The problem
Billing nobody trained for
Before Nickel, the most distinctive feature of Premier Sedation's business, supporting other anesthesiologists with billing, wasn't actually possible to deliver well. The platform existed in concept, but the payment infrastructure to back it didn't.
Doctors have a hard time with billing, especially in this line of service. They've never been trained on it. In a traditional medical office, the doctor treats the patient and the billing is done by someone else on the back end. Once you insert that billing aspect between the doctor and the patient, they honestly struggle with it.
Dr. Garrett “Reed” Poole, Co-owner & CFO
The complication wasn't just that doctors don't like billing. It was structural. Any platform that helped them collect would need to keep each physician's funds completely separate, give one assistant operational access across all of them, and handle recurring monthly invoicing back to the doctors for Premier Sedation's services, all under one roof.
On top of that, every payment flow had to feel effortless on the customer side. Anesthesia patients are one-time engagements who shouldn't need to create accounts to pay. The anesthesiologists being billed monthly shouldn't need to remember passwords. Every roadblock (a missing reminder, a forgotten login) meant a payment delayed by a week or more.
And underneath all of it sat the fee question. Dr. Poole, a self-described shopper who researches every option, had been frustrated for years that ACH wasn't free. “I figured we could be in a world where ACH is free, essentially. There were some good options out there, but they weren't quite free.” His search for one finally ended in an unexpected place: he asked an AI chatbot to help him find a solution, and it surfaced Nickel.
The solution
One platform, six practices
After a consultation with the Nickel team, Dr. Poole signed up and started using the platform for his own practice. During that first conversation, Nickel shared a feature that should solve many of his billing challenges: a master account with child sub-accounts. That structure became the foundation of Premier Sedation's billing offering.
I was really quite surprised that feature existed. It's been great, because it lets us offer real value to our anesthesiologist clients. We can say, ‘We can help with your billing.’
Dr. Garrett “Reed” Poole, Co-owner & CFO
Premier Sedation operates a master account with a child account for each affiliated physician practice. Lindsay, the operations assistant, sends payment links and collects deposits on behalf of each physician, but funds flow directly into that physician's own account and never pass through Premier Sedation. Each doctor is then billed monthly for the administrative work.
Each month, Premier Sedation sends recurring invoices to its affiliated physicians. After the first payment, each customer's payment details are saved: no Nickel account, no login, no password required. “It's literally three clicks,” Dr. Poole says. “The more roadblocks there are, the less likely the payment comes in. Making it quick and seamless with Nickel means we actually get paid faster.”
Dr. Poole ran his first six months on Nickel without the QuickBooks integration, then turned it on. “Once I synced with QuickBooks, it made everything even more streamlined.” The integration brought bookkeeping and payments into one view, replacing the patchwork of tools the team had been juggling.
When Dr. Poole asked whether he could disable ACH on a single invoice while keeping it on by default everywhere else, Nickel's team updated the feature the same day. “I was quite surprised. It sounds like it was already in the works. They were just able to roll it out right then.” That responsiveness has been a pattern, not a one-off, and it's part of why Dr. Poole has kept expanding his business with Nickel.
