The Great Debate Over Insurance

In guiding people towards the life-changing work of TPA, I’ve spoken with over 2,500 psychologists and wellness professionals over the past 7 years.

By “spoken with”, I mean a proper, ~45 minute meeting where we discuss, in detail, all aspects of their practice:

• Are you only performing individual sessions or do you also host small groups? 
• What demographics do you see the most of?
• Is your location urban? Suburban? Rural? Telemental?
• What is your private pay rate? Does your intake process differ? 
• Everything else about their practice you could imagine

That is a LOT of conversations with practitioners in need. 

Think about how much you would learn speaking for nearly an hour with over 2,500 people in the same field, with similar issues and desires. 

Obviously, if I’m speaking to a practitioner, they need help. Their practice isn’t perfect and they’re not where they want to be.

Sometimes, they begin venting. This is a natural part of the process. 

One topic that comes up time and time again involves frustration with the insurance panels. 

“I am so tired of the insurance providers” – a statement, in various incarnations, I have heard more times than you can possibly imagine. 

You hear complaints about the different providers at various levels of intensity, and certain patterns emerge. 

For example, BCBS tends to reimburse more (not always, but often), whereas Cigna and Aetna tend to reimburse less.

Tricare pops up a lot around military bases. Medicare / Medicade reimburse next to nothing (much like the dreaded EAPs). 

Regardless of the specific details (about the panel in question), fundamentally, the complaints are almost universal:

1. “I’m never reimbursed anywhere near my full rate and I can’t afford to go on like this”
2. “Even though I have my own practice, by taking insurance I feel like I’m still working for someone else”
3. “I hate having to diagnose clients” (because the diagnoses can follow the client for the rest of their lives)
4. “I hate how clients are limited in how many times a year they can see me”
5. In general, “Dealing with insurance is such a headache”

So with all these complaints, and as common as they are, why do practitioners still feel the need to get paneled? 

In my experience, this boils down to two core issues:

1. Morality around not accepting insurance
2. Fear that without accepting insurance, there simply won’t be enough calls / referrals to keep their practice alive

The second of these issues certainly makes sense on the surface. Considering that practitioners are taught absolutely nothing about how to grow a booming, successful practice in grad school, AND the fact that 80% or more of the calls that come from listing services like Psychology Today ask “Do you take X insurance?” (and then hang up if you don’t), seems like it would be wise to get paneled with everyone possible, no? 

The first of these issues, the morality piece, also makes sense on the surface – if you only accept clients at your private pay (self-pay) rate, surely many won’t be able to afford you, yes? 

What if I told you that if you actually have your practice growth process in place – a process that is dialed into your particular needs, in your particular location, centered around your particular modalities – that you can have plenty of self-pay referrals? 

An average individual practitioner typically wants 20-30 weekly sessions at their proper rate – that’s often 0.0001% of the population in the area around their office (and even less than that if leveraging remote help, telemental, and so forth). 

Do you really think it’s impossible to get 20-30 weekly clients, in a target area that contains tens of thousands, hundreds of thousands, possibly even millions of people, that will self-pay? 

Not only is it possible, it happens all the time.

It only feels impossible because most practitioners are walking around blindly in the world of practice growth and attracting good fit clientele. Thus, practice growth remains a great magical mystery, and half of what is regularly relied on is overcrowded listing services that act as “doctor-shopping platforms” for clients. 

Hence all the “Yes, do you take X insurance? No? Ok thank you <click>” referrals received. 

Therefore, no, you do not have to rely on insurance panels for practice growth. You can de-panel or, if new, bypass them entirely. 

As such, if your practice growth technique is: 

1. Pass out business cards
2. Cold call doctors and beg for referrals
3. Get on all the saturated listing services
4. “Do a good job and hopefully over the next 10 years people will hear about you”

…and other forms of what I like to call “hope-based marketing”, then yes, I recommend you get on every panel you can, suck it up, and march forward. 

However, if your practice growth technique involves

1. Proper metrics
2. Proper market analysis
3. Proper tracking, both financial and marketing
4. A modern, known-good, individualized approach to practice growth using the latest tools and techniques technology has to offer

…aka everything we include in the Therapy Practice Accelerator process, then you can absolutely choose to be self-pay and enjoy a booming practice free of the headaches and hassles of the average provider. 

Regarding the other issue that keeps people stuck on the panels, the illusion of morality – did you ever think about this? 

Say you have a target of 25 weekly clients and you get to 20 motivated, dedicated weekly clientele paying your full rate. If you do the math, that’s likely 2-3 times (or more) the monthly income of that same number of weekly clients were they leveraging insurance. 

With just those 20 clients, you are now earning FAR more than you did previously (maybe $10,000/mo, maybe $15,000, even $20,000+) – you can now afford to take on 5 (or more) weekly clients PRO BONO, if you so chose. 

Meaning, not only is that moral, you’re saving those clients:

1. The cost of their copay
2. The cost of any deductibles they might have
3. The general headache of dealing with the panel itself

Therefore, if you have proper, modern, tuned marketing systems in place for your practice, and you choose to target private-pay, you can earn more and give back more than ever before. 

If you so choose. The choice is, as always, up to you.

If you’d like to discuss creating this level of freedom for your practice, book a call with one of our practice growth specialists today.

-Victor