I know complaining about the insurance system is a cliché. To doctors, the medical insurance system is like a KPI system that goes too far. It sets incentives for "someone" to get paid instead of for fixing patients. Talking to Dr. Stephens, I discovered how she's able to work outside of the system while building a sustainable practice that actually works around solving real issues.

When I site down with Dr. Lindsay Stephens, founder of Motus Clinic and talk about her journey from working in hospitals with insurance to building her own independent practice, I realized we were talking about something fundamental: how the healthcare system shapes what kind of doctors we become.

I've spent 17 years in practice—first in cruise ship on the Mediterranean Sea, then big international hospitals in Beijing, then transitioning to private practice here in San Francisco. Dr. Stephens has 10 years running Motus Clinic after years working within the insurance system. We both arrived at the same conclusion: the limitations of insurance don't just affect doctors. They fundamentally limit how medicine can actually work.

Insurance Limitations: The Box-Checking Problem

Dr. Stephens was direct about it:

"I think insurance will never work. It's built on, in and out, you are a piece of paper and you are a handout. You are like, check a box. It is about someone else getting paid."

In my field, acupuncture reimbursement through insurance is severely limited. Insurance will typically cover acupuncture for pain management or infertility. But acupuncture treats so much more—internal medicine issues, sleep disorders, postpartum recovery, pediatric conditions, stress management. Because insurance doesn't cover them, a doctor working within the system can't develop expertise in these areas. The insurance system literally shapes what kind of medicine gets practiced in America.

The Economics: A Lose-Lose for Everyone

The financial reality is stark.

Insurance reimbursement rates are set by insurance companies, not practitioners. An acupuncturist might only receive $15 on some sessions, depending on the code and payer. You often don't know the exact rate until after you've submitted the bill, and payment can take 5 to 6 months.

When you do get paid less than expected, do you spend hours fighting with the insurance company to recover $20? "You don't know that until after you bill it. Usually the answer's no, it's not worth your time," Dr. Stephens said.

This forces practitioners into an impossible choice: take on more patients or spend administrative time that could go to patient care, instead of doing our job as healers.

You can't survive on these rates. The only way to maintain income is to increase volume—see more patients, spend less time with each one. When Dr. Stephens was working with insurance, she was seeing 15-30 patients daily. Now, outside the system, she sees 8-9. "The outcomes are bad when you're rushing through volume. I'm busy making the same money, and my outcomes for my patients are crap. Why would I do that?" she asked.

But patients aren't getting a deal either. Insurance premiums increase year after year—sometimes by 14-15% or more annually. Deductibles have skyrocketed. People pay monthly premiums and thousands out of pocket before coverage kicks in. So they delay care. It's a lose-lose: doctors can't practice well, patients can't access care they need, and the insurance company takes a cut.

How Medicine Actually Works: The Collaboration Model

I learned what real medicine looks like via working in a team. At the hospital where I worked, we had postpartum care units with entire floors dedicated to new mothers. We had OB/GYN doctors, pediatricians, nutritionists, and physical therapists all working in the same space. Everyone communicated about the same patient. We didn't just treat symptoms. We understood the person. We addressed root causes.

That's what Dr. Stephens is building now with her corporate wellness model. She meets with employees individually to understand their actual needs—not what insurance covers, but what they actually need. Then she brings in other practitioners: massage therapists, chiropractors, nutritionists, physical therapists. They work together seamlessly because they're not constrained by insurance codes. They can say, "This person needs both acupuncture and strengthening work. Let's coordinate that."

When doctors work together, time becomes available. Dr. Stephens described the difference: when she was managing insurance workflows, time went to claims and appeals. Now she spends time with patients and builds trust:

"I had to deliver. You're paying money, you want something for that. I became so much better at understanding my patient."

This enables real problem-solving. When a patient comes in with chronic pain, she doesn't check a box. She asks: Is your stress high? Do you have mobility issues? A strength discrepancy? What's your home life like? She might discover five different things contributing to the pain. That's why she works closely with collaborators now. Not just referring, but actually coordinating care with shared understanding.

Building a Vested Network

Right now, with the Puzzle Exchange Podcast, I'm working on something I find deeply exciting: building a community of practitioners who work outside the insurance system and actually collaborate.

What I hear over and over from practitioners is this: they want to work together. They want to tackle complex cases with other experts. They want to exchange ideas. But the fragmentation of the current system makes that nearly impossible.

I want to build something different. A network of open-minded practitioners from different disciplines who have been carefully vetted and commit to genuine collaboration. Not just referrals. Actual communication. Actual coordination. When a patient comes to me with a complex issue, I want to know exactly who to send them to and that we share the same philosophy.

Dr. Stephens recognized this too:

"Finding people that are capable of doing that kind of collaboration is hard. But I would love to create like a network of pre-approved people where we already have a system for how we communicate with one another and how we do the referrals."

This is what we're building. Where patients get actual collaboration instead of fragmentation. Where we have time to know our patients and think deeply about hard problems.

The insurance system makes that nearly impossible. Working outside of it makes it possible.

If you are a San Francisco Bay Area wellness practitioner, and you can resonate with this, I'd love to invite you to be our guest to share your thoughts on the podcast.

Book a time with me below and share your ideas.

—Dr. Deb