How to Start Building a Direct-Pay Option Without Dropping Insurance
If you're frustrated with shrinking reimbursements, rising admin costs, and the feeling that you're working for insurance companies more than your own business, you're not alone.
But here’s the good news: you don’t have to go cold turkey on vision plans to take back control.
You can start building a direct-pay option inside your practice while still accepting insurance. You can give your patients choices. You can create recurring revenue. And you can do it without blowing up your current model.
This isn’t about rebellion. It’s about freedom.
Here’s how to do it smart, safe, and profitably, one step at a time.
1. Start With a Clear Goal
Going out-of-network is not the goal for most practices. Building a sustainable, patient-friendly business is. The direct-pay model helps you do that by giving you financial predictability and greater independence.
Ask yourself:
Do I want to reduce insurance dependency?
Do I want to increase profitability per patient?
Do I want more flexibility in how I deliver care?
Once you’re clear on your goal, it’s easier to create a direct-pay structure that supports it.
2. Offer a Membership Plan Alongside Insurance
One of the easiest and most effective ways to introduce a direct-pay option is through an in-office membership plan.
Patients who are uninsured, underinsured, or tired of confusing benefits are often looking for clarity and simplicity. A well-designed plan can give them that.
Here’s what a basic version might include:
One comprehensive eye exam per year
Discounts on glasses and contacts
Emergency visits or follow-up care
Priority scheduling or extended hours access
Charge a flat monthly or annual fee. Keep it simple. Make it easy to understand. Most patients are more than willing to pay out-of-pocket when the experience is better than dealing with their benefits.
You can keep your insurance relationships while offering this plan to anyone who prefers transparency, speed, or a better overall experience.
3. Build Care Packages for Specialty Services
Not everything in your practice has to run through insurance. In fact, many of your most valuable services probably aren’t covered anyway.
Examples include:
Dry eye therapy
Myopia management
Vision therapy
Specialty contact lens fittings
Pre- and post-op LASIK care
These are ideal for direct-pay options. You can bundle them into flat-rate packages with built-in follow-ups, progress tracking, and support.
Patients appreciate the simplicity. You get paid fairly for your expertise. And you begin training your team and patients to see value beyond their plan coverage.
4. Train Your Team to Communicate Options
You can have the best membership plan or direct-pay bundle in the world, but if your staff can’t explain it confidently, it won’t work.
Train your team to say things like:
“You’re welcome to use your benefits, but we also offer a simple in-office plan that many of our patients love.”
“This treatment isn’t typically covered, but we’ve created a package that makes it easy and affordable.”
“We want to make sure you’re getting the best value, not just what the insurance allows.”
Give them scripts, confidence, and clarity. Make sure they understand the why, not just the what.
5. Don’t Compete With Insurance. Rise Above It.
The goal is not to battle VCPs. The goal is to offer something better.
Insurance is built on confusion, complexity, and limited options. Direct-pay models offer clarity, flexibility, and personalized care. You don’t need to convince every patient to abandon their benefits. You just need to offer a better alternative.
The truth is, many patients don’t actually like using their insurance. They use it because it’s all they know.
Once they experience a clear, simple, value-packed membership or care plan, they often realize it’s a better way to receive care.
6. Track the Right Metrics
As you introduce direct-pay options, shift how you measure success.
Track things like:
Monthly recurring revenue
Patient sign-ups for membership plans
Revenue per patient visit
Specialty service conversions
Patient retention over time
These metrics give you a better sense of practice health than new patient volume or insurance reimbursements alone.
Over time, you’ll see the shift. Direct-pay patients are usually more loyal, more consistent, and more profitable. They value the relationship, not just the reimbursement.
Final Thought: You Can Build This While Staying In-Network
You don’t need to flip a switch and abandon everything that’s working. You can build your direct-pay model in parallel with your current insurance contracts. You can test it, grow it, and shape it around your ideal patient base.
The goal is not to burn bridges. It’s to build your own.
And when the time comes, if you ever choose to drop a plan, you’ll already have a system that supports your business without it.
You’ll be ready.
Want Help Building a Direct-Pay Model That Fits Your Practice?
We work with independent optometrists who are ready to create recurring revenue, improve profitability, and serve patients more directly without overhauling their entire business.
Let’s talk about how to start small and scale smart.
How to Start Building a Direct-Pay Option Without Dropping Insurance
If you're frustrated with shrinking reimbursements, rising admin costs, and the feeling that you're working for insurance companies more than your own business, you're not alone.
But here’s the good news: you don’t have to go cold turkey on vision plans to take back control.
You can start building a direct-pay option inside your practice while still accepting insurance. You can give your patients choices. You can create recurring revenue. And you can do it without blowing up your current model.
This isn’t about rebellion. It’s about freedom.
Here’s how to do it smart, safe, and profitably, one step at a time.
1. Start With a Clear Goal
Going out-of-network is not the goal for most practices. Building a sustainable, patient-friendly business is. The direct-pay model helps you do that by giving you financial predictability and greater independence.
Ask yourself:
Do I want to reduce insurance dependency?
Do I want to increase profitability per patient?
Do I want more flexibility in how I deliver care?
Once you’re clear on your goal, it’s easier to create a direct-pay structure that supports it.
2. Offer a Membership Plan Alongside Insurance
One of the easiest and most effective ways to introduce a direct-pay option is through an in-office membership plan.
Patients who are uninsured, underinsured, or tired of confusing benefits are often looking for clarity and simplicity. A well-designed plan can give them that.
Here’s what a basic version might include:
One comprehensive eye exam per year
Discounts on glasses and contacts
Emergency visits or follow-up care
Priority scheduling or extended hours access
Charge a flat monthly or annual fee. Keep it simple. Make it easy to understand. Most patients are more than willing to pay out-of-pocket when the experience is better than dealing with their benefits.
You can keep your insurance relationships while offering this plan to anyone who prefers transparency, speed, or a better overall experience.
3. Build Care Packages for Specialty Services
Not everything in your practice has to run through insurance. In fact, many of your most valuable services probably aren’t covered anyway.
Examples include:
Dry eye therapy
Myopia management
Vision therapy
Specialty contact lens fittings
Pre- and post-op LASIK care
These are ideal for direct-pay options. You can bundle them into flat-rate packages with built-in follow-ups, progress tracking, and support.
Patients appreciate the simplicity. You get paid fairly for your expertise. And you begin training your team and patients to see value beyond their plan coverage.
4. Train Your Team to Communicate Options
You can have the best membership plan or direct-pay bundle in the world, but if your staff can’t explain it confidently, it won’t work.
Train your team to say things like:
“You’re welcome to use your benefits, but we also offer a simple in-office plan that many of our patients love.”
“This treatment isn’t typically covered, but we’ve created a package that makes it easy and affordable.”
“We want to make sure you’re getting the best value, not just what the insurance allows.”
Give them scripts, confidence, and clarity. Make sure they understand the why, not just the what.
5. Don’t Compete With Insurance. Rise Above It.
The goal is not to battle VCPs. The goal is to offer something better.
Insurance is built on confusion, complexity, and limited options. Direct-pay models offer clarity, flexibility, and personalized care. You don’t need to convince every patient to abandon their benefits. You just need to offer a better alternative.
The truth is, many patients don’t actually like using their insurance. They use it because it’s all they know.
Once they experience a clear, simple, value-packed membership or care plan, they often realize it’s a better way to receive care.
6. Track the Right Metrics
As you introduce direct-pay options, shift how you measure success.
Track things like:
Monthly recurring revenue
Patient sign-ups for membership plans
Revenue per patient visit
Specialty service conversions
Patient retention over time
These metrics give you a better sense of practice health than new patient volume or insurance reimbursements alone.
Over time, you’ll see the shift. Direct-pay patients are usually more loyal, more consistent, and more profitable. They value the relationship, not just the reimbursement.
Final Thought: You Can Build This While Staying In-Network
You don’t need to flip a switch and abandon everything that’s working. You can build your direct-pay model in parallel with your current insurance contracts. You can test it, grow it, and shape it around your ideal patient base.
The goal is not to burn bridges. It’s to build your own.
And when the time comes, if you ever choose to drop a plan, you’ll already have a system that supports your business without it.
You’ll be ready.
Want Help Building a Direct-Pay Model That Fits Your Practice?
We work with independent optometrists who are ready to create recurring revenue, improve profitability, and serve patients more directly without overhauling their entire business.
Let’s talk about how to start small and scale smart.