We really have something special going here. If you have a few minutes, please read through my story:
I had felt frustrated working under the paperwork-heavy oppression of managed care companies that took away the time and energy that could have been better used for case-preparation, colleague consultations, and continuing education.
I wanted to give it my all for each client, and even to do so for people who are just calling and looking for a specialist in an area that is not us. I enjoy spending time helping people find the right therapist for their needs, even if it takes me a long time to do. But being as giving and helpful as I would like just isn't feasible under most managed care contracts.
I have learned how to refocus my energies back where they should be. That is, either not on the paperwork, or not on becoming nearly burnt-out seeing so many clients to make up for pay rates that have remained relatively the same since the 1980's (just think about how the cost of living has changed since then, such as with gas going up ~275%!). I believe I must lead the balanced life that I endeavor to help my clients find. Appropriate self-care is the first order of business in caring for others. I like the analogy of flying on an airplane, for even a parent needs to put the oxygen mask on his or her self before helping his or her child put one on.
How do we achieve proper self-care in this field that is dominated by HMOs? Though the bulk of the answer is revealed only to those who join us long-term (or those who see us for our Psychotherapy Business Coaching), I will reveal a small sampling here (there are so many ways that we can find comfortable ways for each unique practitioner, but the below does give an idea):
I. Better assessments produce better therapy, so do an assessment for everyone: A Jay Haley therapy tape in the 1980s said, "In order to end properly, you must begin properly". The context here is different, but the statement remains the same: Especially in family therapy, but is also sometimes/often true for individual therapy, we can better understand the identified client by understanding the whole family, rather than just that single client in isolation, or hearing about the family members in only that one person's view. I often ask clients if they would like a more thorough evaluation as the basis for the therapy. What I can then do is to meet with each family member separately, learning about each of them, in order to see the whole [family] picture, rather than just the piece that is the identified client. This means billing for a 90791 for each person seen & assessed (as of the time of originally writing this page, the most I did was 5). I have been doing this for years, and as an added bonus it makes it easier for other family members to be involved when helpful. It also makes the whole family more comfortable with you than if you are just a name to them. Remember, this tip is only one of many strategies we have that can not only earn you more money without necessarily costing your client any more co-payments, but can also improve your ability to offer them the most comprehensive and effective treatment possible.
II. Do better out of the panel, than in: We have found that there are insurance panels that pay much better (as much as 300%!) out of the panel, than in, plus some panels no longer require, or make requirements less stringent, to do OTRs when you are not in their network. We have charts of the rates for several plans out-of-network versus in. We even have special strategies for how to make each panel work well for you and your client.
A. Blue Cross: When not in the panel, many plans set the pay rates at a percentage of “reasonable and customary”. This will net the provider far more money per session in the long run, even if you fully waive the entire deductible (Blue Cross stated that if the provider is not in-network and wishes to make less or no $ for the deductible period, then they can do so, though note that there may be significant legal difference between a sliding-fee-scale, forgiving balances due, and fee reductions on conditional waivers). We've found many Blue Cross Plans in the area with a mean deductible of ~$350, and then pay 80% of reasonable and customary, which works out to ~$100+ per session paid to you by the insurance! At the reasonable and customary rates, the bulk of the deductible is paid off within the first two sessions (the allowable rate is even higher for 1st sessions), and then you earn between $24 and $38 more per session than in-network if you are to be philanthropic by waiving everything in excess of a co-pay or any amount, less the co-pay listed on the card for in-network services. Or, if you prefer to charge the 20% difference, then you’ll make ~$150 per session, as clients pay you what amounts to be about $15 more than what their regular in-network co-pay is already! You also have the option of balance billing when out-of-network, which would allow you to make a normal professional wage for your level of education and experience as a medical provider. By making more per client, you can pace yourself by seeing the ideal number of clients per week that allows you to lead a balanced life and do all the case preparation you would like. This will result in better focus and attention to each client; therefore you will be able to do an even better job than you are already doing.
III. Use our marketing materials, combined with the good name of the practice, to get more cash paying and "insurance assisted" (rather than "insurance-locked") clients. This means absolutely little to no insurance paperwork, again allowing you to focus on the therapy instead of the bureaucracy.
This chart explains our practice, with finalization of benefits according to contract:
Frequently Asked Questions:
Practice FAQ (please also read prior to an interviewing)
Please contact Sam.Schaperow@gmail.com for more information. 860-447-2047
(information on this page is accurate as of its writing; please contact us regarding any potential changes caused by he insurance system)