Dr. Tea Nguyen (00:00.0)

Practicing medicine without insurance is possible. Imagine a private practice where you get to see your best patients every day providing medical services you truly enjoy, all without the hassle of insurance. My name is Dr. Tea Nguyen, and I'm a recovering specialist who was completely burned out from insurance-based medicine. I pivoted into direct care, where patients pay me directly for my medical services and have never looked back. If you're a private practice owner or planning to become one, 

Dr. Tea Nguyen (00:30.648)

who's looking to be free of the grind of insurance and your craving simplicity, efficiency, and connection with patients, you are in the right place. This podcast will help you map out your exit plan and uncover the mindset needed to thrive in today's economy. Welcome to the Direct Care Podcast for Specialists. 

Dr. Tea Nguyen (00:54.094)

Why 2026 is your year to go direct. If you've been feeling, hearing or reading the rumbles around opting out of insurance because guess what? They are paying less and they've been like that for like 20 years. Nothing new is happening except social media. Social media has really amplified the problem that we've been seeing a lot in the news lately. And I think it's time. This is going to be the snowball effect. 

Dr. Tea Nguyen (01:21.346)

You're already here listening to the podcast. You're already learning about what it takes to become the owner of a successful direct care practice. And I know you've been reading and talking to other people about it. So why not just take the next step and start looking at your insurance contracts, start seeing what you don't want to do anymore. It's a new year, so it's time and it's an opportunity for you to get rid of stuff you just don't like doing. And that's okay. 

Dr. Tea Nguyen (01:51.534)

You don't have to feel shame around that anymore. You can finally say, I'm over it. Because for me in 2025, there were many things I got over. And I think it was because of perimenopause to be honest. Having low energy capacity, low emotional capacity for things that are getting in my way, tipped me off to the point where I am now at midlife saying no a lot more frequently. 

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and I am proud to be able to walk away from things that just aren't serving me or my future. So I'm often over on LinkedIn expressing all of my thoughts, which sometimes it feels like I'm shouting into the void. And sometimes I get to connect with some amazing people. One of those people includes a gentleman who you might've heard of, Mark Cuban. He's an entrepreneur of many things, but maybe you've recognized him from Shark Tank. 

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He's a business guy and I don't normally talk or gush over people with lots of money, i.e. billionaires and so on. But what we are seeing are public figures who are stepping into the space of healthcare and trying to solve this enormous problem where people are not getting the medical access that they thought they were going to have by having insurance. And he has a business called Cost Plus Drugs that I send a lot of my patients to to get cheaper prescriptions basically because he bypasses the middleman and is able to sell directly from pharmaceuticals to the consumers. So he's now in the direct care landscape and he often reposts, he comments and likes all things direct primary care and I'm stepping in to talk more about direct specialty care. And so it's exciting times for me because 

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I feel like this is my mission to really put the mic literally and figuratively to people who are moving all of us towards a different projection, towards the direct care projection. And he's gotten my attention finally, talking about something I care so deeply about. And that's what it takes. It takes an alliance of people who have 

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bigger access to more people in order for us to move forward. Now I'm doing that with you, with other physicians within this space. And I think this is going to be the year where I collaborate with more people who have more connections. And so I'm putting this out there into the universe that someday we get to share the space on direct care, that I get to shake the hands of Mr. Cuban and say, this is what I do best. Show me where to go. Put me in coach. 

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What can I do to make this bigger? So that's where my mindset is for 2026. He's gotten my attention. So all that to say is that people are taking notice and people who have a bigger mic taking notice is just very exciting for me because we all feel the pressures of health insurance. We all experience it as a patient and as the doctor delivering that medical care. It's convoluted. It's messy. It's nonsensical. 

Dr. Tea Nguyen (05:03.382)

And it's really expensive, all for what? For somebody to be able to afford another island, but it doesn't really provide the high level of care that we deliver. We're not getting paid or being compensated appropriately for that without, you know, doing more paperwork. And the patients suffer because they get stuck in this confusing system where they have to wait for a prior authorization. They have to wait for the doctor to fill out certain paperwork for them to get the thing that they need. 

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that the doctor already recommended, right? We're all stuck in this and it's not just annoying, but it's changing the way healthcare is being delivered. Now, I'm not here to really change the world in that way. I'm here to give you a different experience in medicine because you have control of your choices right now in this moment. Big changes down the road takes time, but today you can actively change your trajectory 

Dr. Tea Nguyen (06:00.322)

by taking one small action every single day, which includes things like listening to this podcast, you're already doing, connecting with other direct care doctors and participating in these conversations online and anywhere else you get invited. People are taking notice. Direct care is the track where you get your power back, especially as a small business owner. So I've opened up my private Facebook group. 

Dr. Tea Nguyen (06:28.002)

which you're invited to join if you're not already there. It's where I'll do monthly Q &A sessions to help you get onboarded to think like a direct care specialist. And when you're ready to make the commitment to go further, I'll announce the next group coaching cohort in there too. So let's stay connected so that you don't miss out on this. All right, let's kick off this episode with three common questions doctors are asking me about direct care and what it really takes. 

Dr. Tea Nguyen (06:57.144)

First question is, if I open another office in the future, can I make it only direct care or because I take insurance, am I still required to bill insurance in that office too? This is a great question and I'm glad that you're asking it because you're thinking about what is possible for you. So here's the lowdown. If you are employed right now, it means that you're contracted with insurances and maybe you don't know all of the 

Dr. Tea Nguyen (07:26.19)

contracts you're bound to, but now is a good time to start collecting the data. And when you start to make the decision to either quit or opt out, however this looks for you, and you start building a direct care practice, you have to keep in mind what the contract is really about. It's binding you to the obligation that if you have a contract with that insurance, you have to bill that insurance for billable services. 

Dr. Tea Nguyen (07:54.156)

That means you cannot cherry pick and decide to open a different entity and select for people like choosing to bill or not bill. If they have a contract that you're assigned to that you're legally bound to, you have to bill out the services. That's just all that there is to it. And I was in a sticky situation early on where patients came to me because I was a cash practice. And at the time I was a hybrid, so I had some insurances left. 

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that I was contracted with. They came in, they said that they didn't have insurance, but one of my employees did investigative background work because that's just part of her job. Every time a person walks in, they check out and make sure that they don't have like the Medicaid or the Medi-Cal state insurance. There's a portal for people to log into and check in on that. Well, the patient came in and said she had no insurance. 

Dr. Tea Nguyen (08:48.706)

My staff does the verification just to be certain that I wasn't doing anything illegal. And I offer her services and treatments and things, told her the cash price. She didn't hesitate to pay, but we caught it. Before I put myself into any legal trouble, my staff says, actually, your insurance is active. We cannot collect cash from you for this service. If we were not in the routine of checking our patients' benefits, I could have been in real legal trouble. I could have... 

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accidentally done something illegally like charge a patient cash when I have a contract that specifically says I can't do that. So that's why I don't coach people on having a hybrid practice. You're either all in or you're not because I don't want doctors to get in a sticky situation like that, which is time consuming and it's really not worth all of your effort and it's not worth of your expertise. Like you deserve to be paid so much more than these contracts. 

Dr. Tea Nguyen (09:48.906)

And so if you are already bound to insurance, whether you're employed or you have your own private practice, you have to know and understand that if you decided to open a separate LLC, like a business entity providing medical services, you still got to bill insurance for the ones that you're contracted with. Unless you provide aesthetic services or other non-covered services. We've got doctors doing regenerative medicine and functional medicine. 

Dr. Tea Nguyen (10:16.194)

those types of things. So it is a distinct entity in which you have legal documentation that makes it very clear as to what you can and cannot do. Other instances that come up, I have doctors who do coaching, which is a non-medical service. But if your malpractice is covering you as a doctor and you're using your doctor credentials to bring people into your world, there's going to be some legal issues there as well. So you're kind of 

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kind of treading a gray line, which is something that I don't advocate very much, but just keep that in mind. If you take insurance here, you take insurance there. If you want to open a direct care practice, make it very clear that it's a separate entity. There are separate entities that are more med small, like for example, and then you would have to have the legal structure set up for that, including having the healthcare attorneys review your paperwork and having your LLC business designations and so on. I hope that answers your question. 

Dr. Tea Nguyen (11:15.766)

I'm sure I'll be answering this more than once this year, but it's a great question because, you know, I always tease like, you know, doctors who want to have a hybrid, they want it all right. And the thing is, it can be done, but it does take a little bit more effort than if you were just strictly a direct care practice. And I just like things simple and clean and I don't want to break any laws. It's as simple as that. All right, second question. 

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Does direct care only work in areas where there are lots of income? Great question, because the assumption is only people who have money can afford direct care, right? I'm sure you've thought of this at one point, and I thought of this at one point too. So personal experience, I started my private practice in Watsonville, California, and the household median income was around $35,000, $38,000. 

Dr. Tea Nguyen (12:13.518)

It's really not that much for California. I opted out of insurance anyway. Why? Well, I wasn't just crazy, but I was desperate. You know, when you're pushed up against a wall in a hard place, or what is it? A hard place in a rock, whatever the idiom is, you just gotta do things. You gotta be resourceful, you put on your creative thinking hat, and you just do what you gotta do. So I opted out because I was not thriving. 

Dr. Tea Nguyen (12:38.97)

And I already had my business established. didn't do any market research. I left an employed job and just found an office space and said, I'll figure it out from here. That's how I function. I don't over plan. And the advantage of that is that I got to play around a lot. got to experiment and I got to do what I wanted to do. The disadvantage of that is yeah, there's uncertainty. And luckily I had a partner who helped me through that uncertainty because 

Dr. Tea Nguyen (13:07.424)

If I was doing it on my own, I don't know if I could. So you do want to prepare yourself financially for this shift so that you don't go crazy, right? You don't burn bridges that you didn't have to. You don't just opt out out of everything. You talk to the people who are doing it. They can teach you stuff. They'll give you the shortcut. And then you just go slow. Okay. 

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people freak out because they think when you opt out of insurance, it's cold turkey. But actually there's a methodology to this and that's what I teach in my coaching program. So going back to the question, basically it says, does direct care only work where people have money? I want to kind of rephrase this a little bit. I want you to kind of decide, make a decision for yourself. Are you going to do this or not? Because there's going to be a lot of things that get in the way. A lot of your fears will come up. 

Dr. Tea Nguyen (13:57.07)

You're going to just want to go back to what you were comfortable with. That's normal. That's okay. Your brain's trying to protect you. But I want you to just observe the world around you. Where do you actually want to set up your practice? For me, I wanted to work where I lived. So I had to figure this out, right? For others, you have a lot more freedom, perhaps, and maybe you want to move to a different city, state, or I don't know, country, but you want to move, right? And so you don't have a reputation to work with. 

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decide where you're gonna go, okay? Just kind of mentally draw the mental picture. It doesn't have to be perfect. And look around that area. If you find other cash health services being offered, things like acupuncture, chiropractor, energy healers, naturopathic medicine, functional medicine, maybe there are other direct primary care doctors or other direct care doctors or even concierge doctors. That is an indication that you can succeed. 

Dr. Tea Nguyen (14:55.372)

It's not a guarantee, but it is the litmus test as to it working for others and you just have to figure out how you're gonna make it work for yourself. So that said, are there direct care doctors in low income areas making this work? Absolutely, how are they doing it? They offer a membership program where it's a low monthly fee and their overhead is near nothing. It's minimal, it's nominal. 

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That means that their profit margins are huge compared to what they would make with insurance. Because when you take insurance, you have to pay for insurance related things. You have to pay for the extra staff because now you're running a volume based practice. You have to pay for very expensive EMRs and softwares that has to submit your claims and then you have to track your accounts receivable and then you have to chase money that's already left the door. 

Dr. Tea Nguyen (15:50.146)

People didn't know what their deductibles were, the copays, the coinsurance, all those things. It requires somebody who doesn't have a medical license to deal with. Although some doctors do choose to take on that task, you decide to do what you want with your life. All I'm saying is when you run an insurance-based practice, there's going to be more setup, more systems that you need to have in place, which costs money. And therefore, it cuts into your profits. That's all it is. 

Dr. Tea Nguyen (16:18.318)

So direct care works, I've seen it work in rural areas, I've seen it work in obvious high income areas. You know, you've got Beverly Hills, you've got New York, all of these pockets. And then you've got everything in between. Now people think that because I'm from California, my practice is in California. I live in some kind of bougie town, which is kind of generic. It's not true. You know, there are places where there's low income like Watsonville, which is just a 20 minute drive from me here. 

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And then there are more expensive places to live, which is directly here in Santa Cruz, but there's also a lot of money kind of everywhere. You know, if people value getting medical care, they will find ways to pay for it. It's as simple as that. I've had a patient who said she's just going to pick up more babysitting hours in order to pay for the service I offered. And you do what you got to do to pay for what you want. I'm here for you when you're ready. It's as simple as that. All right. Last question I've got is, 

Dr. Tea Nguyen (17:15.318)

Is direct care where you bill only cash services or is it a monthly subscription for the services? This is a fun question because I have both. Patients can pay me per service, per visit, for example, or they can buy into a subscription model if they want maintenance care, for example. So I have both set up. It depends on what they come in with. Not everything I do needs to be a subscription or a membership. 

Dr. Tea Nguyen (17:45.442)

Right? If you've got an ingrown nail, you've got an ingrown nail. I want to get rid of that. I don't want to see that back. And that's like a one visit thing. Right? First consultation procedure is done. And maybe if you want to follow up and then I give like a year guarantee that it doesn't come back, you know, and if it comes back, fine, I'll just do it again. It's like a five minute procedure for me. Not a big deal. Whereas palliative care or routine things that I need to see patients monthly over and over again, they pay for that in full. Now I don't have a system set up. 

Dr. Tea Nguyen (18:15.372)

to charge monthly, I think that's just too much mental energy for me at this phase of my life right now. If they want a discount, they pay in full for that. That's the benefit of paying in full, is the discount. Maybe down the road, when I have a little bit more capacity, I'll think about a membership model. But with the membership model, it has been successful. I'm just not doing it. But there's a lot of record keeping or tracking. 

Dr. Tea Nguyen (18:44.94)

pay, credit cards decline. I would like to know why people decline or stop showing up, right? There are these little things that do come with a membership. I'm not quite there yet, but if you wanted to do that, listen, your business is your playground. You can do whatever you want. That's the whole point of having options. The way that I build my practice is perfect for me. And there's going to be a way that's going to be perfect for you. You have to decide on what that is though. 

Dr. Tea Nguyen (19:13.61)

And once you understand the basics of thinking like a direct care doctor, you are then free to experiment. So I hope that these commonly asked questions get you really interested in taking the next step. So what is the next step? If I haven't already answered your questions on this podcast or elsewhere, send them to me because I'm literally everywhere. I'm trying to capture all the doctors who want to leave the system but want to stay in clinical practice. 

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So you can find me on Instagram, I'm @teadpm. I'm on LinkedIn, chatting it up with Mr. Mark Cuban and others. Also on Facebook, come into my private Facebook group, lots of free information there. And if you get lost, because I've said a whole bunch of stuff, go straight to my website at teadpm.com and all of that information will be down in the show notes. I am pouring everything I have into you so that you are prepared to take the next step into direct care, whether you're just starting up or you're looking to scale it. I'm so excited about your personal growth for this year. Let's connect. I'll catch you next week with a new episode. Take care for now. 

Thank you for listening to the Direct Care Podcast for Specialists. Remember, you always have the power to choose. So what will you be choosing today? Wishing you peace and possibilities.