Leaving Insurance, Building Something Deeper

I’ve been thinking a lot lately about what I want AndyND to become over the next few years, and what I keep coming back to is that I don’t want to simply build a bigger practice. I want to build a deeper one.

I want there to be enough time for us to know each other, enough space for the kind of care that doesn’t fit neatly into a 15-minute box, and enough support around the practice that the people doing the work can actually sustain it. I want more opportunities for us to gather outside the treatment room, more collaboration with people I trust, and more of our resources circulating within the community around us. I want to practice medicine in a way that feels aligned with what I actually believe healthcare can be.

The more clearly I can see that vision, the more clearly I can also see the parts of our current system that are getting in the way. So there are some changes ahead. Some of them are practical, some are philosophical, and some are still very much in the “I’m figuring this out as I go” stage. But I want to bring you into the conversation about why I’m making them and where I hope they can take us.

AndyND is leaving insurance

I know that I’m going to lose some of you as soon as you read that heading. For others, it may immediately bring up the question, “What does this mean for me?” 

I hope you’ll keep reading, because I want to work through that with you. You deserve time with your doctor, clear costs, and a say in your care. You deserve to feel that the money you spend on healthcare actually supports your health, and you absolutely should be able to use the insurance you pay for and receive good care.

Wondering where all the $$ is going? 2025: Big Insurance’s $1.7 Trillion Year

I am beginning a gradual transition toward a fully self-pay practice by January 2028.

When I opened AndyND, I came in with an attitude I can now admit was naive: “It won’t happen to me.” Maybe other providers were doing something wrong. Maybe if I followed the rules, documented carefully, submitted everything correctly, and worked hard enough, I could make insurance work.

I was humbled almost immediately.

I have followed the rules. I have submitted the paperwork, spent hours on the phone, documented the care, appealed denials, and waited to be paid. And still, insurance companies have clawed back money they already paid me, changed my billing codes to lower-paying ones without my consent, delayed or denied claims, and required more and more administrative labor just to get paid for work I already did. Some days, I feel like a little ant in a system so big that it doesn’t even have to notice what it’s crushing.

Even when insurers do pay, naturopathic physicians are often reimbursed substantially less than MDs and DOs for the same services. One insurer recently sent me a letter reaffirming that they reimburse my care at a lower rate than medical doctors for the same visit codes, alongside a reminder that my contract includes a nondisclosure agreement. Apparently my work is worth less, and I’m also expected to keep quiet about it... sorry, that’s not likely.

Meanwhile, many of you are dealing with your own version of this nonsense: higher premiums, higher deductibles, shrinking coverage, prior authorizations, and unexpected bills for care you thought was covered. You pay a lot of money into this system and then have to fight to actually use it. We are on different sides of the same problem.

I believe healthcare should be a public good. Instead, we have built a system where our bodies, our illnesses, our labor, and our need for care are opportunities for someone else to make a profit. Patients are asked to pay more, providers are asked to do more for less, and somewhere in the middle enormous companies continue to do very well. I cannot keep building this practice around that.

I want enough time to actually care for you

I built AndyND around having enough time to listen, understand your story, and make a plan together. That is especially important in the kind of care I provide, where hormones, pelvic health, digestion, stress, pain, family life, nervous system regulation, medications, and everything else often overlap rather than arriving in neat little boxes. That is the whole point of the kind of women’s wellness and integrative pelvic care I want to offer: enough time to understand the whole person instead of chasing one symptom at a time.

I also want to be able to earn a living wage, pay the people who support this practice fairly, cover the costs of running an actual medical practice, and still have enough energy left at the end of the day to be a human being. That should not feel radical, but apparently here we are.

And I want to be very clear: you have done nothing wrong by using your insurance. I never want this transition to become some weird moral judgment about who can or cannot afford to pay cash for healthcare. You should be able to use the coverage you pay for and receive good care. The problem is not you. The problem is a system that takes more and more from both patients and providers while giving less back.

My labor, and your need for care, should not be the raw materials for somebody else’s profit.

Access still has to be part of this

This is the piece I am still wrestling with the most. Paying out of pocket may mean a higher cost for appointments, especially when you are already paying insurance premiums, and I take that seriously. I also recognize that I have privilege in even being able to contemplate walking away from this system, and that many patients and providers do not have that option.

I do not want to escape an extractive healthcare system only to create a beautiful little boutique practice that leaves everyone without disposable income standing outside the door. That is not the revolution I am interested in.

So I am thinking about how to build access into the model itself. I already use equity-based self-pay pricing, where patients choose the tier that reflects what is financially possible for them and higher-tier payments help support lower-cost care. You can read more about that here. I am also thinking about community-supported funds, nonprofit structures, membership models, and other ways of redistributing resources so people with more capacity can help make room for people with less.

I do not have every answer yet, and I think it would be concerning if I pretended I did. What I can promise is that access will remain part of the conversation, and I want to keep hearing from you about what would actually make care possible.

Embracing the Matriarchy

The more I think about all of these changes, the more I realize they are connected. Leaving insurance is not only about being frustrated with insurance companies. Moving spaces is not only about needing a new lease. Hosting circles and retreats is not some cute side project that exists separately from my medical practice.

They are all part of me asking a bigger question: What would happen if I built this practice around the things I actually value?

When I talk about embracing a more matriarchal way of doing business, I do not mean taking the same old pyramid and putting a woman at the top of it. That doesn’t really interest me. I am much more interested in questioning the pyramid itself and thinking about relationships over extraction, collaboration over competition, shared resources, community knowledge, care work being treated like actual work, people being paid fairly, and having enough instead of endlessly needing more.

I want AndyND to help build a community where women’s knowledge is valued, our work supports our livelihoods, and we use what we have to help each other thrive. The question I increasingly want to ask about growth is not just, “How do I make AndyND bigger?” It is, “How many people can grow alongside it?”

One of the simplest examples is Wilderness Maven Apothecary, who prepares my custom herbal formulas. If you haven’t been there yet, please go! The space is beautiful, many of the herbs she works with come directly from her own garden, and there is a level of intention in the way the plants are grown, gathered, and prepared that you can actually feel.

When I prescribe one of those formulas, some of the money you are spending on your healthcare goes directly to another woman in our community who is growing plants, practicing herbal medicine, building her own livelihood, and pouring an enormous amount of care into what she creates. That feels very different to me than watching more of our healthcare dollars disappear upward into a giant company.

I want more of that. I want to use AndyND to celebrate people whose work I believe in, refer to them, collaborate with them, pay them, share their work with you, and open doors when I can. Sometimes matriarchal economics can be a big philosophical idea, and sometimes it just looks like buying your herbs from the woman down the street.

The writing may also be on the wall for our current home

Because apparently we are changing everything around here, there is also a move somewhere on the horizon.

The building where I currently practice is for sale. Nothing official has happened yet, but there have been enough hints that there may be a potential buyer that I am paying attention. Depending on what happens with the sale, I may need to move sooner than expected. Either way, my plan is to find a new home for the practice within the next year.

I love my current little office. A lot has happened there, and there is always some sadness in thinking about leaving a space where relationships have been built and so much care has happened. But I also know we are starting to outgrow what it can hold, and I am trying to see that uncertainty as an invitation to build something that fits this next chapter better.

My hope is to land somewhere that feels more like our own: a few treatment rooms, plus a flexible space where we can push the furniture aside and sit in a circle. I want room for other practitioners whose work complements mine to offer regular care, pop-ups, workshops, trainings, and community events. Maybe there is a nutritionist down the hall, another naturopath, a pelvic floor practitioner, or someone offering craniosacral or somatic work. Maybe a trusted practitioner is in town for one weekend and can use the space for a pop-up. Maybe we host trainings. Maybe we make medicine together.

I do not want some giant integrative medicine empire with my name in enormous letters over the door. I want something human-sized, with enough room to grow without growth becoming the entire point.

Healthcare is bigger than the treatment room

Your one-to-one care will remain at the heart of AndyND. I love being your doctor, and I love sitting across from someone, hearing the whole weird complicated story, and trying to figure it out together. But I also do not believe all healing happens inside a medical appointment.

Sometimes healthcare looks like pelvic floor therapy or a prescription. Sometimes it looks like sitting in a circle and realizing someone else has been carrying the same thing you have. Sometimes it is learning how to make medicine from a plant, singing together, eating a beautiful meal, or simply being somewhere you do not have to perform competence for a few hours.

That is why I keep investing in things like the Moon Circle and Wild Return. Those gatherings are not separate from the vision I have for healthcare. They are part of it.

I also want to collaborate more deeply with practitioners I trust in craniosacral therapy, integrative pelvic floor care, acupuncture, somatic therapy, ketamine therapy, herbal medicine, nutrition, and other forms of care that support the whole person. I want providers in our community to actually know one another, so when I refer you somewhere I am not simply handing you a name from a directory. I want to know who I am sending you to and why.

And I want us to gather sometimes when nobody needs to be fixed.

Because that matters, too.

So yes, I’m leaving insurance. But that isn’t really the whole story.

The story I am more interested in is what becomes possible when we stop organizing everything around systems that were never built to care very much about us in the first place.

What happens if more of our healthcare dollars stay close to the care itself? What happens if practitioners can earn a living without seeing people at a pace that makes everyone miserable? What happens if businesses in our community deliberately support one another? What happens if there is room for people who have more resources to help create access for people who have less? What happens if success is not measured only by how big something gets?

I want there to be enough time to listen, enough money to pay people fairly, enough room for rest, enough access that this does not become care only for wealthy people, and enough space at the table for other practitioners and businesses to grow alongside us. I want enough community that we remember we are not supposed to do all of this alone.

That is the direction I am moving. I am sure I will get some of it wrong. I will probably change my mind about pieces of it as I learn more, and there will undoubtedly be insurance surprises, building surprises, financial realities, and moments where I wonder what on earth I am doing.

But I would rather try to build toward something I believe in than spend the next several years trying to make myself smaller enough to fit inside a system that clearly is not working.

Leaving insurance is part of that. Finding a new home will probably be part of that. Leaning harder into community, collaboration, and the matriarchy is definitely part of that.

I’m not interested in simply opting out. I want to use the space we create to build something better.