The Hybrid Model: How to Bill Insurance AND Charge Patients a Subscription

The Question Everyone Asks

"Can I really bill insurance for the visit AND charge patients a monthly fee?"

Yes. And it's completely legal when structured correctly.

Understanding the Distinction

The key is separating two different services:

1. The Medical Visit (Insurance)

• Evaluation and management
• Medication prescribing
• Physical examination
• Diagnosis and treatment planning

This is what you bill to insurance using standard E/M codes.

2. The Monitoring Service (Patient Pay)

• Weekly check-ins
• Side effect triage
• Progress tracking
• Messaging access
• Educational content

This is a non-covered service that patients pay for directly.

Why This Works

Insurance doesn't cover "coaching" or "monitoring between visits." They cover the visit itself. Everything else is fair game for direct patient billing.

Think of it like:

• A cardiologist billing insurance for the stress test, but the patient pays for the gym membership
• A dermatologist billing insurance for the acne visit, but the patient pays for the skincare products

The Non-Covered Services Agreement

This is the document that makes it all work. It clearly states:

1. The monitoring service is separate from medical care
2. It will not be billed to insurance
3. The patient agrees to pay directly
4. They can cancel anytime

Kite provides this template. You customize it with your practice name and pricing.

How to Present It to Patients

Don't make it weird. Here's a simple script:

> "I'm prescribing [medication]. To help you get the best results, I offer a monitoring program where you check in weekly and I track your progress. It's $149/month and includes messaging access if you have questions between visits. Would you like to enroll?"

Most patients say yes. They want support. They're already paying hundreds for the medication—$149/month for professional monitoring is a no-brainer.

What About Patients Who Can't Afford It?

You have options:

• Offer a lower-tier option ($99/month with fewer features)
• See them as insurance-only patients (standard care)
• Provide a scholarship for select patients

The program is optional. Patients who don't enroll still get standard medical care.

Common Concerns

"Will insurance drop me?"

No. You're not double-billing. The visit is billed to insurance. The monitoring is a separate, non-covered service billed to the patient.

"What if a patient complains?"

The Non-Covered Services agreement protects you. They signed it. They agreed to the terms. Keep a copy on file.

"Do I need a lawyer?"

The template we provide is based on standard healthcare practices. If you want extra peace of mind, have your healthcare attorney review it.

The Bottom Line

The hybrid model lets you:

• Keep seeing insurance patients
• Add a premium service for those who want more
• Generate predictable recurring revenue
• Provide better care (because you're actually getting paid for it)

Stop giving away monitoring for free. Structure it properly and get paid.