If you’re not going to be in-network with insurance companies, you
are actually going to have to do things differently than the hundreds of
other in-network therapists in your area. I know from my own experience
that this extra thought and effort is well worth the pay off, but it
does take some intention and strategy. For me, here’s what the payoff
has been:
- I see only clients with whom I love working.
- I get to do the quality of clinical work I believe in, and offer extra services that I know help the process.
- I limit my caseload to something that is manageable enough for me to also run a second business (Center Institute) and to take every Friday off to be with my daughter.
- I can take time off when I want to and still bring in enough money to pay my salary (and yes, I have a salary from my business, that is totally consistent and predictable).
But there’s more than that. I’ve actually learned a lot about myself
and about what it means to me to be a therapist. In leaving the
insurance networks, I’ve learned that…
- I have to OWN what I do. I have to be able to stand up and say what I do… and mean it–not feel shy about it or be tentative.
- I have to constantly be focusing on doing a great job clinically.
This means making sure I am consistently reading to further my knowledge
about the best clinical care for my ideal clients. It means engaging in
trainings that interest me and are relevant to my ideal clients.
- I have to run an excellent business … which means being prompt and
professional in the running of my practice. It means returning phone
calls as quickly as possible. It means having a professional system for
billing and receipts. It means providing extras in the services I offer.
- People do want to have a choice in the providers they visit. They
are willing to work with someone out-of-network if they are getting the
services they want with a person that feels like a good fit. With so
many high-deductible plans these days, people don’t seem to assume or
even worry about insurance covering services as much as they might have
if they had better insurance. And even my clients with great plans, seem
to feel that working with the provider of their choice is worth the
investment.
- Clients want extra help. They are willing to pay for services that
go beyond the once-a-week therapy visit. And this is not just for
clients who are seeing therapists using a DBT model. This seems to be
true for a broad spectrum of clients.
- Insurance companies don’t know about therapy; I do. Once I stopped
giving up my clinical decision-making power over to insurance companies,
I was free to begin thinking about what made the most clinical sense
for the population I work with. And not surprisingly, clients seem happy
to look to a therapist to help with the treatment plan, rather than
their insurance company.
- Therapy is at least as valuable as other things that people pay for –
massage, acupuncture, naturopathic doctors, vitamins, seeing a
specialist… Well, hey there: therapists are mental health specialists.
- Clients act differently when they are paying for your services; I
began to see this when I worked at an agency where some of my clients
paid nothing to see me and some paid something and others paid a lot.
That is not to say I never had a hard-working, focused, no-fee client,
but the trends became clear over time; when a client was investing
financially in the process, they more consistently invested emotionally
and energetically as well. I’ve found the same to be true in my private
practice.
- Charging a fee for service gets easier over time. I remember when I
first started my practice, I had never had to deal with the money end of
the therapy relationship before. And it felt weird and awkward to ask
for money at the end of sessions. Aside from the fact that I’ve done
away with the antiquated check writing ritual that ends most therapy
sessions (I teach an alternative in the Group Intensive program), I have
found that my own comfort with the exchange of money for the service I
provide has gotten much easier with practice.
- It doesn’t matter what other people in your community are doing if
you do your thing really well and get the word out. When I first started
charging real money for my services, I was constantly worrying about
what other therapists were charging and if I was charging too much or
too little in comparison. I worried that if I charged more than the
“senior” therapists in my community, it would be bad somehow. It turns
out, it doesn’t really matter what other therapists are doing. If you
are providing a useful service that potential clients find valuable,
they will invest in it. I needed to let the clients decide if it was
worth it and stop judging and worrying so much.
What scares or excites you most about the thought of working either in- or out-of-network in your practice? I’d love to hear.
To see what other therapists have already said, see comments at: http://centerinstitute.com/what-i-learned-about-therapy-by-being-out-of-network/