Why HormoneSynergy® Does Not Participate in Insurance-Based Medicine

Every medical practice is shaped by the system in which it operates. Reimbursement affects staffing, appointment length, documentation, testing, prescribing and the amount of administrative work required to care for a patient. Those pressures are not always visible during an office visit, but over time they influence the kind of medicine a practice is able to provide.

HormoneSynergy® chose many years ago not to participate in insurance-based reimbursement. The decision was not based on a belief that health insurance is unnecessary, nor was it a way to create a more lucrative medical practice. It was primarily a decision about how Dr. Kathryn Retzler wanted to practice medicine and how much influence a third-party payer should have over decisions made with a patient.

There are financial consequences to that choice. Dr. Retzler's compensation remains well below commonly reported national compensation levels for primary-care physicians, and maintaining a small medical practice built around longer visits and individualized care is not always easy. There are times when the economics of continuing this model are genuinely difficult. We continue because we believe the clinical advantages are worth preserving.

Health Insurance Has an Important Role

Our decision not to bill insurance should not be interpreted as an argument against having health insurance. A serious accident, hospitalization, operation, cancer diagnosis or other major illness can produce medical expenses that few families could reasonably absorb on their own. Comprehensive health insurance remains an important form of financial protection.

HormoneSynergy® is not a replacement for that coverage. Our concern is with the increasing overlap between insurance administration and ordinary clinical decision-making, particularly in areas of preventive medicine where a physician may want to investigate risk before a patient has developed advanced disease.

A physician may believe that additional cardiovascular testing, metabolic evaluation, bone-density testing or another diagnostic study would provide useful information. Under an insurance model, that recommendation may also need to satisfy coverage criteria, diagnosis codes, network rules or prior-authorization requirements. Those policies exist in part to control utilization and healthcare costs, but the criteria used to determine coverage do not necessarily answer the same question the physician is asking: would this information improve the care of this particular patient?

We Still Deal With Prior Authorization

Practicing outside insurance reimbursement does not insulate HormoneSynergy® from the administrative requirements of the insurance industry.

Many patients have prescription drug coverage through their health plans. When an insurer requires prior authorization before it will pay for a medication prescribed by Dr. Retzler, our office handles the authorization. That may require documentation of previous treatments, laboratory information, diagnosis codes, clinical notes, insurer forms, online portal submissions and subsequent communication when additional information is requested or an authorization is denied.

For a large health system, some of this work can be distributed among departments devoted to insurance administration. HormoneSynergy® is a small practice. The same work is performed by a small staff that is also scheduling patients, coordinating laboratory testing, answering clinical messages, arranging imaging, managing prescriptions and supporting Dr. Retzler's patient care.

The time involved can be substantial, particularly when an authorization requires repeated submissions, additional documentation or an appeal.

The broader physician experience reflects the same problem. In its 2025 survey, the American Medical Association reported that physicians completed an average of 40 prior authorizations each week and that physicians and their staff spent approximately 13 hours per week on the process. Forty percent of surveyed physicians reported having staff members whose work was dedicated exclusively to prior authorization.

A 2025 KFF national survey also found that among insured adults who had needed prior authorization during the preceding two years, nearly half reported that the process had delayed access to a treatment, service or medication.

Prior authorization can have a legitimate role in discouraging inappropriate or unnecessarily expensive treatment. The difficulty arises when the administrative process becomes so extensive that physicians and their staff spend hours attempting to obtain coverage for treatment that has already been determined to be medically appropriate.

Preventive Medicine Does Not Always Fit Insurance Criteria

Much of conventional health insurance developed around diagnosing and treating disease. Preventive and longevity medicine often works earlier, when risk is becoming apparent but serious disease has not yet occurred.

Dr. Retzler may be evaluating cardiovascular risk long before a heart attack occurs, changes in bone and muscle before frailty develops, metabolic dysfunction before diabetes is established, or cognitive risk before significant impairment becomes evident. The purpose is to identify information that may allow a patient and physician to intervene while there is still an opportunity to change the course of disease.

This is one reason our practice may use measurements such as ApoB, lipoprotein(a), DEXA bone density and body composition, carotid imaging, cognitive testing and more detailed metabolic or nutritional laboratory evaluation when clinically appropriate.

Not every patient needs every available test, and ordering more tests does not automatically produce better medicine. The relevant question is whether a particular measurement is likely to provide information that could reasonably influence care for that individual.

Because we are not designing our diagnostic approach around insurance reimbursement, Dr. Retzler can discuss that question directly with the patient. Cost remains part of the conversation, as it should, but coverage criteria do not determine whether the discussion can occur.

Prescription Decisions Still Encounter Insurance Rules

Medication is one area where the boundary between our direct-pay model and the insurance system remains particularly visible.

Dr. Retzler can select a medication based on the patient's history, clinical evidence, potential benefits, risks and reasonable alternatives. A patient's prescription drug plan may nevertheless have its own formulary, preferred medications, step-therapy requirements or prior-authorization criteria.

When that occurs, our staff works with the insurer on the patient's behalf. Sometimes authorization is straightforward. At other times, repeated documentation or appeals are required. In some cases another medication may be more affordable under the patient's plan even when it was not the physician's first choice.

Cost has to be considered throughout medicine. The difficulty is the amount of clinical and administrative time required to reconcile an individualized medical recommendation with a separate coverage system, particularly in a small practice where those responsibilities cannot simply be shifted to a large authorization department.

The Economics of This Model Are Different

We are very aware that our patients are paying for care at HormoneSynergy® in addition to the substantial monthly premiums many of them already pay for health insurance. We do not take that lightly. For some families, healthcare has become one of the largest recurring expenses in the household, and paying separately for a physician can understandably feel like paying twice.

We understand that problem personally as well. The cost of maintaining conventional health insurance for our own household eventually became difficult enough that we moved to a more affordable health-sharing arrangement and accepted more financial risk ourselves. That is not something we recommend for other people, nor do we consider a health-sharing program equivalent to comprehensive health insurance. It is simply part of our own experience with the cost of healthcare coverage and one reason we understand how significant these expenses can become.

What many patients may not realize is that the economics on the physician side are also very different from what they might assume. Many concierge practices charge a membership or retainer fee while continuing to bill insurance for covered medical services. HormoneSynergy® does not. Our patients pay us directly for their care, and we do not layer insurance reimbursement on top of those fees. Dr. Retzler's compensation is substantially lower than commonly reported national compensation levels for primary-care physicians, and even when our two salaries are combined, the total remains far below what many people might expect from a concierge medical practice and below the average compensation commonly reported for a single primary-care physician.

That comparison is not offered because patients should feel responsible for the financial decisions of the practice. They should not. It is relevant because it helps explain what this model actually is. HormoneSynergy® was not built around the assumption that eliminating insurance reimbursement would produce greater physician income.

Our model directs a substantial share of the practice's resources toward physician time, detailed review of laboratory and imaging information, patient communication and individualized care while maintaining a relatively small patient population. The practice still carries the ordinary expenses of staffing, technology, malpractice coverage, medical supplies, regulatory compliance and maintaining a clinical facility. We also continue to perform insurance-related work when our patients need it, particularly prescription prior authorizations.

For a small staff, that work can consume a surprising amount of time. Completing insurer forms, documenting previous treatment, responding to requests for additional information and appealing medication denials are necessary parts of caring for our patients, but they are also work for which the practice receives no reimbursement.

There are times when the financial reality of maintaining this model is difficult enough that we have to ask ourselves how sustainable it is. That is not meant as a complaint. We chose this model and remain responsible for making it work. It is simply part of the economics of maintaining a small medical practice in which physician time is deliberately protected rather than continually compressed to increase visit volume.

We also recognize the obligation on the other side of that arrangement. A patient paying directly for medical care, particularly while already paying substantial insurance premiums elsewhere, has every reason to expect value from that care. That responsibility is one reason we try to keep our pricing transparent, avoid adding margins to outside laboratory testing, compounded medications and imaging, and remain candid about what we believe is worth doing and what may not be necessary.

Why Transparent Pricing Matters

One advantage of separating most of our services from insurance reimbursement is that patients can usually know what something costs before deciding whether to proceed.

That is different from the experience many people have elsewhere in American healthcare, where the final patient responsibility may not be clear until a claim has been submitted, processed and applied against a deductible or coinsurance requirement.

HormoneSynergy® publishes or provides its own fees, and we try to give patients realistic information about outside expenses whenever we can. We do not add a profit margin to outside laboratory testing, compounded hormone prescriptions, peptide prescriptions or outside imaging. When we are aware of a substantially more affordable option for an outside service, we can share that information with the patient.

This does not make medical care inexpensive. Laboratory studies, imaging, medications, physician time and medical staffing all have real costs. Transparency does, however, allow patients to understand those costs before making a decision rather than learning about them after care has already been provided.

Insurance-Based Practices Are Not the Problem

Many excellent physicians work in insurance-based practices, health systems and hospital groups. Our decision to use a different model is not a criticism of those physicians.

Many of the frustrations we have with insurance administration are borne most heavily by physicians working inside those systems. They may be responsible for large patient panels while simultaneously meeting documentation requirements, productivity expectations, formulary rules, quality measures and prior-authorization requirements that they did not create.

The physician sitting across from a patient is often not the person who decided how long an appointment should last, whether a medication requires another authorization or whether a particular diagnostic study satisfies an insurer's coverage criteria.

It is therefore too simple to describe the shortcomings of modern healthcare as a failure of doctors. Many physicians are trying to provide thoughtful care within systems whose financial and administrative requirements consume a considerable amount of their time.

Why We Continue to Practice This Way

HormoneSynergy® focuses on preventive and longevity medicine. That work often requires considering several parts of a person's health together, including cardiovascular risk, metabolic health, hormones, bone density, muscle mass, cognition, nutrition, sleep and the changes that accompany aging.

Dr. Retzler has practiced medicine for more than two decades. Over that time, we have become increasingly convinced that this kind of work depends upon something that can be difficult to preserve in modern healthcare: enough physician time to understand the patient, review the available information and think carefully about what should happen next.

Our model gives her more of that time. A diagnostic or treatment discussion can begin with the medical question rather than with reimbursement. Patients can know what we charge and decide whether a particular service is worth the cost. At the same time, we operate a smaller practice with fewer economies of scale and continue to perform insurance-related work, particularly prescription prior authorizations, whenever our patients need it.

Maintaining that model is not always easy financially, and we understand equally well that paying for this kind of care is not easy for every patient. Those two realities can exist at the same time. Our responsibility is to make the care we provide worth the resources our patients are committing to it and to preserve the physician time and clinical independence that led us to build the practice this way in the first place.

That is what we mean by Medicine, Not Marketing.

Frequently Asked Questions

Does HormoneSynergy® accept health insurance?

No. HormoneSynergy® is not contracted with commercial health insurance plans and does not accept Medicare, Medicaid or Tricare. Patients may be able to use eligible HSA or FSA funds for qualifying healthcare expenses.

Should HormoneSynergy® patients still carry health insurance?

Yes. HormoneSynergy® is not a substitute for comprehensive medical insurance. Health insurance remains important for hospitalization, emergency care, surgery, cancer treatment and other potentially large healthcare expenses.

Why doesn't HormoneSynergy® bill insurance?

The practice was designed to reduce the extent to which reimbursement policies influence clinical decision-making. Testing and treatment discussions can therefore focus primarily on medical usefulness, available evidence, cost and the patient's preferences.

Does HormoneSynergy® perform medication prior authorizations?

Yes. Although HormoneSynergy® does not bill health insurance for its medical services, many patients use prescription drug coverage. When an insurer requires prior authorization for a medication prescribed by Dr. Retzler, our staff completes the required documentation and works with the insurer on the patient's behalf. This can require substantial staff time in a small medical practice.

Does practicing outside insurance mean the physician earns more?

Not necessarily. Practice economics vary considerably. Dr. Retzler's compensation at HormoneSynergy® is well below commonly reported national compensation levels for primary-care physicians. Our model places greater emphasis on physician time, individualized care and a smaller patient population rather than high visit volume.

Does HormoneSynergy® understand that patients are already paying for health insurance?

Yes. Many patients pay substantial monthly insurance premiums and then pay separately for care at HormoneSynergy®. We understand that this represents an additional healthcare expense and believe patients should expect clear value, transparent pricing and thoughtful use of testing and treatment when they choose to pay directly for care.

Does HormoneSynergy® add a markup to outside testing, imaging or prescriptions?

HormoneSynergy® does not add a profit margin to outside laboratory testing, compounded hormone prescriptions, peptide prescriptions or outside imaging. We provide pricing information whenever possible so patients can consider both the clinical value and financial cost of a recommendation.

Medical note: This article describes the HormoneSynergy® practice model and is provided for educational purposes. It is not individual medical advice. Health-sharing arrangements are not the same as comprehensive health insurance and may have different coverage limitations, eligibility requirements and financial risks. Nothing in this article should be interpreted as a recommendation to discontinue health insurance or medically necessary care.