I Left the Insurance System and Opened a Cash-Only Clinic in Upland

Before I went to medical school, I worked at Amazon.

That is usually the part of my story people find strange. A chemistry degree from UCSD, then a warehouse-and-logistics company, then osteopathic medical school at Touro, then residency at Harbor-UCLA. It looks like a detour. It wasn't. The years I spent at Amazon are the reason my new practice — Phil Zhou Medical in Upland (in between Los Angeles and San Bernardino)— looks the way it does.

At Amazon, the entire company was organized around a single question: where is the friction, and how do we delete it? Not "how do we explain the friction to the customer." Not "how do we build a department that manages the friction." Delete it. Every extra click, every phone tree, every day of shipping delay was treated as a defect to be engineered out of existence.

Then I went into medicine, and I found an industry that had gone the opposite direction for forty years straight.

What the friction actually looks like

You have a sore throat on a Tuesday. Here is what the system asks of you.

Call your doctor's office during business hours — the same business hours you are also expected to be at work. Navigate the phone tree. Leave a message. Wait for a callback. Get offered an appointment eleven days out. Take the appointment. Take time off work. Drive there. Sit in the waiting room for thirty-five minutes past your appointment time. See the doctor for seven minutes. Get a prescription. Go to the pharmacy. Discover it needs prior authorization. Call the office back. Wait.

Six weeks later, a bill arrives for an amount nobody could have quoted you in advance, from an entity you've never heard of, for a portion of the visit your plan decided not to cover.

Every single one of those steps is a defect. Not one of them exists because it makes you healthier. They exist because the system is not actually organized around you. It is organized around billing.

I spent years inside that system. I did primary care for an underserved population in Los Angeles County at Harbor-UCLA. I still work in hospice, where I've been since 2018 and where I'm board certified as a hospice medical director. I have watched what happens to a doctor's day when the documentation exists to satisfy a payer rather than to take care of a person. Notes get longer and say less. Visits get shorter. The doctor spends the evening finishing charts instead of returning phone calls.

And the strangest part: the person paying for all of it — you — is the only party in the transaction who has no idea what anything costs.

So I deleted the insurance company

My clinic does not bill insurance. Not any of it. No commercial plans, no Medicare, no Medi-Cal.

I want to be honest about the tradeoff, because that is a real one and you should know it going in. If you have good insurance and a doctor you like, you may be fine where you are. If you are on Medicare or Medi-Cal, I am not the right fit for you, and I would rather tell you that on a blog post than after you've driven to my office.

But here is what dropping the billing apparatus buys everyone else.

Prices you can read before you walk in. A visit costs $150. That is the number. It does not change based on how many diagnosis codes I write down or which tier your plan puts me in. There is no facility fee, no separate lab bill from a company you've never heard of, no explanation-of-benefits arriving in November for something that happened in July.

Labs, imaging, vaccines and medications go through at my wholesale cost with nothing added on top. I make my money on the visit and the membership, not on marking up your blood work.

Time. I do not need to see thirty patients a day to keep the lights on, because I am not giving a large fraction of every dollar to the overhead required to chase payment. That means a visit runs as long as it needs to run.

Access. This is the one that matters most, and it's the reason I built a $99/month membership alongside the per-visit price. Members get my cell number. Not a service, not a portal, not an after-hours line staffed by someone who has never met you. Me. Most prescription refills happen by text message. Simple questions get answered the same day, usually within the hour, without anyone having to book a visit for something that could be handled in four sentences.

That is not a luxury feature. That is what medical care looked like before we industrialized it, and it turns out the technology required to bring it back is a phone.

I'm not the first person to do this

The model has a name — direct primary care — and it is not fringe. The American Academy of Family Physicians has an explicit policy supporting it and a whole practice-model resource for physicians considering the switch. The California Academy of Family Physicians maintains its own DPC resources for doctors in this state. Thousands of practices across the country now run this way.

What is still rare is finding one nearby. Which is most of why I opened in Upland instead of somewhere with a longer waitlist of doctors doing this. The Inland Empire has a lot of people and not nearly enough accessible primary care, and I live and work here.

What I actually do

I am set up as a small, general practice — the kind that used to be normal. The full service list is here, but in short:

Primary care. Annual exams, chronic disease management — blood pressure, diabetes, cholesterol, thyroid — preventive care and screening.

Urgent care. Colds and flu, sore throats, UTIs, skin infections, rashes, minor injuries, lacerations that need stitches. The things that send people to a $2,000 emergency room visit at 7 p.m. because nothing else is open.

Pain management. One of my two main focuses. This is an area where patients get bounced between specialists for months, and a lot of it can be worked up and managed well in a primary care setting.

Weight management. My other focus. I use GLP-1 medications — semaglutide, tirzepatide, the Ozempic and Mounjaro family — alongside actual diet and exercise counseling, and I can usually evaluate you and start treatment in the same visit. No insurance prior authorization, because there's no insurance. If you have been told your plan doesn't cover weight-loss medication, this is the workaround.

House calls. Evenings and weekends, for people who can't easily get to an office.

There are things I don't do, and I'd rather be clear about them. I'm not a substitute for an emergency room — chest pain, stroke symptoms, serious trauma, call 911. I don't prescribe controlled substances by text or phone; when they're clinically appropriate, they require an in-person visit and a physical exam every time, including refills. And I'm one physician, not a health system. When you need a surgeon or a cardiologist, my job is to get you to a good one.

The practical details

The office is at 99 N. San Antonio Ave., Suite 210, in Upland. Clinic hours are Tuesday through Thursday evenings, 5 to 10 p.m. — deliberately, because most people's medical problems do not conveniently occur between 9 and 5 on a workday, and taking a half day off to see a doctor is itself a cost the system pretends is free.

The phone and text line is open around the clock: (562) 575-6816. That is a real cell phone, it accepts text messages, and texting is genuinely the fastest way to reach me. Booking is online and takes about a minute.

My assistant is a native Spanish speaker and handles Spanish-language calls and interpretation during visits — there's a page in Spanish here. I speak English and Mandarin.

If you want to know more about my training and background before trusting me with anything, that's all on this page. And I've tried to answer the questions people actually ask — what happens if I need labs, what if I get admitted to the hospital, is the membership insurance (it is not) — on the FAQ.

Why I think this works

The bet I'm making is simple: that if you treat a patient like a customer — which is to say, someone whose time is valuable, who deserves a price before the transaction, and who should be able to reach you when something is wrong — enough people will prefer that to the alternative that a solo practice can survive on it.

I'm running this as a one-man operation until I hit a hundred patients. That's not a limitation I'm apologizing for; it's the point. A hundred people I actually know, who can text me, whose problems I remember without opening a chart.

If that sounds like what you've been looking for, get in touch — call or text (562) 575-6816. You can also find the practice on Google if you'd like to leave a review or get directions.

The first visit is $150. You'll know that before you walk in, which is more than most of American medicine can say.