70. Leaving Insurance for Direct Primary Care: What the Transition Really Looks Like with Lynn Masih, CRNP

Thinking about leaving insurance, but terrified of what happens next?

That's exactly where family nurse practitioner Lynn Masih found herself after nearly a decade running an insurance-based primary care practice. 

On paper, the practice was successful. In reality, reimbursements kept shrinking, admin kept growing, and the pressure to see more patients in less time was making the model feel increasingly unsustainable.

Eventually, Lynn realized the problem wasn't simply her billing company, her overhead, or the way she was managing the practice. She had already looked closely at the numbers and tried to make the existing model work. The bigger issue was the model itself.

So she did the scary thing: she left insurance and rebuilt her practice around a direct care membership model.

And yes, there were plenty of "What if nobody comes with me?" moments along the way.

But her experience offers a useful roadmap for any physician asking the same question.

1. First, figure out whether insurance is actually the problem

Lynn didn't wake up one morning and cancel her insurance contracts.

At first, she assumed there might be a fix within the existing system: a better biller, lower costs, different payers, or a smarter way to structure visits. But after digging into her finances, she found that she was already running relatively lean. The core problem was declining revenue combined with a model that demanded more volume.

Before making the leap, ask:

• Is this an overhead problem, a billing problem, or a business-model problem?
• What are you actually being paid for the time you spend with patients?
• How much volume would you need to make the current model work?
• Does that volume match the way you want to practice?

For Lynn, the answer became clear: making insurance work would mean shorter visits and more patients, which was exactly the opposite of the kind of care she wanted to provide.

2. Expect fear, even when the numbers make sense

One of Lynn's biggest fears was simple: would patients actually pay her directly?

Most of her patients already had employer-sponsored insurance, and she worried they wouldn't see a reason to pay an additional monthly fee.

Her timing made it even scarier. Lynn made the decision in 2025, just as federal layoffs hit her community, where around half her patients were federal workers. Her own husband is a federal employee. It felt like the worst possible moment to ask people to pay out of pocket for their care.

Yet many patients stayed with her, including some who had lost their jobs. The experience changed how she talked about her practice. Instead of comparing the cost of insurance with the cost of membership, she focused on the value: more time, whole-person care and a provider who truly knows them.

That tension is important. You don't necessarily wait until the decision feels completely comfortable. You do enough homework that you understand why you're making it, and you resist deciding for patients what they will or won't pay for.

3. Work backward from the logistics

Once Lynn decided to move forward, the transition became very practical.

She reviewed the termination requirements in each insurance contract. For most commercial payers, a letter or email was enough. Medicare was the bigger decision, and its opt-out deadline ultimately set her launch date.

A few things to know about opting out of Medicare:

• It's a two-year commitment. Once you opt out, you can't bill Medicare, including by moonlighting elsewhere, and you can't change your mind for two years.
• The deadlines are fixed. Lynn had to give at least 30 days' notice before her chosen opt-out date. She decided in June, sent her form in August and launched on October 1.
• You can stay on as a referring provider. Lynn chose this option, so her Medicare patients' prescriptions, labs, imaging and specialist referrals are still covered.

Always check the current rules on cms.gov before you set your dates.

Beyond insurance, anyone making this move needs to think through:

• Patient communication
• Pricing and membership structure
• Cash flow during the transition
• Staffing
• Marketing and patient retention

One of Lynn's biggest lessons? Give yourself more time than she did. She ended up with roughly six weeks to communicate the change to more than 2,000 patients.

4. Communicate more than you think you need to

Lynn didn't rely on one announcement.

She emailed patients, sent physical letters, talked about the change during appointments, and held weekly Zoom sessions where patients could ask questions about how the new model would work.

She also rewarded loyalty. Existing patients were offered a lower membership rate than new patients, plus 10% off if they paid for the year upfront.

Even with all that communication, only about 10% of her existing panel initially made the move.

That might sound terrifying, but it was enough to get started. And around 80 patients prepaid for the year, giving the practice some breathing room while she rebuilt.

5. Be prepared to build your practice again

Leaving insurance also meant losing one of the invisible advantages of being in-network: patients finding her through the insurance system.

Lynn suddenly had to think much more intentionally about marketing.

What worked best for her wasn't flashy advertising. It was trust.

She leaned on:

• Word of mouth
• Existing relationships with specialists
• Reconnecting with former patients
• Local social media
• Community partnerships and educational events

That was a mindset shift in itself: after years in practice, she felt like a beginner again.

6. The payoff wasn't just financial

The biggest change on the other side wasn't simply getting rid of insurance paperwork.

Lynn now sees fewer patients each day and can offer 30- and 60-minute appointments. She has more time to communicate with patients, more control over her schedule, and more freedom to practice the way she originally wanted to.

She even reorganized her week so she primarily sees patients three days a week, giving herself dedicated time for administration, growth, and the rest of her life. On the other two days, she sublets her office to a dermatologist, turning spare capacity into extra income while her panel grows.

For Lynn, that's the real point of the transition: not creating a perfect practice, but creating one whose problems, priorities, and trade-offs she gets to choose.

Thinking about making the leap yourself?

Lynn's advice is to learn as much as you can before you jump: listen to podcasts, read, talk to people already practicing this way, find communities of physicians doing it, and get support for the parts of the transition you don't know how to navigate.

You don't need every detail figured out before you begin.

But you do want a clear understanding of why your current model isn't working, what you want instead, and what has to happen to get from one to the other.

Wondering whether direct care could work for your practice?

Lynn didn't make the leap alone, and you don't have to either. If you're weighing up whether to leave insurance, book a free discovery call. We'll talk through where your practice is now, what's holding you back, and what your next step could look like.