Opening a private membership practice has been one of the most eye-opening experiences of my career. In many ways, I wish I had taken this path years earlier. I entered it thinking I’d mostly help busy high income professionals who wanted more time and attention from their physician. To my surprise, the people I’m having the greatest impact on are the uninsured and the under-insured—the individuals who fall through the cracks of our healthcare system every single day.

The Uninsured Are the Ones Hurting the Most

I care for many people who rely on chronic medications—blood pressure medicines, ADHD meds, thyroid replacement, mental-health medications, diabetes drugs, and more. The alternatives are bleak: urgent care or the emergency department, each typically costing several hundred dollars per visit, often for nothing more than a short refill that forces them to repeat the cycle in 30 days.

Through an independent lab, I can order a comprehensive, preventive lab panel—lipids including Lp(a), vitamin D, CBC, CMP, thyroid, B12, folate, and others—for a flat cash price around $80–$100.

Under many insurance plans, that same panel is billed at well over $1,000, with patients routinely paying $200–$400 out-of-pocket depending on deductibles and coverage rules. These aren’t exaggerated numbers—they’re standard across most commercial plans.

And these uninsured can for a predictable monthly membership fee, reach me directly for routine and acute issues instead of using the ED or urgent care as their safety net. For many, this is the first time they’ve had consistent care in years.

Even the Insured Are Being Punished by the System

What’s striking— is how often patients with good insurance end up choosing cash-price labs because it’s still cheaper than running anything through their plan. The system is so distorted that using your benefits can cost you more than not using them at all.

Many of my own patients are physicians and advanced practice providers, and even they routinely pay cash for testing because it’s faster, far less expensive, and avoids the endless prior-authorization loop. They also appreciate having continuity — seeing the same doctor every time, the same or next day without waiting weeks or being shuffled through a rotating lineup of clinicians.

Here in Rochester, choices are limited. With two major health systems dominating the market, patients don’t have access to common national options like Quest or LabCorp. For imaging, Borg & IDE is one of the few independent centers with reasonable cash prices. Many standard studies that cost $1,000–$4,000 through insurance can often be obtained for several hundred dollars when paid out of pocket. Some patients even elect to drive to Buffalo for lower cash costs.

Home sleep studies, mobile ultrasound and imaging, ambulatory cardiac monitoring—these can be arranged within days for a fraction of the insurance-billed cost. Through traditional routes, patients routinely wait months for specialist consults, only then to wait again for testing.

And every time I order something outside the “system,” I have to ask myself:

Do I prioritize quality and system integration, or do I prioritize the patient’s suffering, worry, wait time, and financial burden?

In today’s reality, that is a real ethical dilemma—not because the alternatives are unsafe, but because access and affordability have become obstacles in themselves. ( 6+ months to see a neurologist anyone?)

The High-Deductible Trap

Most people don’t realize how punishing typical insurance plans have become.

A common commercial plan in our region looks like this:

  • Monthly premium: $450 – $650 (roughly $5,500 – $7,500 per year)
  • Deductible: $2,000 – $4,000 before insurance pays a single dollar
  • Co-insurance: often 20% until you reach the out-of-pocket maximum
  • Out-of-pocket max (individual): up to $9,000 – $12,000
  • Out-of-pocket max (family): up to $16,000 – $18,000

This means a typical insured person pays $6,000 in premiums and still avoids care because they must spend another $3,000+ before their insurance even starts helping them.

That avoidance isn’t irrational—it’s survival.

On top of that, patients are nudged into using one health system exclusively. Seeing someone out of network triggers what can only be described as a financial penalty, making “choice” in name only.

What Healthcare Providers Face in Rochester

Something I rarely spoke about before opening my own practice is how this system affects healthcare workers themselves.

As a physician, I didn’t want:

  • To be seen by colleagues I work alongside
  • To sit in waiting rooms with patients I also care for
  • To have my medical history reviewed by staff members who know me professionally
  • To be limited to a system where everything is shared and cross-reference

Healthcare providers need privacy and autonomy, too—and the structure in Rochester doesn’t make that easy. Insurance networks, system exclusivity, and the lack of independent options force many clinicians into uncomfortable positions when seeking their own care.

Rochester has become a healthcare desert for affordability, choice, and timely access.

The people falling through the cracks aren’t fringe cases—they’re everyday residents, hard-working families, and even medical professionals. And we shouldn’t accept that.

Until the system changes, patients will continue to rely on independent physicians, cash options, and creative solutions—not because they want alternatives, but because the “official” pathways have become financially and logistically inaccessible.

Every day I see the real human cost of this system.