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. 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.
I understand working with insurance panels is a personal choice. This was about my own personal experience and how letting my client and I choose their care works.
3/7/2016 07:59:02 pm
3/2/2017 07:54:04 am
Thank you so much for sharing this. I've just started my private practice and within only one month I'm feeling the pressure to get on panels. I feel exactly the way you do. I want my business to thrive but I do not want to become a robot.
Hi Terri, I'm glad you found this article helpful. I have made a few changes since I wrote that, which was about a year ago. I have added just a couple insurance companies. I am mainly cash based but I use insurance to fill in my gaps. I'm at about 75% cash, 25% insurance. I find it a very nice blend. ~ Liz
3/2/2017 09:35:39 am
Interesting! may I ask how that experience has been for you? Which companies did you contract with?
Hi Terri, I currently work with Cigna, Tricare and CalOptima/Medical. I can't imagine working with any more and I don't understand how other therapists work with a long list of insurance companies. There's a lot of added work with insurance companies, i.e. treatment plans, discharge summaries, must diagnose, then to bill them is added time and you only get about 60 - 65% of your regular fee. BUT, as I said earlier, it's nice to fill in the gaps with insurance clients. The insurance companies I work with continually send clients to me which is nice. If I were to rank my 3, Cigna sends me the most, then CalOptima/MediCal and TriCare has really slowed down. I wish you much success and feel free to reach out to me with any questions. ~ Liz
3/10/2018 08:38:51 am
I didn’t realize you could do both! That’s a good idea. :P
5/4/2017 11:35:47 pm
Thank you so much for this gift of wisdom. As a recently licensed LMFT in Calif, I feel the pressure of getting on panels. Your article has relieved the pressure and reminded me that it's not a requirement, but an option and that I need to focus on my own goals in my practice, not what everyone else is telling me to do, like, "get on insurance panels!" I also sent you an email. :) thanks again.
I'm glad you found this article helpful. Being a new therapist can be daunting. Don't feel pressured to get on insurance panels. You have to wait at least 2 years anyway before any insurance company will consider you. Focus now on marketing. Search other therapists in your area and invite them to lunch. Share your experience and you can learn about their practice. I do that when ever I can and I've referred out to others (who are a better fit for my client) and they refer to me. I've also sent postcards to local Drs offices and I've personally met psychiatrists. Especially psychiatrists who don't take insurance. Create a web page! I have a great marketing guy who created my logo, designed my business card and can even sent out tweets for me if I need him to. (Let me know if you need his info.. he's very reasonable). Get your name out there. Best of luck to you and feel free to reach out to me with any questions! ~ Liz
2/16/2021 10:47:23 am
Hello can you please provide the information for the person who created your logo. Thank you for all of the wonderful formation.
2/16/2021 12:26:06 pm
2/26/2018 09:37:13 am
3/10/2018 08:37:59 am
Hey! Thank you for this post, I am about to enter into the realm as a psychotherapist and huge concern of mine is making $60/hour doing the work we are doing. It’s grueling. I’m curious in your current line of practice, how much income to expect with your aptitude, drive, and understanding of marketing. I believe I will be an out of network provider and liked hearing that some insurance will do partial coverage. But like I said, I don’t want to do this line of work making what the average salary of an MFT, or school counselor makes. I’m willing to work hard, but I’m also not willing to work for free. Curious the salary of someone with a built clientele that you have, owning your own business and how many years that took. Also I’m curious how many clients you see a week this way. Are you working 40 hours?
10/17/2019 03:14:45 pm
Can you please tell me if Associates are allowed to accept insurance and, if so, which insurance plans allow for Associate MFTs? Thank you! Colette Craig
3/25/2021 11:47:38 pm
Hi Liz, Thank you for sharing your journey. I've been searching for some time on this particular topic: private practice providers and insurance woes. Ironically, I'm in the complete opposite situation as I'm a seasoned biller/coder but will be sitting for my LMHC exam soon, pending covid19. I've since been reaching out to PPP, offering billing services but haven't had much luck. I currently have 2 therapists I bill for, and although word of mouth is helpful, the competition is fierce. Any suggestions on how to grow my network? Thank you graciously for your time and I look forward to hearing from you soon.
3/27/2021 01:21:29 pm
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