and typically last from 30 minutes to an hour as needed. In addition, the practice will also see patients who aren’t members on a walk-in basis, similar to cash-only practices that haven’t gone the direct primary care route.

If there’s one criticism of the practice, it’s that the web site doesn’t include prices, instead inviting patients to call and request pricing information. Dr. Potter did share with me that most patients pay between $70 and $120 a month, with the younger patients paying towards the lower end and older patients paying at the higher end. Compared to what self-pay patients and even many with “comprehensive” insurance pay these days for a doctor’s appointment, these fees seem pretty reasonable for anyone who will be visiting the doctor more than a few times a year.

The practice is located at 3011 Harrah Drive, Suite T, in Spring Hill, and those looking for more information should either call (615) 614-2500 or e-mail

Posted in Cash-Only Doctors, Direct Care Practice | Leave a comment

Cash-Only Pharmacy Offers Savings on Medicines

I’m pleased to introduce another member of the Self-Pay Patient team, Yana Krinker! Yana is a DC-area resident who works at the U.S. Patent & Trademark Office, and who has an interest in self-pay healthcare and health economics. She will be writing occasional articles for the site, hopefully allowing us to get out more frequent content. Please welcome her to the site!

Many self-pay patients looking to save on prescriptions drugs are familiar with chain store discount programs (Costco and Walmart have popular ones) and drug price comparison websites such as GoodRx, but another excellent resource that hardly ever gets mentioned is the cash-only pharmacy. As I explain below, self-pay patients may want to check prices at Medsavers Pharmacy or another cash-only pharmacy before filling their next prescription.

Medsavers Pharmacy is a family owned and operated pharmacy in Austin, Texas founded in 2005 on the principle: “we don’t deal with insurance companies.” By refusing to work with third party payers, co-owners Pharmacist Chris Johnson and his wife Bryna, are not required to stock a certain amount of brand-name drugs, thereby lowering overhead costs, and insurance companies can’t influence the prices Medsavers charges for medications.

For customers this translates to drug prices which are often significantly less than cash prices offered by other pharmacies. It also means that all shoppers, regardless of insurance status, are charged the same prices on prescription drugs. Medsavers pharmacy has a retail location in Austin, and for those of us who don’t live in central Texas, Medsavers will ship any non-controlled prescription for $5 (within the states where the pharmacy or supplier is licensed). Continue reading

Posted in Prescription Drugs | Tagged , , | 5 Comments

More Cash-Friendly Medical Practices

I continue to get people asking me “where can I find a doctor or other medical provider that treats self-pay patients fairly,” by which they mean will offer them an honest, straightforward price to patients. Fortunately I also continue to get e-mails and calls from doctors and other providers telling me about their practice, or self-pay patients letting me know about those that they have found. Here’s a couple of recent ones:

Alliance Internal Medicine & Aesthetics

Located in Fernandina Beach, Florida (which looks to be about 30+ miles north of Jacksonville), the husband and wife team of Drs. Sam and Catherine Featherston* offer a primary care practice that also provides cosmetic treatments. Both are trained internists, and it looks like they just opened, at least judging by the special they are currently running offering 25 percent off of all medical treatments for the month of September (one of the great things about cash-friendly practices is they tend to offer deals and specials that can be real bargains).

The prices look excellent too. A basic visit dealing with two chronic conditions or one new condition is $45, which probably equates to either a Level 2 or Level 3 visit (10 minutes and 15 minutes, respectively) which Healthcare Bluebooks show as an $82 and $137 fee, respectively for that area.

Walk-in visits are also $45, and phone or video consultations are the same price.

The “About Us” section of their web site provides a brief explanation of how the Featherstones have set up their practice, and it fits quite nicely into the self-pay world:

At Alliance Internal Medicine & Aesthetics, we believe that: health care does not have to be expensive; you shouldn’t have to wait for weeks or months to see your doctor; you shouldn’t have to sit for hours in a waiting room; you should be able to see your doctor and not an assistant; and you deserve to have a doctor who keeps in mind that most people are living on a budget and who will consider costs when prescribing medications, ordering tests, etc. We feel that governmental departments and managed health organizations have created a system where health care costs are now prohibitive and medical decision making is largely out of the hands of patients and physicians. We have decided to opt out of those systems in order to not be bound to their price plans and other bureaucratic restraints. This allows us to keep our costs down and we enjoy passing along those savings to you.

Self-pay patients in the north Jacksonville and Nassau County areas of northwest Florida can contact Alliance Internal Medicine & Aesthetics through their online contact form or call them at 904-206-9354. The office is located at 1001 Atlantic Avenue in Fernandina Beach.

Gold Direct Care

I haven’t reported on a lot of doctors in the Northeast that have embraced self-pay patients, so I’m happy to be able to write up Gold Direct Care, a direct primary care practice located in Marblehead, Massachusetts, about fifteen miles northeast of Boston. The practice was started by Dr. Jeffrey Gold, apparently a native of the area, in February of this year. He explains on his web site why he opted for the direct primary care model:

When I made the decision to become a Family Practice Doctor, I had a vision of what I thought my practice would be like…it would be in a community similar to where I grew up; I would have personal relationships with all of my patients; I would be accessible to my patients when they need me; I would be able to spend as much time as I want with my patients; and the list goes on and on.

Over the course of the past couple of years, due to many factors, it became very clear to me that my vision for how I wanted to practice medicine was not coming to fruition; at least not in the dysfunction of the current healthcare system. I started to read about a movement in the world of primary care medicine called Direct Primary Care (DPC)…The more I read and the more research I did, it became obvious to me that the vision that I had for how I wanted to practice medicine- as well as the vision that I had for how my patients deserve to have me practice medicine- could be achieved by opening my own DPC practice. I truly believe that Direct Primary Care is a large part of the solution to the healthcare crisis in this country…

I am the first doctor in the state of Massachusetts to open such a practice, and I know it is the right thing to do for me, but most importantly for my patients.

As do most DPC’s, Dr. Gold offers free visits, same- or next-day appointments, and unlimited communications (phone, video, e-mail, etc.) for a monthly fee. The fees are adjusted for age, starting at $30 a month for those 21 and under, $50 for those 22-30, $75 for the 31 – 44 age group, and $90 for those between 45 and 65. He also offers membership to those age 65 and older, charging $125 a month. He also has posted on his site the discounted lab prices he can offer patients, such as an electrolyte panel for $5 that Healthcare Bluebook says has a “fair” price of $18 (meaning that’s what insurers typically pay) and a Vitamin B-12 test for $45 ($39 according to Healthcare Bluebook, so a little higher but not much).

His web site also notes he offers discount prescription drugs, details of which aren’t available but can offer huge savings. I recall being on a panel earlier this year in Vermont discussing self-pay health care and Dr. Josh Umbehr of Atlas M.D. in Wichita, Kansas, mentioned during his presentation that he was able to basically give away most generic medicines to his patients without having to charge them (it’s built into the monthly fee, obviously) because it was so cheap for him to get as doctor. I can’t recall the exact numbers he gave, but it was for Imitrex, a migraine medicine that I recognized because my wife used to take it. The name brand costs close to $400 for 9 doses and the generic version costs about $15 for nine doses according to, Dr. Umbehr said he was able to buy a large bottle with 1000 doses for about $10. It literally would have cost him more to bill his patients $0.01 for each dose than to just give them away. If Dr. Gold is able to offer even remotely comparable savings on prescription drugs, the monthly fee could be the bargain of the year in the state of Massachusetts.

So, self-pay patients in the Boston area, or “fully insured” patients who aren’t terribly satisfied with third-party payer, take a look at Dr. Gold’s practice. He can be found at 123 Pleasant Street in Marblehead, or reached by phone at 781-842-3961 and e-mail at

*Somehow I managed to get the names wrong in the initial post, my apologies! It is Drs. Sam and Catherine Featherston, not sure why that was so difficult for me the first time around.

Posted in Cash-Only Doctors | 18 Comments

Reporter Looking for People With Unexpected Medical Bills

I’ve been contacted by a reporter looking for anybody who would like to share their story regarding unexpected medical bills, primarily those of insured individuals who wind up getting an “out of network” provider and the resulting inflated bill. If you’d like me to put you in touch with her, please send me an e-mail at selfpaypatient [at] gmail [dot] com.

Posted in Media | 6 Comments

More Self-Pay Practices – June 2015

I’ve had several doctor’s offices and other medical providers who cater to self-pay patients reach out to me in recent weeks, wanting me to pass along their information. Finding a cash-only or at least cash-friendly doctor is probably the biggest challenge for those of us operating outside the third-party payer system, so I’m always happy to pass along information when I get it (even though I may not be terribly timely). Here are a couple that have contacted me recently, I’ll have more in the coming days and weeks (hopefully).

Associated Urologists of Orange County

Primary care physicians who cater to self-pay patients are generally easier to find, so I’m always pleased to see specialists as well. Associated Urologists of Orange County is one such practice, located in Santa Ana, California. They do accept insurance, but their web site says “We welcome all patients, including Self Pay patients.” They offer a price list for self-pay patients, and according to the page they offer cash prices comparable to what PPO insurance companies pay. I checked out a few of the procedures they had listed and this appears to be the case. A vasectomy, for example, is listed for $800, while according to Healthcare Bluebook in the Orange County area a typical insurer would pay $850. A pelvic ultrasound at AUOC lists for $125, close to the $116 price that Healthcare Bluebook shows.

An initial visit for new patients is $150 while follow-up visits are $75 for self-pay patients, which compares favorably to what I’d guess would be the closest “standardized” visit type, a Level II visit to see a doctor ($161 and $95, respectively).

Associated Urologists of Orange County is located at 1801 N Broadway in Santa Ana, and can be reached at (714) 639 -1915 or by an online form available at

Note: 8/26/2016

Dr. Horiagon has had his license to practice medicine revoked as of March 10, 2016. See Colorado Division of Professions and Occupations, Department of Regulatory Agencies.

Dr. Tom Horiagon

Self-pay patients in the Denver area ought to know about Dr. Tom Horiagon of Littleton, Colorado. He lays out his vision and practice on the home page of his practice:

…Ambulatory care is now an out-of-pocket expense due to high deductibles, narrow networks, and long wait times to be seen in network. Moreover, as hospitals have purchased physician practices, the fees for ambulatory care have skyrocketed in Denver. Hospital master charge lists are not transparent for the most part and indefensible price variations emerge in the absence of constant scrutiny. These price variations can be as much as tenfold for identical services in the Denver metropolitan market.

To make medical care realistically priced, administrative costs, labor costs, and rent need to be as cheap as possible. A 2 room practice like I have can repair wounds, treat simple eye injuries, treat a huge variety of musculoskeletal injuries, and manage the majority of chronic medical conditions with episodic or scheduled visits. Everything is priced by the amount of time I personally spend treating someone ($50/15 minutes). EKG’s, complete pulmonary tests, sleep apnea evaluations, simple urinalysis are all available at the office. High-quality imaging services are available in the same building and the price for patients who pay cash is a small fraction of the cost applied when insurance is used. A network of other providers who have superior quality and cash prices for patients who do not wish to use insurance is used preferentially for referrals.

$50 for a 15 minute visit with a doctor of his experience and expertise (his bio shows board certifications in internal medicine and pulmonary disease, and he received his medical degree in 1981, giving him 30+ years of experience) is a bargain. Again looking at Healthcare Bluebook, an established patient visit to a doctor for 15 minutes runs about $140 dollars in the Denver area. And judging from the introduction on his homepage, it’s clear that Dr. Horiagon is fully on board with the self-pay idea!

Dr. Horiagon’s office is at 26 W. Dry Creek Circle, Suite 640 in Littleton and he can be reached at 720-306-8280 or



Posted in Cash-Only Doctors | 6 Comments

Insured but not letting the doctor know?

I’ve been incredibly negligent in posting here the past several months, hopefully getting down to one job will allow me to post here more frequently (and yes, I’ve said things like that before).

Today I wanted to address something I’ve gotten several e-mails on over the past few weeks. Early last year I put up a post titled “Insured patients can save money by pretending to be uninsured.” The gist of the article was that the negotiated rates paid by insurers to doctors are sometimes more than the cash price the same doctor might charge someone who is uninsured. In those circumstances, for people who are going to be paying the full bill because it’s under their deductible, it’s better to hide the fact that you have insurance and just pay the cash price.

The question I’ve gotten a couple of times recently has to do with the legality of doing this, and what might happen if the doctor finds out you are insured. The answer to the first one is easy – it’s completely legal to not use the insurance you have, or at least I’ve never heard of an insurance policy requiring that their policyholders use them for all treatment.

The second one can be a little tricky. A couple of people have told me that they’ve tried to get the cash price after they have given their insurance information, only to be told they have to charge them the negotiated rate. Unfortunately, this is true, even though the patient will be paying the full price, whatever that may be. Once you tell a doctor’s office you are insured, they are contractually obligated to charge you the rate they agreed to with the insurer.

Someone else described the following scenario: they’ve been getting the cash price by not telling the doctor they are insured, what happens if they find out they’re insured? Will the doctor go back and have to re-price all the past bills? Two thoughts.

One, it depends on what exactly the doctor finds out the patient is insured. If they only find out that now, as of this particular visit the patient is insured, they’re likely going to assume it’s new coverage and not ask about whether past visits could have been covered under the insurance policy as well, so this shouldn’t be a problem.

If, on the other hand, the doctor discovers the policy was in effect during previous treatments, there might be a problem, and I just don’t know what might happen. Some doctors might opt for a “water under the bridge” attitude and not worry about it (there’s not much financial incentive for them to pursue the higher charge, as the marginal increase in revenue is likely to be gobbled up with the bureaucratic hassle of going back and dealing with it), while others may insist on going back. It probably depends on the doctor and how devoted they are to the third-party payment system (if they were offering good cash prices to begin with, the answer is probably “not very”).

I’d be interested in hearing any experiences anybody has had that relate, shoot me your thoughts at selfpaypatient [at] gmail [dot] com.

Posted in Cash-Only Doctors, High-deductible health insurance | 44 Comments

Cash-only Neuro-Ear Doctor in Louisiana

If you’re a self-pay patient in Louisiana and need a neuro-otologist (that’s a doctor who treats neurological disorders of the ear – I had to look it up too), I’ve got good news for you. Dr. Gerard J. Gianoli has ditched third-party payment, and gone cash only. The Wall Street Journal carried an op-ed by Dr. Gianoli today:

Saying Goodbye to Third-Party Medical Payments

The Affordable Care Act is raising costs, restricting patient choice and doctor freedom, and putting bureaucrats in the treatment room. It isn’t good—but it’s here to stay, largely intact, at least until a Republican president can work with a Republican-controlled Congress.

But that doesn’t mean nothing can be done. The onus is now on physicians to innovate and improve patient outcomes within the restrictive confines of an ObamaCare world…

If what many providers advocate is true—that doctors, not bureaucrats or politicians, know what’s best for patients—physicians must begin offering solutions. This requires thinking like entrepreneurs and innovators, not lab coats awaiting orders from outside parties on how to deliver medical care… Continue reading

Posted in Cash-Only Doctors | Tagged , | 10 Comments

Kiplinger’s reports on self-pay health care

Last night I read an article in Kiplinger’s reporting on the growing trend of people who are opting out of third-party medicine and simply paying directly for their care. Kiplinger’s, for those of you unfamiliar with the publication, bills itself as a source of personal finance and investment information, and they provide a pretty good overview of self-pay healthcare.

Pay Cash for Your Health Care

In an era of higher health insurance deductibles, rising out-of-pocket costs, shrinking provider networks and fewer choices in health care, more people are taking matters into their own hands. Instead of using their health insurance for all of their care, they’re going off the grid and paying cash so that they can see the doctors they choose or get the drugs they prefer. Some are paying a fee to their primary care physician in exchange for longer office visits and 24/7 access.

Going off the grid doesn’t mean ditching your health insurance altogether. You’ll still need insurance for big-ticket medical care. But it usually makes sense to get a high-deductible policy to save on premiums. Payments you make in cash may count toward your deductible, and if you contribute to a health savings account or a flexible spending account, you can usually use that money tax-free to cover your out-of-pocket costs for medical expenses, even if your insurer doesn’t count them toward the deductible. The payoff: more control over your care, which may cost less than you’d pay with your health insurance policy…

One quibble, of course, would be that you don’t necessarily need health insurance for big ticket medical care – plenty of self-pay patients do fine without it and are able to afford what would otherwise be too expensive simply by shopping around and considering all of their options, including medical tourism. And of course there are alternatives to conventional health insurance too, such as critical illness policies and health care sharing ministries.

The article covers concierge care and direct primary care, as well as describing how the story of Jeff McElroy and his experience at the Surgery Center of Oklahoma:

Jeff McElroy’s 8-year-old daughter, Caroline, needed surgery to remove a mass in her ear. McElroy had recently changed jobs, and the McElroys’ first choice for the procedure, the Surgery Center of Oklahoma, in Oklahoma City, wasn’t covered in his new insurer’s network. McElroy asked the surgery center how much it would cost if he paid cash to have the surgery done there. The answer: just $1,700.

His policy would have covered the surgery at a local hospital for $7,600, but because McElroy’s policy had a $6,400 deductible, he would have had to pay most of the bill out of pocket. So he chose the surgery center and paid cash. “It was the same surgeon and the same surgery,” says McElroy. The surgery center submitted the expense to his insurer to count toward his deductible. He also used money from a health savings account to pay the bill.

McElroy, who is a certified financial planner, thought about switching to a lower-deductible policy during open enrollment for 2015 coverage but changed his mind after he did the math: He could save $150 a month in premiums with the high-deductible policy, make the most of the growing number of stand-alone facilities and providers in Oklahoma City that offer cash discounts, and contribute up to $6,650 to a health savings account to pay the bills with tax-free money.

McElroy’s story is something I expect to be replicated many times in the coming years, as high-deductible health insurance spreads and more people realize the ‘negotiated’ rate they’re being asked to pay, often billed as a ‘discount,’ far exceeds what they’ll pay if they just go to a cash-only or cash-friendly provider or facility.

Getting a publication like Kiplinger’s to promote the benefits of self-pay medicine is significant, I think, and hopefully will help more providers of health care services to realize there is a growing market filled with patients who don’t want to invite a third party into the doctor-patient relationship and instead just want to pay directly for their health care just like they pay for other important goods and services.

Posted in High-deductible health insurance, Price Transparency | Tagged , | 2 Comments

Altrua Qualifies for Obamacare Exemption

It’s been so long since I posted here I’m sure a few of you wondered if I’d been hit by a bus, kidnapped by the insurance companies, or just lost interest. Fortunately the answer to all of these is ‘no,’ but I have been swamped with my work that pays, at least that pays in ways that fill my bank account and allows me and my family to eat!

I’ve got a bunch of things that have been sitting in my in-box (of course), and I’m planning on beginning to work my way through them over the next few weeks with a number of fairly short post.

I thought I’d start by sharing what is probably the biggest news, that Altrua Healthshare, one of the five health care sharing ministries I’m aware of, recently received a letter from the Centers for Medicare and Medicaid Services confirming Atrua members are exempt from the tax Obamacare levies on many uninsured people (I’d blogged about Atrua’s merging with Blessed Assurance Bulletin, which is what allowed them to qualify, here: Altrua qualifies for Obamacare exemption, plus more on CMF Curo).

Here’s a link to Altrua’s recent press release announcing the good news: Altrua Gains Recognition as a Health Care Sharing Ministry

This is great news, of course – there was some question early on whether or not Altrua might qualify but I’m pleased to see that Altrua members, who have done the responsible thing and arranged to take care of potential major medical expenses outside of the conventional third-party payer health insurance system, won’t be penalized.

I haven’t heard from the other four ministries: Christian Care Ministry (better known as Medishare, and with a sweet new web site, by the way!); Christian Healthcare Ministries; Samaritan Ministries; and Liberty HealthShare. There’s really not much doubt the first three qualify, but there is some question about Liberty although they seem pretty confident they’ll qualify, and I hope they do. I’ve got a message in to the head of Liberty and will share it with you when I get it.

Posted in Affordable Care Act, Health Sharing Ministries | Tagged , , , , , | 26 Comments

4 quick tips on prescription drug savings

I was on the David Madeira Show this morning, talking about alternatives to conventional health insurance. David is a member of Samaritan Ministries, one of the five major health sharing ministries that bring together people who want to share medical bills outside of conventional insurance, so of course we got to talking about sharing ministries (I’ll be posting David’s experience with Samaritan soon, it’s a great story that proves wrong those who say sharing ministries don’t work for high-cost medical needs).

Anyways, in the course of our conversation, David mentioned the post I wrote on Altrua merging with Blessed Assurance Bulletin, meaning that Altrua members would be eligible for the exemption from having to pay Obamacare’s tax on the uninsured. David referenced it as, and I’m paraphrasing here, “the most recent post on The Self-Pay Patient site, dated October 15…”

Yeah. It’s been a while. I’m happy to be so busy with work that actually pays, but still.

So, I’m going to have to try to be better about posting here, but in order to do that it probably means a lot less of me writing stuff, and a lot more of me cutting-and-pasting from other interesting things I find that I think will be helpful for self-pay patients while not violating any copyright laws.

Like the article below, on prescription drug savings. I’ve covered some of these things here before of course, but one that I haven’t was the bit about re-evaluating your medicines periodically. I know from personal experience (not mine, but family members – I’ve probably had less than a dozen prescriptions in my entire life, thankfully) that it’s easy to allow inertia to take over in terms of medicines, and just assume that since you’ve been taking a particular drug for months or years that you need to keep taking it. 

Unfortunately I think a lot of doctors also don’t think much about reviewing medicines, and just keep renewing the same one over and over. Continue reading

Posted in Prescription Drugs | Tagged , , , , | 8 Comments