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Welcome to The Modern Midlife Collective—where midlife isn’t a crisis, it’s a rebirth. Hosted by Dr. Ade Akindipe, DNP, and Dr. Jillian Woodruff, MD, this is the podcast for women ready to unapologetically own their power, thrive through the ups and downs of hormones, weight, and self-care, and show the world that thriving at 40 and beyond isn’t just possible—it’s your birthright.
Biweekly, we bring you science-backed insights on hormones, menopause, longevity, and sexual health—real tools to empower women in midlife and beyond. With a fearless blend of functional medicine, real-life wisdom, and no-nonsense empowerment, we’re here to challenge the norms, break through the barriers, and help you step into a life of vitality, confidence, and unstoppable strength.
Ready to rise? Let’s do this.
Ade Akindipe, DNP (00:27)
Okay, before we dive in today, we want to briefly recap the last episode because this conversation really builds on itself. In part one, which was very long, we spent a lot of time really talking about the important things about insurance. We talked about why so many women feel frustrated, rushed, really confused in the healthcare and midlife. We also talked about what women are asking for. What insurance is designed to cover.
and why so much of the care women simply need isn't paid for by the system anymore. So if you haven't listened to episode 25, go ahead and do that and start there because today's conversation will make a lot more sense in that context.
Jillian Woodruff MD (01:05)
Exactly. So let's talk about what happens next, because this is where women start asking a very reasonable question. Why am I being asked to pay for more health care, even though I already have insurance that is supposed to pay for health care? And you may be hearing terms like cash pay, self-pay, subscription, medicine, direct primary care, direct specialty care.
And it can feel confusing, unsettling even, if no one's explained why these models exist and what they're meant to do. And so today I think we should tell you about what kind of care may be good for you and or may not be right for you and explain why these options are showing up, which is what the background was meant to do, like what the system, the insurance based system is built for.
what people are wanting is outside of that scope. And then these are some of the options that providers have come up with to one, better care for patients and two, also provide a better work life for the provider too, so they can get back the reason really why they went into medicine.
you know, it's hard. There's, there's never one solution to a problem. So we'll just give you a few solutions and work through whether they make sense or not.
Ade Akindipe, DNP (02:30)
Yeah, absolutely. I think this is where, after all, we just discussed last week, last episode, why some providers may start to think along the lines of those different kinds of care models. Because for a lot of providers who still love what they do and they're not burnt out, they don't want to leave health care entirely. So this is often when that question comes up like,
Do I wanna keep doing things the way I've been doing it in the insurance model? Or do I want to step outside the traditional insurance model? So when patients hear about cash-based or non-insurance-based care, they often think that, that provider is just about money. They just wanna make money. And I really wanted to slow that down because that's not really what's happening. As we discussed, there are so many expenses that come with the insurance-based care.
And even though they're not billing insurance, there are still a lot of expenses, but at least there's a way to make things make sense for them when it comes to paying out of pocket for that particular service. So at its core, direct primary care or specialty care means that you're kind of bypassing the insurance-based model where insurance is kind of dictating care. And then there is a relationship with
you the person, not the insurance. So you're dealing with the provider that you're seeing. So instead of billing insurance for every visit, you're paying out of pocket and that could be maybe you're on a subscription where you're paying month to month, or there's an annual fee that covers access. And maybe there's more communication between you and the provider. There's a lot more care coordination. So some of it can mimic what insurance looks like, but the gist of it is that you are ⁓
able to spend that more in-depth time with your provider. So if you have all these symptoms, we talked about brain fog, fatigue, maybe you've been dealing with it for some time, but you didn't get the answers. So you seek out someone specifically to address that problem. And maybe that's more in-depth testing that you may also have to pay out of pocket for. And then the provider is helping you a lot more integrative or functional kind of testing.
That's looking more of why things are happening. And often, the costs are more transparent. So you probably already know how much you're going to spend when you go there. That's one of the advantages of that. So they're investing in the time versus the infrastructure of billing, where you're looking at diagnosis codes, CPT codes. So none of that exists when it comes to that. However, if you wanted to...
maybe turn around and bill your insurance for the cost that you paid for upfront, that can be done. It's not guaranteed that your insurance will cover all of those costs because you have a relationship with the provider, the provider's not submitting, but you can now resubmit that bill to your insurance for reimbursement.
Jillian Woodruff MD (05:24)
Do you know if that's difficult or not? I mean, dealing with insurance altogether, find difficult, but yeah, how difficult is that something they're used to or?
Ade Akindipe, DNP (05:27)
Yeah, you know what?
It's not very popular. I recently just switched to the direct pay model and I have, mean, that was the selling point I think for a lot of the patients that are continuing to see us is that they are still the ability to bill the insurance as long as we provide the diagnosis codes, procedure codes, all the things that they would normally need in the insurance world, we would submit it to the patient and they would get it. We've had some patients actually get reimbursed.
for those services. Of course, it's another layer and it's something else that you have to do after you get seen, but some people, you know, they're willing to do that.
Jillian Woodruff MD (06:06)
So it's being billed, you're billing it as an out of network provider. Okay. So there could be some reimbursement for that. And depending on the type of insurance, the reimbursement could be exactly what's billed. could be, you know, they may pay a portion, right? They may pay, let's say if they would have paid 80 % of what the provider in network billed, they may pay 60%. But...
Ade Akindipe, DNP (06:10)
Correct.
Yeah.
correct.
Jillian Woodruff MD (06:31)
It depends, right? Different states, it's a little bit different. I know when I moved here 10 years ago, the out of network, if you were out of network, it actually got reimbursed at higher rates. Interesting, right? Because you're giving it, if you're a network, if the provider's a network, they're offering a discount to patients. well, tell us more about your practice and about direct care.
Ade Akindipe, DNP (06:42)
Yeah.
Yes.
Yeah. You know, this decision to go completely cash pay was not a very easy decision because you have that guilt that you're not giving the patients what they need or they're having to pay more to see you. But when I had to look at the whole picture of what the mission of the clinic was getting to, the vision that I saw for the clinic, I think it made a lot of sense because I wanted to...
spend the time, I wanted to give them the quality that I wouldn't necessarily be able to do with such a small practice. Because I did try it. I did try the traditional and the self-pay model. But then it became very confusing. Like, well, why are we charging for that? And why is any of the insurance not covering it? So it got very confusing over time. What is self-paying? What's not self-pay? So we decided to just go ahead and just remove it completely.
and focus on more direct pay, whether it's in terms of a package where they're with us for some period, maybe they're doing some coaching, nutrition coaching, or just mental rewiring process of forming good habits, or they're just wanting primary care, but on a routine month to month basis, maybe like direct primary care basis. So it was uncomfortable at first, especially after hearing all those frustrations, but.
I was right there in that struggle myself, it just made the perfect sense now, now that I'm seeing it a year later. Why does it coaching or rewiring your brain around eating or managing your blood sugars, which I found a lot of people didn't really understand. It's like, here it is. Here's your medication. Yes, you can buy a CGM. We can even go to the point of even helping you put it on, learning how to read it.
and then building sustainable habits that will allow you to bring down your blood sugars. all of that, trying to do that in a 15, 20 minute, even a 30 minute visit, some of those visits take a lot longer, it will be really hard to do all of that. So it reduces complex midlife symptoms from a chronic or non-urgent, all those things you rush into a 15 minute, it just leaves a patient feeling like they're
a lot more complete. you know, there's a lot of back to back, a lot of communication between patients back and forth, you know, looking for clarity, it didn't work, let's try something different. So even if they're not in front of you, you're still able to go back and have that dialogue either through text messages or through emails. So it's been a really good, you know, that model really aligns with how women in midlife are wanting to be cared for.
Jillian Woodruff MD (09:25)
Right, because you wouldn't really have that time, that back and forth time or communication time with patients in a traditional model. You'd be, right? What is it meant for like your office infrastructure? Have you noticed changes in that way?
Ade Akindipe, DNP (09:33)
Correct.
Yeah, actually it's it's funny because you actually have to now have more systems in place because These people are they're paying for quality. mean they're paying out of pocket So if you want to justify Having a practice where it's self-paying and you want to give them what they're asking for so what I've seen is that I've had to put like Systems in place of checking in with patients. How are things going? You're halfway through your program
Are you doing well? we need to do anything proactively to, you know, under the insurance model, I don't know that I would have to do that. I mean, where do I get the resources to do all of that? But because they're paying for that service, I can make sure that maybe we have our virtual assistant proactively reach out. How are you doing with your meal plan? How are you doing with your fasting? Do we need to tweak anything? So there is a, you know, an onboarding and offboarding processes for that.
And then also just having the availability. They can book an appointment, they can get in there, and they can get out when they want. So just having the flexibility in the schedule. So you won't have a full schedule, but you'll have enough time. So we're seeing less patients, but more higher quality. But there's always room for improvement, always, always room for improvement.
Jillian Woodruff MD (10:49)
So, right.
But you don't really need to have a full schedule because now the money that is being paid is going directly to their care, right? As opposed to the money that's being paid that's going to the billing person, the coding person, the compliance person, right? So there's more.
Ade Akindipe, DNP (11:02)
correct.
Right, you have less staff. You just have less staff. So right now, I think we're a team of four, because before,
you just need a lot more. You have a biller or coder, know, someone's gonna do all of the work. So you're able to automate some of those things, but some of those things still need hands-on human touch. So talking directly to the person, but just making sure that everything flows well, which took some time, and we're still working on that every time, but it saves money.
But you also have to make sure that you are delivering the quality that you're saying that you're going to, you know, the patient's getting if they're going to pay out of pocket.
Jillian Woodruff MD (11:41)
Right. Well, my practice looks different because I am mostly insurance-based, but I do offer cash pay services like aesthetics and cosmetic gynecology and some of the hormone care that insurance doesn't cover. So there's that, but the women's health component is insurance-based and it's limiting. know, have, know, traditionally,
In my work life, I've always accepted insurance. Access is super important, but quality care and not just sufficient care is also important. So it's made me just think differently about how, what I can do. If I'm being honest, I have been thinking about direct specialty care for a while. But yeah, it's difficult because I don't want to stop caring for
all of these people, but I'm increasingly aware of the limits of what I can sustainably offer within the current system. And, you know, there's this pressure to be everything for everyone, but the reality is I can't be or do all things for all people. So maybe a better question to ask myself is whether I can do most things really well for some people instead of doing a lot of things a little bit.
you know, for everyone and then burning out. So direct specialty care, which is, you know, a newer thing is feels like an opportunity to offer deeper and more comprehensive care, especially for women with these complex hormone issues or longstanding sexual health concerns, the life transitions. These don't say we keep saying that they just don't fit into short problem focused visits. Now I already offer a longer
Ade Akindipe, DNP (13:01)
Right.
Jillian Woodruff MD (13:25)
visits because yeah, it doesn't work. if I actually, I'm like really interested in, in people and their health like that is part of my lifelong learning. love to be able to dig in and solve these problems, which you really can't do in the short visits, but in doing the longer visits, it does increase the burden for all of the staff to go and find all of these labs and talk to their
other providers and it increases the burden for me to look into these things and research their problems. And then of course, yeah, we, we won't make as much, right? Because you need to, the system set up to work on volume and not on, not on the, the, I don't want to say not on quality because the quality is very important, but the quality of care for your focused problem, your acute problem. So.
Ade Akindipe, DNP (14:08)
Right?
Yeah.
Jillian Woodruff MD (14:20)
Right?
Yes, the insurance doesn't want you to have quality care, but maybe not as comprehensive if it's not an acute issue, I should say.
Ade Akindipe, DNP (14:31)
Yeah, absolutely right. Just because it's an insurance basis, I mean, it's not good quality. But I think when it comes to things like direct specialty care, if you're, and I think that's what made me switch over because I felt like in some ways it's not really specialty, but it's special for midlife women because these are the little things that they need to really succeed. We know that as they start to navigate hormonal changes, they get more higher risk for
Jillian Woodruff MD (14:36)
Mm-hmm.
Yes.
Ade Akindipe, DNP (14:58)
insulin resistance, how do we reverse that? So you're not ending up on medications and it takes time. And maybe you're someone that just hasn't been used to eating well, but now you're in menopause or perimenopause and you want to learn to rewire that process. It takes time and some handholding. So I think, you you just have to be honest about what model works well for you as the patient. And of course the provider too, you know, how do you want to practice, know, your love for
learning and really helping people. Maybe that's what works, but for someone who wants to maximize access and predictability, insurance-based care may still be the best fit. But if you're looking for more in-depth time, ongoing conversation, even time between visits, then maybe the direct care might be the best option. there's no right or wrong at all. It really just depends on ⁓
where you are and then just the feasibility of it too, you, what state you're in, in Alaska, whatever that might look like, it might not be feasible in the town that you're in.
Jillian Woodruff MD (16:00)
Right, right. I think you're right. You know, care for midlife women, that is absolutely a specialty. And you know, you may have been eating right all of your life and not had any issue, but your body's changing, transitioning, and you have to learn that new, your new body, you know, you have to learn how to support it in the best way. And it's different, the things that worked before don't work now. So it's absolutely a specialty and it's one that a lot of people don't know.
Ade Akindipe, DNP (16:21)
Yeah.
Jillian Woodruff MD (16:27)
how to take care of. So absolutely. And there are other specialties that are joining in this direct care route, even surgical specialties. There's urologists, there's gastroenterologists that are offering direct specialty care. It seems scary, know, daunting to, okay, go and see somebody or go for surgery without the use of insurance, but.
I like you said, can do more of, you know, can get reimbursement. and the other thing is you, maybe it's a combination. So maybe it's insurance for a major medical need and not for your, the, the day to day, month to month care that you need. So that would be deciding between, okay, a high deductible plan means a lower premium that you pay per month. Right. So.
Ade Akindipe, DNP (17:17)
Exactly.
And that's exactly how I explain it to patients, exactly what you just said. It doesn't mean that you're going to abandon your insurance. Absolutely not. If you want to get a major test done, if you want to go to the hospital, you still need all of the insurance to cover that. And you can get a high deductible plan, like you said, pay low premium and only use it when you really need to. So that's a way to do it. And you can always get those reimbursed.
Jillian Woodruff MD (17:17)
you can get that down.
Ade Akindipe, DNP (17:41)
the fees you incur from the direct specialty care.
Jillian Woodruff MD (17:44)
All right. One fear that creeps in is taking good care of your health only possible if you're wealthy, you know, because it's expensive. So, you know, to be honest, healthcare is expensive. And at this time, there's no way around that. There's time, there's expertise.
Ade Akindipe, DNP (17:52)
Hmm.
Jillian Woodruff MD (18:06)
there's medications, there's testing, there's staffing, all of it is incredibly expensive. And so the reality is it can feel unfair, especially when you are making these payments for insurance or you can't afford the insurance that you really need, right? Because even if you do a high deductible plan and you're not doing some sort of direct
subscription methods, still it can be, you know, expensive when you have that need to be able to cough up this much money, right, to pay that out of pocket cost.
Ade Akindipe, DNP (18:41)
Yeah, absolutely. Yeah,
it's, I'm glad we're having this conversation because I have heard that talk that, you sometimes it's like only rich people, this is only for rich people, you have to have money. Absolutely not. It's not saying that if you can't afford everything, you shouldn't try to do anything on it. Definitely not also saying that your healthcare only matters if you can pay cash. Absolutely not. It's really about understanding
how the system works so you can make the best possible decision within your real life. Maybe it's about putting money aside for savings so that you can use some of that money. That's why those HSA, FSA contributions are also there. If you have that with your job, it's a way to maybe say, put some aside for that. We've had some patients do that.
It's really understanding how that all works out and what might be a good fit for you.
Jillian Woodruff MD (19:36)
Exactly. So things like FSAs and HSAs can be incredibly helpful, especially for midlife women. The FSA, the flexible spending account, you set aside your pre-tax dollars and you can use those throughout the year for healthcare expenses. I believe they go away at the end of the year, right? So you have your year and you can use them, whatever you don't spend, lost, right? Okay. And then there's HSA, the health savings account. I feel like this is a better one.
Ade Akindipe, DNP (19:56)
That's right.
Jillian Woodruff MD (20:02)
It does the same thing, but you can roll it over. So a lot of people use this more as an investment because you can take these pre-tax dollars, roll them over and then use them later in life, like after retirement and such. And I think that's like the smart thing to do. I use my FSA, I bought a Peloton, so, and a growing machine. Because you're putting these pre-tax dollars away, right?
Ade Akindipe, DNP (20:18)
It is.
Awesome. Yes.
Jillian Woodruff MD (20:27)
You can use them for more and more. see patients coming in, they're using them for those lab, like the function health lab test where you can get a comprehensive test and then they bring the results to talk about, which is another thing that takes a lot of time because when you do some of these comprehensive lab visits, they do have the, like a summary of what it showed.
Some of them use more AI to do it, but then you don't have that like person to person evaluation, which is really necessary for a lot of these things. So I think it's great. think the, I do the function health too. I think they're great to have that, you know, comprehensive lab test, but then you need to take that somewhere. You need to go somewhere with that in order to use it for your longevity. So you can use these.
Ade Akindipe, DNP (20:56)
Yeah.
Jillian Woodruff MD (21:17)
funds for that, but then you have to have a job that allows you to put that money away into these things. You can put a certain amount away per year that you could use for health care, but then you really have to be strategic with your health care. And I think that as we get older, it does take more strategy and thought, whereas when you're in your 20s, maybe you're really just not using the health care system. So it doesn't make sense to ...
do direct care or to have a plan that's a high premium plan, right? Because you may not be using it, but you wanted to be there, in my opinion, for the just in case because things happen.
Ade Akindipe, DNP (21:58)
Yeah, absolutely. I mean, it's not a perfect solution, but it doesn't fix the system, but it can at least help level the playing field a little bit that there's something that you can do. Either if you don't have an HSA or FSA account, putting some money aside as you get older because the reality is not everything will be covered. So keeping that in mind that the funds are there, you're not having to use credit cards and put yourself in debt.
financial situation because of your health, right? So just as importantly, good care doesn't have to mean all the care. Sometimes it means prioritizing, you know, one longer visit instead of many rushed ones. One area that's most affecting your quality of life right now. One provider who can help you connect the dots. So, you know, it's not about doing everything. You don't have to get on the latest craze and
Sometimes it can get really complicated with all the information that we are exposed to today and you think maybe this might be an issue for you, it's about doing what matters most to you in the season that you're in right now.
Jillian Woodruff MD (23:01)
That's so well stated. That's right, because exactly.
in your season, what is important to you at this time. It doesn't have to be a lifelong commitment to this new way of care, but to get you through what you're going through. I love how you said that. And, you know, because we can't ignore the reality that insurance premiums are rising and benefits continue to narrow. You know, I have the same insurance. I accept a certain insurance plan that I have as a consumer. And the premiums went up last year. I think they went up again this year.
Ade Akindipe, DNP (23:19)
All
Jillian Woodruff MD (23:33)
and they said it's because of rising costs of healthcare. And I thought, okay, well me as the doctor, my costs have gone up. I want to renegotiate the things that you will pay for. So I submitted a request for renegotiation because there's certain, it doesn't make sense to me, but they pay different people differently. people who have been probably in medical
for much longer, they may be paid higher for the same thing that somebody else may be doing. So I said let's renegotiate and they're like no we didn't mean your costs, we're not renegotiating. I just think that's crazy you can just say that. Nope, nope, no we're just gonna, we're gonna pay you less instead. you know there's frustrations all around. The goal for me and the goal for you I know is to provide this care because we feel like we're doing something important.
that will make such a big difference in people's lives. And that makes, I'm sure it makes you feel, it makes me feel really good, right? ⁓ But I know it's frustrating for patients to not feel like they're getting, you know, what they pay for. So these other systems are there hopefully to give, you know, another way, another way of approaching care that's just a little different.
Ade Akindipe, DNP (24:35)
Absolutely.
That's right. So we're hoping that this allows you to be more thoughtful and informed about how you spend your health care dollars, understand what insurance does well, where it falls short because it's not a perfect system, and help you decide where you might want to invest additional dollars, whether that's a preventative care, nutrition, hormones, or longer visits.
there's definitely grief in this conversation, grief that healthcare doesn't look the way we thought it would on both sides, on the patient side and the provider side, but that choice now involves money in a more visible way. just understanding when you go to the doctor or just being more, I guess, aware that that cost, there's a lot that goes along with it, like we talked about in the previous episode.
so that you understand that the clinic isn't trying to take all the money away from you. There's also lot of barriers and all those hoops that we have to jump over as clinicians. So it definitely is our goal is to make sure that you are as healthy as you possibly can and you have a choice. There's different choices that are available to you.
Jillian Woodruff MD (26:00)
Yes, and for practices that continue to offer insurance-based care, the patient partnership is important. recognizing that copays and deductibles, they are part of the bill and insurance doesn't mean fully covered. That's the tough one for.
me as a consumer and me as the provider that yeah insurance it doesn't mean that they cover 100 percent of anything. Timely payment is essential because I know my team certainly wants to get paid. I can say I won't take a paycheck that's terrible right but you know this the staff is they're not going to volunteer that.
So, but also the thing for your care, if you want the most of your care, the time being spent on you, then things like you getting your, your
Results from other providers. Those are like things that are difficult for you and difficult for us, but they will really Significantly decrease the time that we spend on administration so we can spend more time looking at those results and figuring out how to help you or looking at that ultrasound you had at this out-of-state place or this MRI report if you're able to gather those and we need like a better way of being able to Keep all of our medical information when people come in with their
me, I for one, am like, you've got it all, this is, can look at it now, yeah. I know they feel like, they feel bad like we're gonna think something, and like, I'm like, thank you. Right? Yes, I wanna see it all together. So that's, you know, part of the partnership.
Ade Akindipe, DNP (27:16)
I love that.
I love it. I love a good binder with all the history.
No.
Yes, this helps me help you.
Yes.
Jillian Woodruff MD (27:36)
There are things that, you know, the reminders and things, they're good for everybody, right? They're good for the patient. They're good for us to bring in in business. But the more that, you know, patients can really do on their own helps so that time can be spent on you when we're with you and not these other administrative things.
Ade Akindipe, DNP (27:42)
Yes.
Yes, and it impacts
everyone. know, longer wait times, shorter visits, fewer independent practices, and less flexibility. So the more you can do and more ownership you can take over your own health, the better. So this episode isn't about telling you what kind of care to choose. We want to be very clear about that. It's about helping you understand the landscape so you can make better informed decisions that align with your health goals, your values, and your life.
Jillian Woodruff MD (28:06)
Yes.
Yes, women in midlife, well all women, all men, we all deserve thoughtful, comprehensive care and honesty about what it takes to deliver that care.
It is a very medical care, healthcare is complex. And so I think it does help us to understand it, but you know what you deserve and you should get that and you should make sure you get that, you know, advocate for yourself. If today's conversation brought up questions or experiences or maybe a totally different topic you want us to explore, we would love to hear from you. Please email us at connect at modernmidlifecollective.com.
Ade Akindipe, DNP (29:02)
Thank you so much for spending your time with us today and trusting us to have these conversations with you. Until next time, bye-bye.