I have made the choice not to contract with managed care companies for my professional services.
Here are the 8 reasons why . . . .
Reason #1 – Conflicts of Interest
As a Licensed Professional Counselor, I am required to avoid potential conflicts of interest.
My primary concern is for my client’s well-being.
Therapists working under the constraints of managed care companies are sometimes put in the position of having to choose between what is in their own best interest and what is in their client’s best interest.
I do not want to be put in that position.
Managed care companies were created to “manage” and contain escalating health care costs.
Their bottom line is to reduce costs and raise profits; it is not to increase the quality of care or quality of life for my client.
In many cases, therapists who contract with MCC are actually paid to NOT see clients.
Reason #2 – Restricted Choice
Often managed care companies restrict the client’s choice of therapist by offering only short-term / brief therapy that I refer to as “drive-by” therapy.
Such therapy meets the financial criteria of managed care companies but may fail to afford my client the opportunity to get the information / therapy that s/he wants / needs.
It is my belief that this often results in my client’s quality of care being compromised.
And, this, of course, can result in the possibility of my client’s needs going unmet.
Managed care companies often choose to limit what therapies are offered, can restrict what is discussed in therapy, and decide which clients can be seen and for how long. Some managed care companies have even included “gag clauses” in their contracts to prevent therapists from suggesting more effective treatments.
Reason #3 – Professional Expertise
I believe that my client should be able to access the full range of mental health professionals according to client needs.
Often managed care companies restrict the professionals that clients are allowed to work with – preferring to refer clients to therapists who have a record of providing short-term therapy rather than to other therapists who may provide better results or offer a different packaging of services.
Reason #4 – Contractual Limitations
I believe that a client has the right to full disclosure of any arrangements, agreements, contracts, or restrictions between any third party and me that could interfere with or impact your treatment.
Managed care companies may label counselors’ choices to advocate for clients in this manner as “Managed Care Unfriendly Behaviors” and take such actions as they deem fit.
Typically “violations” such as these result in therapists being removed from provider panels or censored in other ways.
Reason #5 – Privacy / Confidentiality
By contracting with managed care companies, it is likely that I would be required to share my client’s deeply personal information with gatekeepers and utilization review professionals; it would mean potentially allowing literally hundreds of other to have access to my client’s personal information.
Reason #6 – Medication
Research has consistently shown that medication for problems with mood is most effective when combined with psychotherapy. Nevertheless, managed care companies frequently approve medication only for their members rather than permitting them to also work with a mental health counselor.
Again, the appearance is that of being more concerned about money rather than my client’s needs.
Reason #7 – Time
Managed care companies usually require therapists to justify and convince Utilization Review professionals before treatment is approved / continued.
This is time-consuming for the therapist and for the client who is required to continue his / her therapy in “fits and starts.”
Reason #8 – Diagnosis and Stigma
Managed care companies typically cover only those services deemed medically necessary which is defined as being literally about life and death and the treatment of illness.
This means that they require a diagnosis of mental illness for my clients.
My practice is solution- focused on quality of life and personal goals.
My work with clients focuses on prevention, exploration, and personal growth rather than simply survival.
We typically talk in terms of possibility and resourcefulness, gratitude and integrity, commitment and personal responsibility.
Working with managed care companies is not a choice that I can ethically make.
I Know Better
I have mental health professionals declare on a regular basis that you “can’t survive in private practice without participating in managed care.”
But, I know better.
What I know is that you can’t thrive – both personally and professionally – while participating in managed care.
Once I realized the ethical implications of working with managed care companies, I terminated all of my contracts with managed care.
It’s not a decision that is right or necessary for all therapists but it was the best decision that I’ve made to date.
I am now celebrating 10 years of being an insurance-and- managed-care-free private practice.
I’m thriving and you can, too!
All it requires is courage.
If you, too, run a practice without managed-care, I hope you’ll drop in here to chat about your experiences.
And, if you have yet to make the choice to opt out of managed care, I would be happy to help you find your courage and to help you create a path to a fee-for-service only practice.
Great info, thanks! There is a piece of me that feels very conflicted about not working with low income individuals- do you alleviate this concern by offering any sliding scale spots?
Robyn, I have several thoughts about this. The short answer is that I do set aside some “slots” for reduced fees. I’m going to write a post on this shortly to give you some ideas about how to handle these choice points. Stay tuned!
Hello. I am a LICSW who recently left a position at a community mental health agency in order to develop a private practice. I knew I wanted to practice free of insurance restraints however, it was appropriate therapeutically for certain clients to follow me into the private world and these are all Medicaid/Medicare folks. My hope was to build up the rest of my practice as an out of network provider. I find I am turning people away right and left because of this.
Tamara, I wonder if you would share a concise but thorough explanation that you use to educate clients about the benefits of working w/ an out of network provider. Do you market your practice via local paper etc. and/or via letters to psychiatrists, inpatient facilities? I do not have a sliding scale but have agreed “in the moment” to reduce my fees for a few pvt pay folks who request this at the end of our first session. FYI, I use a program called “myclientsplus” to set up client files, bill etc. Have been very happy w/ this software and the tech support. Cost is only $19.95/month.
Well said about managed care. However, I am curious about how to offer services to low income.
Doesn’t the mental health parity act do something to address this issue?
Hi, Travis! That’s a good question but, no, it really doesn’t. At least, not in the grand scheme of things.
“The Mental Health Parity and Addiction Equity Act of 2008 requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.” Here’s are links to a Fact Sheet and a FAQ Sheet on MHPAEA of 2008.
The truth is that the restrictions and limitations of working with managed care are equally applicable to dentists, physicians, and mental health professionals.
I am beginning a new practice and do not want to contract with managed care for the above reasons, in particular the loss of privacy. I would, however, like to provide a bill that could be turned in to insurance should the client so desire. Would this place me in a position of being required to provide data to the insurance company?
Hi, Verline! I think you are on the right track. I do provide a bill to my clients that they, in turn, may choose to submit to their insurance companies for reimbursement. This does NOT require me (or you) to provide any data to the insurance company.
In the event that insurance companies need additional information i.e. clarification about dates of service, diagnosis, or supplemental information, I provide such information only to the client for him / her to submit to the insurance company if s/he chooses to do so.
I have had an insurance company attempt to communicate directly with me about a client by telephone. I simply explain that I have no authorization to confirm / deny that I have a client by the name of ____________ and then I refer them back to their own client for additional information.
Like Verline, I will be starting in private practice with psychologist who has 20+ years of experience, but does deal with managed care. I have worked as a licensed counselor for 6 years now (in state-funded agencies) and ready to make the leap into private practice. Excited but also a little nervous because so many clinicians assume and tell me that I must get on panels to see patients, otherwise, they will not be interested or able to see me. I do not agree, but I want to to know how can I make this work from the “get-go” for someone like me with 5+ years of experience in the field, but new to PP? Thanks!
Hi, Cynthia! Thanks for dropping in! You absolutely DO NOT have to work directly with managed care to build your private practice! In fact, my experience has been that because my hands have not been tied by managed care – dictating who can see me and for how long – I have a full and busy practice. And, I am not alone. (Perhaps others reading this can speak to their own success in building independent practices?)
The key is in helping potential clients understand the full implications of you working without the constraints of insurance companies and also understanding the financial differences up front. For many clients, the monetary difference between you filing their insurance claims and they filing their own is nominal. And, for others, paying their deductibles is the equivalent of seeing you 5-10 times. By then, for many clients, their clinical work is over! And, for still others, the services they are seeking to use are not covered by their insurance companies at all – I’m thinking of things like couples counseling.
Just take the time, Cynthia, to get really clear in your head about the benefits and costs to your client when they work with insurance. Then, you’ll have a truly informed discussion with they about why you choose not to work with managed care. It won’t be a sales push or a snow job. It will be you informing your client of ALL the implications rather than the ASSUMED implications of working with managed care.
I am so happy to have found this thread! Those of you just starting private practice are asking the exact questions I have about managed care. I am an LLPC and in Michigan, I am finding that getting panneled is nearly impossible until I become an LPC. So, I am going to attempt to be out of network and, with Tamara’s great “8 reasons Why I Do NOt Work with Managed Care Co” I have more confidence than ever to try it this way.
I have a friend whose been in private practice for 20plus years and is thriving working out of network. Best of luck to us all!
Caroline
Hello Tamara,
I have been considering transitioning into private practice from agency work, for quite some time now, and appreciate the information you have provided. I would like to know what information would be required for out-of-network clients, who are interested in billing their insurance provider for services rendered?
Thank you.
Hi, Len! Welcome to Private Practice from the Inside Out! I’m so happy to have your voice here! Here’s a post that shows you what to include on your receipts for all your clients – and here’s a terrific webcast explaining the revised CPT codes that took effect here in the USA in January 2013.
Let me know if you need anything else to launch that new practice!
Hello Tamara,
Thank you for the information you provided on Out – of – network receipt information. I have decided to move forward with plans to open my private practice. Since my post, I have completed my website (haven’t launched yet), blog-site (launched), and many of the pertinent documents and consents required, including my Out-of-Network Receipt. I plan to open in January…fresh year and fresh start, after working for agencies over the past ten years.
It isn’t without fear; this prospect and process of becoming an entrepreneur, but I’m taking a leap of faith. I cannot thank you enough for the invaluable information, encouragement, and support you provide to fellow mental health professionals, like me and so many others.
Again, Thank you!
Sincerely,
Lenora
Hi, Lenora! You are so welcome and I’m so glad you’ve found your way to Private Practice from the Inside Out! I’m excited to hear about your plans to open your private practice in January! With ten years of agency experience, your clinical experience will far exceed those of your peers who opted to go straight into private practice after grad school. And, what an exciting chapter you are venturing into. Just this week, Jenny Glick wrote a guest post talking about how Ordinary Choices Rarely Produce Extraordinary Results. That’s what that “leap of faith” is about, isn’t it?!
I hope you will let us know when / where we can find that new website and blog of yours so that we can come check them both out and celebrate with you! Oh! I forgot to ask – Where will your practice be located and who do you hope to work with? And, if you decide to host an open house to show off your new practice, you might want to check out A Few More Reminders for Your Open House.
In any case, please do drop back in often to chat and let me / us know how we can support you on your journey!
Hello Tamara,
I plan to launch my website at the end of this month. It can be located via http://www.seedcounselingservices.com, once it is published. The name of my blog is The Apple Seed Blog: Getting to the core of self-discovery and wellness, and can be located via http://www.theappleseedblog.com, which is currently active with a few posts.
My practice will be located in Kissimmee, FL, which borders South Orlando, FL. I am starting out of the gate slowly, and so will have a virtual office, while also providing Home-Based Therapy Services. The population served by my practice will be Seniors and Adults, seeking support for Grief and Loss, Phase of Life Transitions, to include Chronic and Terminal Illness, Anxiety, Depression, and Stress Management. I will also provide support to Family Caregivers, and offer Support Groups.
Thank you again, for providing such an invaluable forum for Professional Mental Health Practitioners to learn, grow, connect, and feel supported!
Best Regards,
Lenora
Robyn, I love the idea of not working with managed care, for many of the same reasons you stated, but I am concerned about generating enough business…so many of my clients either have the financial need or a desire to “use” their insurance benefits that they are paying for. How do you find enough clients that are willing/able to pay directly for services?
Jennifer, in my experience, it’s FEAR rather than not enough clients that keeps a therapist’s calendar less-than-full. Think about it . . . between my family members and neighbors, friends, and colleagues, there’s PLENTY of folks needing our services. The “trick” for me has been to differentiate myself from the other therapists up and down the street i.e. niche, niche, niche and to be bold enough to ask for what I truly want.
In the last 12 months, I’ve had 1 client choose not to work with me because I did not work directly with insurance companies. Once they understand why I choose NOT to work with managed care and how that choice benefits them, they are typically grateful that a professional counselor took the time to fully explain the implications of the choice.
I am having more and more clients as for out of network receipts but then the insurance companies want ICD and CPT codes on these forms. One reason I was trying to avoid insurance companies it that I did not want to have to diagnosis clients. I realize for some clients a diagnosis is liberating but for many people it is a means to pathologize them. But now I am getting phone calls from these companies asking for records. As you have noted previously I am not complying with these requests for privacy reasons but I am wondering if I am am required to supply these forms or codes at all. I am a mom and have a small part-time practice and don’t even own a copier or fax machine to comply with these requests anyway. If a client wanted a copy of their record I would supply this but I don’t believe I need to do so for insurance companies. Also, if another provider ask for a patients records I like to make sure the client wants this first and signs a release but putting together these records takes alot of time. Can I charge a client to release their records to their psychiatrist? I do paper charting. I love being a therapist, but paperwork makes we want to find another profession.
Hi, Christy! It’s great to meet you and thank you for dropping in to ask these questions.
Almost every therapist new to private practice asks some version of these.
So here’s the deal . . . .
It depends.
Being competent to diagnose is a basic standard of care across all mental health disciplines here in the United States.
That means that it’s critical that you maintain your skills in assessing and diagnosing clients regardless of how you choose to use them.
I can appreciate your position that diagnoses are not appropriate or even necessary for all clients.
However, I am not an attorney and am in no way offering you legal advice.
As a professional counselor, my understanding is that as long as you can justify why you are choosing not to use a diagnosis, you are not legally or ethically required to do so unless you have entered into contracts that stipulate otherwise.
If you are practicing as an out-of-network (OON) provider and you can justify why you are not providing a diagnosis for your client, then I believe you are in good standing with the insurance company.
However, it is important to note that most insurance and managed care companies do require a diagnosis and CPT code from you in order to provide reimbursement for your services.
Thus, the moral and possibly ethical dilemmas arise.
Do you choose not to provide the information on your receipts resulting in your clients then not being able to utilize their insurance companies’ benefits?
Or, do you provide the information that you believe is either unnecessary or potentially harmful to your clients?
Many therapist make the choice to provide the information and rationalize that “at least the client doesn’t have to pay as much.”
However, if you believe that the diagnosis or CPT code that you provide is inaccurate or harmful to your client, my understanding is that you have literally violated the law, violated the standards of practice in your community, and violated every code of ethics that I am aware of.
Note that if you have entered into contracts (with employers, with clients, with managed care companies, or otherwise) agreeing to provide certain information, you must legally provide it and you must do so in a timely manner; if any of this conflicts with your ethical codes or your personal beliefs, you are still legally required to provide it.
And, your legal obligations do not absolve you from your ethical or moral obligations . . . and vice versa under most circumstances.
All of that is to say that when legal and ethical requirements conflict, your best choice of action would be to change your work circumstances so that you are no longer required to engage in such practices; you cannot simply choose to comply with some requirements and not others.
And, yes, you can charge a reasonable fee for releasing records to their health care providers; however, it is also noteworthy that you remember that you are ethically required (and sometimes contractually required) to coordinate care with other providers.
The size of your practice, your status as a parent, your method of charting, and the work-related machinery that you own do not factor in to your legal and ethical obligations.
I think the other thing that needs to be said here, Christy, is that what’s most important about all of these considerations is that you establish a written policy addressing these things, you discuss it fully with all clients, and that they affirm in writing that they understand your business practices.
This must be part of your informed consent process.
It’s a lot to consider, isn’t it Christy?!
And, again, I think most therapists who are new to private practice bump up against these dilemmas.
I tell my coaching clients that “We get paid to make judgement calls every single hour of every single day.”
It’s also why I chose to leave managed care behind – not because they required me to diagnose but – because they added just one more layer of expectations and obligations that required me to make ethical judgements that I preferred to not deal with.
Thank you for taking time to drop in here to join the discussion; I hope you’ll be back soon!
Tamara,
Hopefully, your page is a God send. Today after practicing for over 15 years in a rural part of West Texas, I was at my wit’s end and nearly in tears. Another night spent until midnight reviewing authorizations and new forms and overwhelmed with 4 companies wanting to use their own credentialing classes for trauma training that are “required” to be on their panel. It is crazy! I have specialized in trauma work with some of the best training available already. It is really overwhelming to think of all of the hours of paperwork and now more training. I hope that finding your site is a beginning of a new path for me.
Mary
Hi, Mary! It’s so nice to meet you and thanks so much for dropping in here to check out Private Practice from the Inside Out! I can so relate to where you are! I was chained to managed care for the first 7 years I was in private practice. I thought that’s what we had to do to survive. But, what I learned was true for me is that it was killing me! I was jumping through so many hoops so fast and I believe it was unknowingly at my clients’ expense. I realized along the way that I was continuing to play with them out of fear and nothing else. Now, that may not be true for you or a lot of other people but I can see that it was true for me.
I count one of the best days of my entire life being the one on which I resigned from the last managed care company. It was scary at the time but I promise you, it was much more freeing than anything else I’ve done! I don’t know exactly what you are looking at changing for your practice but if there’s questions you have or anything I can do to support you in re-shaping your private practice into the practice that you love, please don’t hesitate to speak up!
If you sign up for my email updates, you’ll receive emails usually twice a week letting you know I have posted new information. The online community here is supportive of each other and it is growing. I hope you’ll add your voice often – letting me know what you like and what you need and letting your peers here know that you are supporting them, too!
Again, Mary, I’m so glad you dropped in and took time to introduce yourself. I look forward to chatting with you!
I have been in private practice for three years and have never accepted insurance because of the same reasons and more as stated above. I have always had a full practice. The most important thing is that you need to be good at what you do, believe in yourself and in your clients’ abilities to heal. Then your schedule will be as full as you want it to be. We all belong to communities who need good therapists, and they will gladly pass on your name as a referral to the people they know who need help as long as you have been effective with someone they know. It’s a season for our profession. People are hurting; the sandbags placed downstream from the past 25 years are being overrun by the flood of hurt as the family disintegrates. It is not by coincidence that we are in place to do this work at this time in the history of our world. There is a need, and if we do it well, insurance or no insurance, we will fulfill our mission to bring healing in the emotional realm to so many in need.
Kathie! Welcome to Private Practice from the Inside Out! And, thank you for such a thoughtful comment! I completely agree and couldn’t have said it any better!
I hope you’ll drop back in and introduce us to you and your practice!
It looks like I’m a couple years late on reading these very helpful posts. Like Verline, I want to be able to provide a “bill” for my clients to submit to their insurance company to be reimbursed. One ct stated that their insurance company (Anthem BCBS) require that I be on their panel before they reimburse the ct. The ct has temporarily put therapy on hold until the issue could be resolved. So, I began the process, recieved applications, et. et. I am now starting to second guess this.
Do I need to be a part of their preferred provider network in order for my ct to receive reimbursement?
I live an work in a small community. My full time job is in an OP agency that requires 70 miles of commuting a day, often in snowstorms over a 9,000 foot mtn pass on a 2 lane winding road. I REALLY want my private practice to thrive so I can spend more time with family! But it also means limited clientelle pool. I’ve put together a unique offering through a collaborative and work with a personal trainer and nutritionist / health coach to assist ct’s with mood and anxiety disorders (also helpful for other disorders) to reach more clients. But this integrative approach adds up financially for the ct, so I almost feel obligated to find ways to help them cut costs.
Your website is a gold mine of a find for me! Thanks!
Patrick, welcome to Private Practice from the Inside Out! I’m so glad you are finding the resources and information here helpful! That’s exactly why I leave my posts open for comments . . . . Therapists come along when they are ready! There’s no rush and, as you’ve noticed, there is plenty of info for those who are brand new to private practice and those who have been in practice for decades and are just ready to expand their practices or take their businesses in new directions!
Managed care companies are the ones that get to decide whether or not to reimburse a client for your services. Although technically they can override any of their policies as they see fit, the reality is that most adhere closely to their own rules. Insurance and managed care companies often require a client to use one of their preferred providers. However, some of them also allow a client to seek services “out-of-network” at a reduced rate of reimbursement. The reality is that each company will dictate what each client is able to be reimbursed for and even within one company you may have each client having a different policy to adhere to . . . network providers may differ, out-of-network provider options may differ, deductibles and even rates of reimbursement may differ.
I just took a look at your website, Patrick, and I love the name of your practice! What a great idea and a great concept, too! And, I love that you list “Walk and Talk Therapy” as one of the services that you provide! I want to suggest that you and your colleagues take a look at different ways of packaging your services together. Consider offering mix-and-match services for a set fee, selling packages of service hours that clients can choose from, and even educational / support / accountability services as adjuncts to your current work.
There are many places that are geographically challenged. Parts of Colorado, Montana, Wyoming, and certainly Alaska come to mind where this is concerned. Those areas offer challenges but they also offer benefits. Your integrative approach might be very attractive to EAPs and managed care companies marketed specifically as preventive / proactive services so if you haven’t considered marketing to them (and you don’t mind working directly with those companies), you may want to add this to your list of possibilities!
In any case, thank you for dropping in today. If / when I can be of help to you and your colleagues, I hope you will let me know! I look forward to hearing from you, sharing what I know, networking with you and learning from you, too!
Thanks Tamara,
I met with the team last week to address this very issue (among other things) of “packaging” our services at a lower cost. Since this is such a new and different model / approach, we are working out the kinks and trying to streamline the services. As soon as we establish a few more “success stories”, we’ll follow through on media (newspaper) connections to get the word out.
Oh, Patrick, you are ahead of me then! Just want to make sure you understand though that I wasn’t necessarily suggesting that bundling your services should be for lower costs. That might be true for some of your packaging. But, there might be other incentives in those packages instead of lower cost including easier access, possible free add-ons (think products or services), or greater access (think weekends, certain times of day, etc.) . . . . That’s what I was thinking. And, you don’t have to limit your ideas to the three of you in Base Camp Collaborative. Perhaps you have a chiropractor or dentist or day care down the road that might also be interested in creative packaging of services.
And, I’m getting ready to write a guest post for Julie Hanks on the ethical use of testimonials later this month. I’ll let you know when that gets published. Perhaps you’ll pick up some ideas there on getting / using those success stories, too!
Hey, Patrick . . . I just noticed that you don’t have a little picture of you next to your comments. You’re missing an opportunity to help people remember who you are. If you want to have a little picture of you show up in your comments, you can find out how right here. It’s really simple – I promise!
My name is April. I am excited about the idea of not working with insurance companies! I have been in private practice for only a few years but have only been billing Medicade. Most of my other clients are court ordered and don’t have insurance or the insurance won’t pay for their treatment(for example sex offender treatment). Not that my partners have left town and I am on my own, I was planning to start the daunting task of getting on some of the insurance panels. After reading your reasons, I was so happy to see that I was not the only one who felt that way about managed care. Can you provide a list of insurance companies that will not reimburse the clients if they choose to see someone out of network? Thanks for all the great info!
Hi, April! Welcome to Private Practice from the Inside Out! I’m so happy you’re happy with your decision! As I’ve said before, choosing to work directly with insurance and managed care is such a personal decision. There’s not one right answer that fits everybody. What I do know is that once I got clear about my own decision and intent to follow through with it, I was just as excited as you sound!
The list that you are asking for does not exist . . . and even if it did it would be out of date by the time it was published. That’s because most of the insurance companies – at least the major ones – renegotiate their terms every year with the employers they contract with. That means that services that are covered one year may be partially covered (or not at all) the next. Likewise, decisions about if / how to cover out-of-network providers also change.
If you are serious about wanting to provide services out of network, then I would get rid of the myth that “It can’t be done” and just do it!
April, I hope you will be back often to chat and share your adventures in private practice!
Tamara,
I’m so glad that I found this post while perusing your site tonight! I’m in the very beginning stages of opening a private practice. I’ve heard horror stories of working with managed care and all the time & headaches it causes; however, I guess I was under the impression that as someone just starting out in private practice, I needed to work with managed care to establish myself and a client base. I live in southern Maryland and the area that I’m looking to open my practice in has several military bases as well as many DoD employees. I worry (even after reading your post!) that if I try to open a practice that does not participate with TriCare, I a)won’t get many referrals and b)will lose out on clients once they learn that I am out-of-network and don’t bill TriCare. Thanks again for the great info!
Hi, Amanda! You’re actually referencing two distinct myths that most therapists believe . . . . MYTH #1 – that managed care sends any one therapist enough referrals to fill their appointments. Grant it, there is the exception . . . the well-established, long term practitioner who has garnered the favor of a managed care company and really does get a majority of her referrals from them. But, Amanda, that really is the exception and not the rule. Most therapists who work directly with managed care would tell you that they do not get enough referrals from managed care to fill even half their appointments . . . and so they limp along trying to get more referrals through managed care all the while struggling to fill those empty time slots while slogging away at the hoop-jumping and paperwork.
MYTH #2 – that clients won’t be interested in working with you if you are out-of-network. In the last 10 years, I have had no more than 3 potential clients choose to work with someone other than me specifically because of me choosing not to work directly with managed care. If you are clear about (1) why you choose not to work directly with insurance, (2) are committed to helping your clients learn to navigate pursuit of their own reimbursement, and (3) make it relatively easy for your clients to submit their claims to their insurance companies by providing a good receipt, I think you will find your experience to be similar to my own.
It makes me sick to see both managed care professionals and also those masquerading as “professionals helping therapists get on insurance panels” mislead mental health providers by using fear and shame-based tactics to feather their own coffers. The truth is that there are honorable reasons one might choose to work with managed care and there are also honorable reasons one might choose to work outside of managed care.
If you desire to work directly with managed care, go for it! There’s nothing wrong with that choice . . . as long as you and your clients are fully informed about all that that means. But, please take the time to read the small print and consider the implications. Don’t make the choice based on fear or shame. You and your clients should have choices.
On the other hand, if you choose to not work directly with managed care, then I can tell you . . . it’s not only possible, there are significant benefits . . . for you and your client, too.
And, if by chance, there are those of you reading who do not believe that you (and other therapists) deserve to make a good profit, then stay tuned! Later this year, I’ll be talking with you about this very thing!
Very informative! It may also depend on the location of your practice and the clientele you serve. I have experienced quite a few people who could not do out-of-network because the payments would be too expensive and they did not qualify for our sliding scale plan. They did have to seek another therapist. I also have clients who are seeing me and I am out of network for them.
How do you address the person who cannot afford to not use their insurance?
Thanks!
Hi, Camille! It’s good to have your voice back here again!
I want to be careful here how I respond to this (and am hoping others will share their thoughts, too). Most of the time, if I hear therapists say that their practices are not as busy as they would like them to be, the explanations that usually follow sound something like this . . . .
“I can’t get on insurance panels . . . . ”
“Clients can’t afford my full fee . . . . ”
“There’s too many therapists in my area . . . .”
“There’s not enough clients in my area . . . . ”
“I’m not on the right insurance panel . . . .”
Do you notice anything these “explanations” have in common? They are never about the therapist.
The reason I mention this is because I’ve never met a therapist who couldn’t grow her practice in the very location that she chooses by applying some strategic marketing and creative thinking. I’m sure there may be one out there . . . but I haven’t met her yet. (Oh, this just begs for a blog post or two . . . or perhaps a class . . . !)
So . . . how do I address the person who cannot afford to not use their insurance? I have an honest conversation and strive to make it a win-win . . . and that may look a lot of different ways. I love the way DeeAnna Nagel has chosen to deal with it. Art therapist Giora Carmi titrates the time. Here are some of the things that I consider and here are some ways that I’ve dealt with clients’ financial needs.
The bottom line is that if it’s not a win-win, it’s a lose-lose . . . for both me and my client!
I recently joined a practice practice with another group of ladies in the area…None of us accept insurance…well, that’s a lie, I just signed on with Medicaid and am apparently the only one in the area that does (I know there’s a reason for that) but will keep my Medicaid clients to a minimum. That being said, the rest of my clients are self-pay…we explain it much like Tamara does and clients appreciate that…and will schedule anyway. For those who are lower income, perhaps you can think of some different ways to help them out, for instance, every other week sessions or shorter sessions, or some way as to not devalue your worth as a counselor but is still able to meet the needs of the client.
Evan, thank you so much for taking time to drop in today. These are excellent ways to provide your services and to honor the relationship that your new clients has sought. What therapists often fail to realize is that there is nothing magical about the clinical hour. Research has shown that clients typically benefit equally from 30 minute, 60 minute and 90 minute sessions. A little heart-felt creativity can go a long way in meeting clients’ needs.
I know it’s been a long time since I dropped by. Your website is always great!
I hear therapists say similar things regarding their practice building results. I actually do not mind taking insurance but I must add that I have an office manager who deals with it. If I had to do this myself, it would be a much more difficult task. When I stated my practice I did this task myself but I had far less clients so I had time to do it, that’s not the case anymore. I do understand the stumbling blocks that come with accepting insurance. I tend to see far less problems in my private practice than when I worked for the state of Georgia. The treatment plans and documentation required by medicaid was enormous.
Hey, Camille . . . can I ask you a few questions about your office manager?
** How long have you been in private practice?
** How long have you had her?
** How many hours / week is she there?
** What percentage of her time is dedicated to some aspect of working with insurance / managed care?
Hi there,
I’m in my third year of private practice and my mother is the office manager. I’m seeing about 20 people each week. I would like to see around 25. We have one other therapist that she does billing for. She’s been the office manager since the second year of my practice. She is at the practice Mon – Friday, with exception of some Wednesday because those are slow days. I would say the majority of her time is spent on the billing (let’s say almost 50% of her time) and the other half is admin, client calls, maintaing business operations, etc.
That’s such helpful information, Camille! I’m thinking of doing a post on hiring office managers:) And, now that I’m reading this, I’m wondering about a post on the pros and cons of hiring your family member. I’ll reach out to you back channel . . . .
Oops I didn’t know how to edit this but wanted to add she’s at the practice from 10:45a to 5 pm. That’s flexible because we may have a particularly busy or slow day.
You are an inspiration to me Tamara! I have been in the field for over 20 years and I’m just now branching into private practice. Many of my colleagues believe I am taking a huge risk of failing in my practice by not taking insurance but after dealing with the horrors of managed care in many of my jobs as a social worker, I cannot bring myself to do it for the reasons you mentioned above. I have the experience, but need the confidence and the skills to attract my ideal client. This has been very difficult in the 2 months I’ve been in practice. So far my track record are clients that will come in sporadically and cancel the day before our appt more often than keep the appt consistently.
Hey, Lisa! I’m so glad that you dropped in to share your situation. I’m actually excited for you! With 20 years experience, I suspect you bring a wealth of knowledge and skills with you. Of course, there is risk when you transition from the safety net of an agency or institution into private practice, but choosing not to take insurance is not where the risks are. Growing your confidence and learning the business of private practice rather than the clinical piece of private practice, is important but the good news is that you’ve already figured that out.
When building a private practice, the first year is often bumpy. However, if the phone is ringing and they are scheduling appointments with you, you’ve won half the challenge! If they aren’t following through with their initial appointment, you need to put more “glue” between you and the caller meaning you need to focus more on building a relationship with the caller while on the initial phone call. If there is enough “glue,” the caller will actually show up for the appointment. Does that make sense? If you need help figuring out how to do that, let me know! You can hire me for an hour and we can talk through ways you can make that happen.
Lisa, I hope you will drop in here often to chat and let us know how building your practice is working for you!
Tamara,
I am so sorry I got busy going in different directions, I never submitted a guest post! Is this something that would still be beneficial? I understand the topic may be expired by now. Please back channel to let me know.
Hi, Camille! I’m so glad you dropped in to share your pin boards, too! And, do tell . . . what is the tool that allows you to schedule your pins? It sounds a lot like HootSuite for Twitter – which I love.
I love Hootsuite! It’s the answer to my social media upkeep for sure. I answered about the Pinterest tool on your other post so the other pinners could see. 🙂
http://www.allthingsprivatepractice.com/10-reasons-why-i-use-pinterest-to-build-my-psychotherapy-practice/
I know what you mean! When I talk to therapists about blogging and other forms of social media, I often get the reply “But, that takes too much time!” I chuckle and say “No! It takes less time if you set up the proper structures, know which tools to use when, and schedule your posts, tweets, (and now pins)!
Hi Tamara,
Just wanted to thank you for your time and this valuable information. I am new to private practice and was considering getting on panels, but will stick with networking and private pay. Thank you.
Hi, Elliott! Thanks so much for dropping in to chat! You are so welcome to the information. I’m glad that you find it useful.
I hope you will be back often to chat with us, Elliott. I look forward to networking with you, sharing what I know, and learning from you, too! By the way . . . where are you and what do you do?
Hey, I noticed that you don’t have a tiny little picture of you up beside your comment. Those are called “gravatars” and are really easy to set up. Here’s instructions for how you can do it.
In a collaborative working office and we are deciding to start the new year insurance panel free. However, disentangling ourselves, separately, will be a challenge. I have reviewed your posts and will bring this information forward to my office mates. I can’t say I’m not nervous, but excited about not having to ‘chase the money’ anymore. Thoughts/ Insight??
Hi, Michelle! Welcome to Private Practice from the Inside Out! I’m excited for you and your colleagues to be taking the steps to become insurance-free! I think you will be surprised at how much freer you feel in making both clinical and financial decisions for your practice. Stepping out of the insurance / managed-care loop makes it much simpler to do what is in both your clients’ and your own best interest – and to see the places that are muddy i.e. risky and avoid them.
As for thoughts, I would suggest that you plan a celebration for this act of courage and start to have the conversataions now around what will be different and better when you are no longer chasing the money. In fact, feel free to touch base back channel should you be interested in writing a guest post on the 10 best things about not chasing the money! I think there are lots more therapists who would like to find the courage to believe that this is even possible! Here’s a link to my guest posting guidelines.
Tamara,
I am relatively new to private practice (slightly over 1 year) and so far have been operating as a fee-for-service provider. While I enjoy my services not being dictated by the insurance companies, in an attempt to increase my patient volume I started looking into becoming paneled. I would much rather stay as a fee-for-service clinician and would be eternally grateful for any guidance you can offer as to having a greater access to patients than I’ve enjoyed thus far. Thank you in advance.
Hi, Mila! It’s so nice to meet you! And, welcome to Private Practice from the Inside Out!
This is such a common questions that I want to take this back to the “front” of this blog in a new blog post to answer this. (I hope you don’t mind the delay.)
Hi Tamara,
I am new to private practice (while maintaining a full time community mental health agency job, as well) and I still have a while before I will be able to even think about getting on insurance panels. I would prefer to never have to but I hear so many conflicting sides (they help build clientele, too much work, etc.) My goal is to eventually be exclusively in private practice. I have created a niche (children, adolescents, and their families) and I have my information on Psychology Today. I am getting referral calls however as soon as they tell me what insurance they have and I tell them I only take self-pay, the conversation is all but over. What is the “magic” elevator speech that reels them in?
Kristen, I love this question! Thank you! It’s not magic at all! And, I was just thinking earlier this month that I need to talk to you guys about this, too! So . . . I’m crazy swamped right now but give me a few weeks and I’ll try to get this out to all you guys.
In the mean time, where are you and what is it you do?
And, thank you, thank you for following my blog and dropping in to chat tonight!
My relatively new practice is currently private pay-only and I work with children, adolescents and adults. Like Mila, above, I’ve been getting by with a small number of clients whom I provide a Superbill if they want to submit to their insurance for out of network benefits. Recently I grudgingly applied for the one insurer which other clinicians have told me is relatively high paying and easy to work with. I did this because of the fear that I will have insufficient referrals without doing so. I must echo that so many clinicians have told me that you MUST work with insurance to obtain referrals – yet I personally know three therapists who are thriving with self-pay practices!
I haven’t been approved yet and when/if I am I will be able to review the contract before making a final decision about accepting insurance. I am receiving my referrals through Psychology Today, Good Therapy, Therapy Tribe and Help Pro as well as a few clinicians who refer to me, some schools and physicians. I have mailed letters but not followed up face to face with the physicians. I feel that they would not welcome someone showing up in their offices unannounced. Doctors’ offices receive so much traffic from Pharmaceutical Reps who bring food, candy, gifts every time they walk in the door. I don’t think I can compete with that type of marketing effort. Maybe I’m wrong! I’m eager to read your updated post on this. Thanks!
Thanks, Laura, for introducing yourself and telling us a little bit about your practice! That’s so helpful to all of us in trying to connect with each other here online. Here’s a post I wrote a while bacin of Effective Strategies for Getting Referrals from Primary Care Physicians. (You are not competing with the pharmaceutical reps so don’t worry about them.)
Hello Tamara,
I was recently informed, that in order to bill for services, as an Out-of-Network provider, for clients paying privately, but who would like a receipt to provide to their insurance carriers for reimbursement, that the therapist, must have an NPI number. Is this true? If so, do you have to apply for an insurance panel to receive an NPI number?
Thank you in advance.
Hi, Lenora! And, welcome back! You do need a National Provider Identifier – freqently referred to as NPI. It’s really easy, free, and quick to get one. Here’s how.
Hello Tamara,
Thank you for the information on obtaining an NPI number. Since our last correspondence, I have applied and received my NPI number(s), both for an individual and organization. I have been approached by a colleague (LCSW) and her partner (Psychologist) who are in the process of starting their own Counselor Resource Practice, which provides private practitioners with management consultation, case consultation, referral resources, marketing, and an opportunity to work as a contracted practitioner in their group practice.
I would have to become a Medicare provider, at the very least, given the practice is primarily geared toward the gerontology population. I would be given the discretion of selecting and denying referrals. They also provide the billing services, along with a program for documentation, appointment scheduling etc. for a split-fee. I am considering this avenue as an opportunity for a secondary income and professional support for both my work with their group practice and my new private practice, which will be solely-private pay (opening January 6, 2014).
I have also, launched my website and continue to work on posting on my blog, which will become more frequent once I establish my practice.
Again, Thank You for the invaluable information and support you have provided me and continue to provide to fellow mental health practitioners. Wishing you all continued success!
Best Regards,
Lenora
Hi, Lenora! You’re so welcome to the information!
Hey, I’m really happy for you that things are moving along; however, I also want to caution you to be very careful about the groups you choose to join. Around here, there is at least one guy that is offering a large range of benefits similar to what you describe for thousands of dollars up front and then a big percentage of your earnings, too! While that may seem like a good deal to someone newly in private practice, it’s not a very good way to be in control of your own business. Paying thousands of dollars over a 10 year period can really add up. And, once you learn (and put into place) the systems that you need to keep your practice running smoothly, the bulk of the expense goes away . . . unless of course you have bought in to some high dollar contract. It’s a brilliant business model for those that own the company; but for the individual therapist who may be contracting with them, it’s not always the best choice. Just consider the long-term implications when signing any contract . . . whether it is a contract for office space, generating referrals, or with managed care. I see too many therapists who are short-sited in their goals . .. just “in a hurry to get started.”
And, if the situation that you are describing above is different from what I am describing, I hope it is a wonderful “next step” on your journey! Please do stay in touch and let us know how we can suppport you as you grow your business!
Hi Tamara,
Thank you for the information. The practice I’ve been invited to contract with, is owned by a clinician I know well from my work with her at an agency, and her partner, who is a psychologist. Whatever referrals I accept, we would split the fee 60/40, given they provide the referrals, marketing, etc. I will review the contract carefully, and give thoughtful consideration before making my final decision. I appreciate your advice and will keep you updated.
Thank you.
So a 60/40 split (favoring you) is definitely a higher split than some but if that is covering quality marketing, building in some consultation, office space and some office equipment and utilities, then that could make the split do-able. So happy that your opportunity is coming within the context of a clinician that you know well and trust . . . . That counts for a lot! Please do stay in touch and keep us updated!
Best wishes to you in whatever ways you celebrate the season!
Thank you, Tamara!
The info on your site has been so valuable to me as I’ve begun my women’s center/private practice. I was considering looking into insurance panels tonight, but this post (and lively thread!) reminded me why I decided to avoid it in the first place.
*smile, and long sigh of relief*
Lauren! How kind of you to take time to tell me how I have been helpful to you in starting your women’s center! You’ve made my day!
And, you’re in Ridgewood, New Jersey! I was just there this last year. It’s such a lovely part of the country! I’ll definitely look you up if I head back up that way!
Please do! There will be a cup of tea and a whole lot of “thank you”s to greet you.
🙂
🙂
Our office is ‘almost’ finished with managed care contracts and we are excited to be at the finish line! It has been a long 6-8 month process since we began, and while some individual companies still have not validated our request to end our agreements, we are working our way around this be updating the CAQH profile to list companies whom we know have been faithful in payments. Any suggestions for maintaining contact with those companies who haven’t responded to our initial letter of intent to cancel our agreements? Overall, our payments may dip slightly, but I think the quality overall will improve and with the changing times, people have begun to realize all things cost, including mental health care.
Congratulations, Michelle! I’m so happy for your office! Becoming a managed-care-free practice was hands down the best decision I’ve ever made in private practice! You will be freeing up more time to see the clients you really want to be working with without the hassles of having a third set of eyes in your clinical work!
And, yes, I do know how to handle those companies that either haven’t gotten around to responding or those that are choosing to drag their fee in responding. Unless your contracts stipulate otherwise, you can send a certified letter giving proper notice to each company and then be done with it; or, if you prefer, you can contact an attorney to send official notice to each of those companies on your behalf.
I hope you’ll drop back in to celebrate when the final nail is in the managed-care coffin so that we can celebrate with you! Best wishes on your journey!
Hello Tamara,
I’ve been so grateful for your website since starting my practice one year ago. I find your information to be thorough and practical, and it’s offered me guidance in a number of decisions I’ve made.
I’m currently in the process of leaving insurance panels, as well as raising my rates. After giving it a lot of thought, I feel this is in the best interest of both myself, my clients, and my business.
I’m wondering if I need to have clients sign a new contract or notice regarding these changes, or if I can just tell them verbally?
I will still be offering services as an out-of-network provider. Thank you so much for any guidance or suggestions!
Hi, Sarah! Thanks so much for following my blog and taking time to join this conversation. Here’s How to Inform Clients when Your Fees or Reimbursement Policies Change and Guess What I Learned about Raising My Fees? I think this tells you everything you need to know but let me know if you need anything else!
Tamara,
Thanks so much this was very helpful!
Hi, Sarah! Thanks for dropping in today to let me know that this info is useful to you. I hope you’ll be back to chat more with us later!
Hi Tamara!
Just found your website, ironically googling information on how to get “on” insurance panels. I have been in private practice for a year now and have a small client load that barely covers my costs. I have been considering getting on insurance panels to hopefully increase my client load but against my wishes. I too practice from a solution focused and also from Reality Therapy with clients and they have all found it very helpful. Fortunately for them and unfortunately for me this means my clients see progress faster and are done with sessions. After a year of trying to not take insurance I thought I would try until I came across your blog. I live and work in a very heavily saturated counselor/therapist community which does not help. I market heavily online on all social media and feeling discouraged. Any advice for me? I would so appreciate it.
Hi, Rose! It’s great to meet you here! Thanks for dropping in to talk. You’re not alone in thinking that managed care is a therapist’s life raft with a guaranteed influx of clients. It’s not. Most therapists figure that out after they’ve jumped through all the hoop, done the send-me-clients-dance for a while, and still just limped along.
The secret to building a strong private practice (with or without managed care) is to build a strong foundation both on and offline. It’s not either-or. Research has shown that when therapists struggle in private practice, it’s also not about there being “therapist-saturated markets.” The truth is that most of us didn’t come from successful entrepreneurial families; we didn’t go to business school; and, we’re just pretty clueless about how to get people to book appointments (and keep coming back). It helps if we begin by just telling ourselves the truth.
I’m happy to book a consultation with you to flesh out what’s going right (and wrong) in your practice and what you can do about it. But, I did take a quick look at your website and noticed a few things right off the bat.
You’ve started blogging on a weekly basis and that’s a really smart thing to do. Stay focused on meeting your ideal client’s needs and blog about those on a weekly basis. This time next year, you’ll have curated over 50 blog posts to help set you apart from the mass of therapists in the Chicago area. That alone can be a game changer. (Not to mention that Google will love you for that.)
I can’t tell what platform your website is on. Some are better than others. I’m hoping that is a WordPress.org site. That will save you money and time and effort in the long run, give you the most flexibility as your practice needs grow, and really is the standard for a good website.
The other thing I noticed is that you said you are marketing heavily on “all” social media. It would be nearly impossible, by the way, to market on “all” social media; but it would also not be necessary to “market heavily.” Don’t wear yourself out. Market smart rather than densely. You need a strategic social media marketing plan – and you need to follow it.
There isn’t any indication on your website (that I was able to find) that you are engaging in social media anywhere than other on your blog. You need to add “share” buttons to make it easy for your readers to share your blog posts with others on LinkedIn, Twitter, Facebook, Google +, Pinterest, etc.
I hope some of this info is helpful, Rose, and that you’ll drop back in to let us know what changes for you over time. Wishing you the best of luck on your journey and looking forward to helping you grow your practice right here at Private Practice from the Inside Out!
Hi Tamara,
Thanks for the great info and feedback. I definitely need to market smarter not harder 🙂 I am making adjustments to my website as well as adding more content to the blog and the social media buttons (they were there and not sure what happened to them!). Good call on the gravatar as well! I so appreciate this blog and your advice, it has been a little tricky to connect with other therapists in my town for support, I will keep trying but so far not such a great welcome by the seasoned therapists…so thank you!
Rose
Hey, Rose!!!!! There you are! How nice to see your smiling face! You’re so welcome!
What do you mean by “tricky?”
Hi, Rose! I just noticed that you don’t have a little picture of you showing up with your comments. That picture is called a gravatar and here’s how you can easily set one up for yourself – How a Tiny Little Picture of You Can Drive Traffic to Your Website .
Hi Tamara!
First, you are quite an inspiration to me, as I venture out into the private practice world! I have been reading your work, following your posts on social media, etc. I am SO GLAD you wrote this, and I aspire to have a full fee practice as well (for similar reasons). What do you find to be the best way to market OFF line, and, when would you recommend taking the “leap of faith”? (I realize that may be a hard question to answer, because everyone is different…but in your experience, do you think counselors who take the leap early are more successful because they “have to” be…because they have no other choice at that point? I have always been fond of the Zen saying, “Leap, and the net will appear.”
-Christine Reber
Hi, Christine, and welcome to the table! I’m so honored that you would take the time to write and share such kind words about my work! And, I’m happy to help you get there – to that full fee practice!
I hope you don’t mind that I want to take both of your questions to the front of this blog so that more mental health professionals will see it. I’ve got other questions in the hopper and cued up already so it’s going to be a little while. I’ll try to remember to let you know, though, when yours are cued up to go live so that you won’t miss the posts!
In the meantime, you may want to check out Polishing Your Chit-Chat for More Effective Networking.
Thanks so much, Tamara!
You’re so welcome!
Hello Tamara,
I just found your blog and it is full of great information! Thank you! I am a Speech-Language Patholgist working on starting my own private practice in 2015. I plan not to work with managed care companies, however I will provide the families I serve with the information needed so they can bill their insurance themselves. I would like to know if I have to obtain a # from CAQH if I only plan on taking self-pay patients?
Thank you for your time,
Maria
Hi, Maria, and welcome to Private Practice from the Inside Out! There’s at least a handful of your SLP colleagues who hang out here. Happy to have you join us! No, you don’t need to apply with CAQH unless you want to file insurance for your patients. However, you should obtain an NPI# so that your patients will have the ability to request reimbursement from their insurance companies. Here’s what you need to know about NPI.
Hey, Maria – I noticed that you don’t have a little photo of you that shows up with your comments here (and on other blogs, too). They are called “gravatars. Here’s a link to a quick tutorial that shows you how to set up your own gravatar http://www.allthingsprivatepractice.com/how-a-tiny-picture-of-you-can-help-drive-traffic-to-your-website-or-blog/ . (Don’t worry! It’s so easy that even I could do it and it’s absolutely FREE!)
Hello Tamara, I recently found your website and find it so helpful! I am starting my own private practice, currently on the side of my full-time job, and have decided not to take insurance at this time. Working within agencies for the last 10 years, I am aware of the problems that can come up with having to meet their requirements, and the difficulties it makes for justifying the need for continued care for clients. I’m excited about this new venture, and nervous, which is to be expected. I have seen you talk about giving client’s receipts to send off for reimbursement to their insurance companies. Can you provide more information on this? I am needing a little more guidance on what I should include, and what the insurance companies need from me, this way I can help client’s out as much as possible. Thank you so much for all your help!
I, too, have decided not to work with insurance. It was a difficult decision as I do believe in making therapy financially accessible to people who need it, and I do see value in being a part of the healthcare system. Ultimately, however, I found that the decision had the most to do with my time and how I want to spend it. Even if not taking insurance means receiving referrals more slowly or people having to go elsewhere, it allows me to use my time to develop my skills as a therapist (pursuing further education and training) as well as working on developing other services and streams of income for my practice, rather than on contracts, paperwork, and chasing after payments.
Hi, Jeremy! Welcome back to Private Practice from the Inside Out!
I often remind therapists that if you are charging a fair amount and working insurance-free, you can certainly give back . . . Your money, your time, and your talents in generous quantities. Just think about the amazing amount of charitable good done by the mega-rich like Bill and Melinda Gates. They couldn’t give a fraction of what they give if they only charged a pittance of what they are worth. Instead, they charge what the market will bear and they are able to generously give back so much more.
IF a therapist’s true motivation is providing services to those who cannot afford it, then I urge you to consider what you could be giving back simply by charging a higher fee.
I am so glad to find this website and blog. It is helping me with starting my private practice. I was fearful about not dealing with manage care.I now know it can be done. Thanks
Good morning, Pat! I’m so glad you are finding this information to be useful! I was initially terrified of getting off the preferred provider networks and equally terrified of telling potential clients that “I don’t work directly with managed care.” However, it turned out to be the best decision I’ve ever made for my practice. If you need help figuring out how to navigate that journey, feel free to reach out for a consult! I talk with therapists every day about this stuff and am happy to share my tips and learning curve with you! It’s 100% possible to have a mental health practice and be managed-care-free!
Best wishes to you on your journey!
This is an excellent website! I’m so glad I found it. I am a licensed psychologist in Oregon and I am starting a private practice from the ground up. I recently moved from Wisconsin where I worked for 2 years, and where I could have easily build a private practice based on my reputation and contacts. However, I had to come back to OR and I am SO grateful to see that there is help for people who do not want their work dictated to them by managed care organizations. This is wonderful!
Hi, Matt! Welcome to Private Practice from the Inside Out! I’m so glad you found us here! How did you hear about this website?
I hope you’ll make yourself right at home, get my updates sent right to your inbox, prowl around on this websit and jump right in to the conversations, too.
I think you’ll find this blog full of information and inspiration to help you grow your business.
You might also be interested in my private Facebook group by the same name: Private Practice from the Inside Out w/ Tamara Suttle. Just click on the link, and request admission. It’s open to all students of mental health and mental health practitioners.
Hi Tamara,
I am a ratively new RN that has become a Lactation Consultant and I am also in the process of learning other complimentary therapies. I want to offer a variety of services under the umbrella of post partum wellness. We were pretty much told in my LC program that with the Affordable Health Care Act that we would need to become insurance providers because women are now receiving consults for lactation as part of their benefits. That’s great but I just know it will be a headache! I am at step zero right now and am wondering if it makes sense to contact various physicians t see if they will take me on as a staff member or if I should try to see clients at their homes and drum up physician referrals. This thread is long and I wondered if ACA actually can dictate this and even rates charged.
Thanks in advance!
Kara
Kara, I have worked with nurses doing lactation consulting but this is not my area of expertise.
However, I think that these are both professional paths that could work well for you – working as an employee under a physician or working independently.
Mental health professionals often struggle with similar choices.
What I know is that regardless of what ACA dictates, there will always be individuals who choose not to use their benefits and choose to go outside of the normal path in obtaining health care.
Kara, I appreciate you taking the time to drop in to chat today and hope you’ll be back often to join the conversations here.
Where there is a will to work outside of managed care, there is a way, Kara.
I speak to therapists and allied health professionals every week that are doing just that!
Thank you for your post on 8 reasons not to work with managed care companies. I am in the process of deciding on what I should do. I hear so many bad stories about insurance companies taking forever to pay or not paying at all. How can I assure a successful private practice without managed care when most people do not like paying out of pocket? Any feedback would be much appreciated.
Thank you
Kristina Artimova
Hi, Kristina!
You are voicing a concern that many therapists who are moving into private practice want to know.
Thank you for asking it here!
In fact, I hope you don’t mind if I take the time to answer this in a new blog post.
I’ll link back to it here when I get it up – hopefully within the next week!
Thank you for this article! I am about to drop all insurance companies and could use some of that courage you talked about helping PP find when they want a fee for service only practice 🙂 Any insight, encouraging words, etc is greatly appreciated!
Congrats to you, Nicole, on making the transition to a managed-care-free practice! I would be happy to help you make this change. You can complete my contact form right here – http://tamarasuttle.com/contact/. Once I get a little more info from you, I’ll send you some info about working with me. I’m sure we can find your courage and your joy, too!
Tamara, I can’t thank you enough for your insights on managed care and sliding scale fees. I am completing my PhD in Clinical Pastoral Counseling after working in the field of secular psychology as a therapist and clinician. One reason I switched to Christian counseling was the interference of the state in what I could and could not say to clients regarding faith and spirituality, the other reason was being fed up with insurance companies dictating care and even putting us in the position of potentially lying about diagnoses in order to get care approved. I have been struggling with the decision about sliding scales as well as getting involved with insurance companies again and you have really helped me solidify my decisions. Thank you!
Hi, Karen! It’s so nice to meet you!
Thank you for dropping in to let me know that you find my work helpful to you.
That’s the goal!
I hope you’ll drop back in to let me know what state you are practicing in and how the state as restricted what you can say as a therapist.
I’m really interested in this.
I would take issue with your comment about “insurance companies dictating care and . . . Putting us in the position of potentially lying about diagnoses.”
I think a lot of therapists actually believe this to be true.
However, the reality is – at least in my experience – insurance companies provide detailed contracts that therapists knowingly enter into when those contracts are signed; and, at no time does that absolve therapists from using our best clinical judgment or fudging on diagnoses.
Having said that, I totally get and remember the temptations related to working under the confines of managed care and I applaud you for recognizing the complications that can arise from making the choice to work directly with managed care.
As I said before, leaving managed care was the best decision I ever made for my own work in the field.
I hope you’ll be back often to join the conversations here.
Best wishes on your journey!
I agree with your view; however after being in practice for over 2 1/2 years, reading quite a few books on building PP, creating a website, being on Psychology Today and having a very comfortable private office, I just don’t have the amount of clients I wish I had. I think most of my clients find it difficult to spend $60 to $70 a session, which by the way is very competitive with other therapists in my area. This is why most recently I seem to be leaning toward attempting to get on insurance panels and taking insurance again. I hope you can persuade me to change my mind, but I think I’m more interested in filling my appointment book now, so I can pay the rent on that office and all of my school loans… I read about all these success stories that do not take insurances and I wonder what I’m not doing or what I’m doing wrong. I have a ton of experience in the field and the alphabet behind my name and I think I’m a darned good therapist…
I love your post about why not to be on insurance panels. My colleagues and I are just starting a practice in New Jersey in Feb 2016. I wanted to know some tips for how we can just be fee-for-service.
Hi, Juan!
Thanks so much for joining the conversation here at Private Practice from the Inside Out!
You can find tips scattered throughout many of the blog posts here but one post that specifically talks about this transition is How to Crush Private Practice with Cash-Paying Clients.
I look forward to helping you grow that cash-paying therapy business!
I can’t tell you how much you have made my day!! I am taking the plunge into solo private practice after a 17 year hiatus working in a technical college as an instructor and counselor. I am licensed clinical psychologist who was in a private practice for 10 years prior to going into the college system to avoid the tremendous burn out of managed care and insurance companies. It truly did me in and I said I would never go back to private work if I had to deal with insurance companies! So here I am, “retiring” in my mid-50s to launch my dream of offering Christian therapy and coaching services. I have gotten many looks of disapproval from folks when I say I am only accepting private pay which has led me to doubt myself and my decision. After reading your post and all the great responses from other therapists has renewed my determination and hope that it is possible!! My dream is to provide therapy and coaching for as long as my brain stays sharp, and that will be much more possible without the burden of dealing with insurance companies. Thanks again, for offering your website and blogs to help the rest of us who need the encouragement and inspiration!!
Hi, Richelle! Welcome to the conversation!
And, congrats to you for “taking the plunge” into private practice!
What’s important to remember is that there are MANY right ways to build and run a private practice and there are MANY ways to meet our clients’ needs.
There never was “one right way” regardless of what we were taught.
You can do this, Richelle!
And, in addition to my blog, you might also find additional support in my private Facebook group if you are active on Facebook.
Hi Tamara,
Thank you for the invaluable information! I am a school psychologist (Ed.S.) and recently opened a private practice where all services are billed as out of pocket expenses. I am considering becoming an out of network provider, but cannot find a step by step process to do so. I have applied for my NPI, and understand the process of explaining the fees to clients and giving them a “superbill”. Is there anything else I need to do on my end in terms of CAQH, becoming paneled or credentialed by agencies? If I am an out of network provider, am I able to provide services in client’s homes, or must they come to an office space I provide?
I am also wondering who to contact to have an idea of what services I provide which may be covered. I know reimbursement will vary from plan to plan, but it would be nice to have an idea what to tell clients.
Any guidance would be greatly appreciated. Thank you again so much for your help and wisdom!
Hi, Kristen!
Thanks for dropping in to continue the conversation!
So sorry that I didn’t see you comment until just now.
I apologize for the delay in responding.
I consult with therapists every day about how to get paneled and I’m happy to consult with you, too; BUT, this isn’t rocket science so I’m confident you can do this on your own.
Here’s How to Get on Insurance Panels as a Preferred Provider.
This (above) is what is known as becoming “paneled or credentialed.”
And, here is what to know about Out-of-Network Responsibilities for Mental Health Providers.
You do not need to be paneled / credentialed in order to provide your services as a licensed mental health provider; this is what is meant by “out-of-network.”
You are able to provide your services wherever your licensing board allows you to do so; however, I think you are really wanting to know if an insurance company will reimburse you for services provided in your clients’ homes.
If the latter is what you’re asking, then you will need to get that answer from each and every insurance company that covers your work with your clients.
Increasingly the answer is “yes,” they will cover your services outside of a traditional office; however, that is not true for all.
Thank you Tamara for your sound advice and support to our profession.
I have a quick question that you may be able to quickly answer—A colleague of mine stated that LCPC ‘s were required to “opt-out” should they decide not to work with Medicaid or Medicare. –Do you know if this true? As, I had thought that only psychologists/psychiatrists and LCSW could file claims for Medicare and LPC’s & LMFT’s could file claims under Medicaid. I personally have opted not to work with Medicaid for the same reasons you’ve stated on MCC. I also did a bit of research and found this:
Medicare currently recognizes psychiatrists, psychologists, clinical social workers and psychiatric nurses for outpatient mental health services. However, Medicare does not reimburse professional counselors for behavioral health services.Jun 23, 2017
Medicare | NBCC
https://www.nbcc.org/govtaffairs/medicare
*I would appreciate your thoughts! Thanks very much! ~ Tamera
Hi, Tamera – I believe you are correct. You cannot opt out of something you cannot get into!
Thanks for your validation Tamara. I was also curious about Medicaid (as most types of mental health professionals can work with Medicaid clients). After more research, I believe I am understanding that only medical physicians are accountable for this.
Thanks again for your wisdom and time!
Tamera
The information you provide on your blog is amazing! I look forward to reading more from you! Thanks!
I have run my own small private practice without accepting insurance -with self pay and sliding scale. Great for me with adequate income and little inconvenience for most of my clients. I have also worked in two private practices and found the work began to serve the insurance industry rather than the client .
Julie, thank you for taking time to share you experience here.
So many new therapists have no idea what is and isn’t realistic in this market.
Your voice makes a difference.
I hope to hear from you again in future discussions, too!