When I first began my work as a therapist I was very excited and wanted to get on as many insurance panels as I could. My reason was so that people who needed the services of a therapist would be able to find me. My number of clients would increase and I would make a nice profit. So I began getting recommendations from my colleagues, as to who they used, what paperwork was required, how many sessions are allowed, how much they were reimbursed for each session and how long did it take to get paid for the therapy appointment. Oh wow! My “new therapist, wanting to help all that I could” bubble burst. I kept asking my colleagues questions such as, “You mean I have to accept ⅓ - ¾ of my regular rate for most insurance panels?” .. and ... “What? We don’t always get reimbursed for services we’ve provided, even though we thought we did all the paperwork correctly?”
Now let me add there were some good insurance panels, so all aren’t bad. But those few that are easier to work with are far and few. And to get on those panels can be very difficult. At least it was for me.
I began weighing my options - calculating rent, office expenses, malpractice insurance, and on and on adding up the expenses of running a private practice. I then tried to figure out how many insurance clients I would need to pay my expenses. I had to realize that even though my fee is, for example, $120/clinical hour I might only be getting paid $60/clinical hour. I realized I would have to take on “more than a healthy number” of clients just to make ends meet. I say more than a healthy number because as a therapist I have my own mental health limits on the number of clients I choose to see. I strive at providing the best quality of care possible for each of my clients. I can’t work like a machine seeing one client after another, with no breaks in between, and be sharp for each of them. Maybe some therapists can do that. But I know my limitations. I need time to gather my thoughts, do some research, confer with colleagues, make calls to physicians/psychiatrists, write appropriate clinical notes, etc. I need to focus on client care and to be sure I’m offering my clients the best support, education, and guidance that I can.
Therefore, I chose to make my practice more client driven. I chose to provide the best care I can for my clients and not have an outside panel tell me what’s in the best interest of the client who they have never met. I chose not to work with any insurance panel. It may not be for every therapist out there but I chose to be an “out of network” therapist. Wow! Scarey!
At first business was slow. My colleagues were getting twice as many clients as I was. My colleagues were also sharing with me their frustrations on all the billing paperwork, re-submissions and phone calls back and forth with insurance panels. I was okay with them having more clients than me. But the tides shifted and in a surprisingly short amount of time my practice was filling up. My practice had, and has, out of network clients.
Marketing, Marketing, Marketing! I didn’t sit back and just wait for clients to come to me. I pushed marketing. I used experiences from past companies where I worked that weren’t even in the mental health industry. Marketing is marketing. I keep my name out there, I’m in the community, I’m on social media, I meet with physicians and nurses and so on. (Let’s see.. last week I met with a psychiatric nurse practitioner and tomorrow I’m meeting with a psychiatrist.) I’ve attended “Coffee With A Cop” meetings where I get to sit with local police over coffee and share what I do. Then everyone I meet with I send a postcard thanking them for the meeting. It’s a high quality postcard with my photo and practice information. My marketing pays off!
When I do have my first meeting with a client I encourage him/her to contact their insurance company and find out what the reimbursement rate is for “out of network” therapy services. Many clients told me their insurance company would reimburse them for part of my fee. Yes, my services would have a higher reimbursement rate, for the client, if I were on the panel but my client would also have restrictions. Many clients found they preferred the openness of my care and getting some or even no reimbursement.
I’ve been providing therapy services for nearly two decades and I have never worked with any insurance panels. I have an appropriate amount of clients, I don’t feel like I’m working an assembly line, and I have a comfortable income.
I feel my way of working with clients benefits them for a number of reasons:
Not all my clients are fee based. I do a certain number of sessions through Give An Hour. Anyone in the military can contact me and request donated sessions through Give An Hour. If I have slots open then that person gets my full attention. I don’t offer less time per session and I don’t limit the number of sessions. When I work with the military through Give An Hour they get exactly the same care, support and guidance as any client in my practice. It doesn’t cost them a dime and I inform my CPA the number of sessions I’ve donated.
It’s interesting that at the same time I had been writing this blog I see that Kelly and Miranda of zynnyme were also writing about insurance panels. Here’s the link to their blog > http://www.zynnyme.com/blog/2015/2/5/how-to-drop-an-insurance-panel . Kelly and Miranda are awesome! They really have insight into a therapist’s business world! Be sure to read what they have to say.
So, I understand working with insurance panels is a personal choice. This was about my own personal experience of not working with insurance panels and how letting my client and I choose their care works.
Therapy in Orange County, California ~
I'm a licensed Marriage & Family Therapist and certified Master Hypnotist who works with individuals, couples and families. I hope I inspire you to take risks and step out of your comfort zone. You might be surprised what you discover.
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Liz Birch, LMFT, CHt
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