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You Have to Take Insurance? This Thriving New Practice in Upstate NY Never Got the Memo…

They cold-opened as private pay only—and they’re killing it after a year in business.




You Have to Take Insurance? This Thriving New Practice in Upstate NY Never Got the Memo…
Dr. Ashley Szalkowski

Dr. Ashley Szalkowski

ASHLEY SZALKOWSKI STARTED her career as an OD working in ophthalmology, so insurance was a mystery to her until she moved into private practice optometry in 2020, working for multiple offices at once. At each one, the insurance plans left her baffled — the only thing about them she grasped was that they weren’t making the offices much money. By the time she cold-opened her own practice late last year, she had decided it would be 100% private pay. We checked in with her after a year to see how things were going. What she told us was eye-opening and inspiring.


At the practices she worked for, Szalkowski would hear staff venting over insurance plans’ complexity and limitations, and ask them why they took insurance at all.

“The answer always was, ‘Well…we have to.’” Later, forming plans to open her own business, she would run into this same unquestioned conventional wisdom. People told her cold open, private pay wouldn’t work. “I was told insurance was the only way to get patients in the door. I was told our area was cheap and wouldn’t pay for glasses… ” It only made her more determined. “I don’t think we should be afraid to challenge the current standards,” she says.

Contracting with vision care or medical plans was at odds with Szalkowski’s vision of  a “concierge experience that was transparent and easy.” Furthermore, “I knew my business model was focused on routine care and optical sales. With my ophthalmology experience I am fortunate to have very good co-managing relationships and felt confident about referring out.”

You Have to Take Insurance? This Thriving New Practice in Upstate NY Never Got the Memo…



Building a client base, she says, has been her biggest challenge. The key is “marketing and lots of it…. We’ve done local paper and magazine ads. Google and Facebook ads. Collaborations with other businesses. Social media — probably our biggest source of patients and referrals.” The practice will be filming a local commercial soon and plans are afoot for vendor displays at summer fairs and festivals.

Szalkowski has been pleasantly surprised by how little pushback she’s had from patients. Those that really want the experience Guild offers don’t care about insurance, she says. “My biggest piece of advice here is to be upfront and transparent with how you operate; it eliminates confusion and helps to make 100% private pay a positive experience.”

You Have to Take Insurance? This Thriving New Practice in Upstate NY Never Got the Memo…


A year in, does she feel vindicated? “Without a doubt.” She starts with the fact that Guild reserves an hour for each and every patient. “In a traditional setting, seeing anywhere between 15-20 patients per day, I would not remember a single name of any of those patients. My job and mind became robotic. I was thinking about staying on schedule and finishing charting rather than connecting with the patient right in front of me.” In return, “These patients actually value you, your time and your service.”

Financially, Guild is exceeding all the expectations Szalkowski had for it. At the time she spoke to INVISION, the practice was on track to gross $250,000 — the average for practices that take insurance — in its first year. “There’s still much growth to be done but I’m proud of what we’ve been able to accomplish, given that we started from nothing.”

Do It Yourself: Open Cold, 100% Private Pay

  • EMBRACE THE NEW. “If you want to do something different,” says Szalkowski, “you’re not going to achieve it by doing what you’ve always done.”
  • TAKE RISKS. “If you’re trying something new, you’ll have many failures along the way. But also many successes.”
  • GET CREATIVE. Make your office and brand stand out, says Szalkowski.
  • BE PATIENT. “Quality over quantity,” she counsels. “Good things take time.”
  • ASK FOR HELP. “You’ll gain invaluable insight and resources from local business, industry contacts and friends and family.”


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