Cultivating success in private practice (w/o insurance)

Mental health clinicians are burning out at an increasing rate.  There are more reasons for this burnout than I could begin to capture in this post but suffice it to say, there’s a lot of overworking and unnecessary bureaucracy behind the scenes of every employed job.

As one case among many, I experienced burnout after just three years working for major hospitals.

Therapists, counselors, psychologists, and psychiatrists find different ways to cope with their burnout. For me, I had to completely reset by getting out of the system that caused it. I left my last hospital position in 2014 to launch my private psychiatry practice; it grew into Mindful.

Launching a private practice requires making many hard decisions. One thing I knew: to avoid any more burnout, I had to increase my time doing actual patient care. This required reducing the number of hours I spent pushing papers.

Among my decisions, I had to choose whether or not to accept health insurance at my own practice. I chose not to accept insurance (and haven’t regretted that decision) while all around me, mental health clinicians are bombarded with unreasonable documentation requests, shrinking reimbursement, and worse:  almost no independence or autonomy in their daily schedules.

My choice may seem controversial and unusual, it bears explaining. Here’s why I believe cultivating success in private practice means choosing NOT to accept health insurance:

Insurance Companies Take More than They Give

Insurance companies are businesses. We can’t blame them for trying to make money. But it’s important to distinguish their role in a patient’s wellbeing. Priority #1 for insurance companies is paying their shareholders, plain and simple. Their interest in customer wellbeing comes second at best.

In a free-market society, the health insurance company wants to retain customers while spending the least amount of money on their customers’ healthcare needs.  The result:  they are incentivized to keep premiums from patients/clients and not pay them out (not even to well meaning therapists.)

Worse, our health finance system rewards procedures (cutting, sewing, inserting) over non-procedures (talking, advising, coordinating).  The result:  those in the “talking” professions are reimbursed at an even lower rate than is necessary to keep your practice running.  

Insurance companies take more than they give:  they take your means of creating a livelihood and give you less flexibility to meet your patient where they are.   

Accepting Insurance Raises the Prices Charged to Non-Insured People

Biz Accounting 101: Income must exceed expenditures.

When a business takes on a new expense, it must ensure the additional cost is still exceeded by money flowing into the business. Sometimes that means cutting other expenses or raising the price of a good or service.

If you panelled with insurance companies, you’re not allowed to raise rates for one party (the insurance company) and keep costs down for someone else (a non-insured payer). There are some wiggly rules for sliding-scale and “pro-bono” but if you don’t get just the right mix (and have really good advice from legal counsel), you could be charged with insurance fraud.  

In order to maintain control of costs and quality for patients and staff, I don’t accept insurance.

Insurance Locks You In or Out

While there are some laws against insurance companies withholding care from patients with preexisting conditions, it doesn’t entirely stop that discrimination from happening. Insurance companies maintain the ability to approve or deny reimbursement for charges of work you’ve already done. 

Insurances companies are private networks with exacting criteria. They  lock people out who need a certain type of care by finding loopholes through obfuscation. In other words: they are intentionally vague about their criteria for coverage.  They leave themselves an out, often as a clause stating that if you as the clinician don’t dot just the right “i” or cross the right “t”, they have the right to come back and request a refund.

Instead of jumping through all the hoops and confusing financial mess to determine what services are or are not covered under someone’s insurance plan, I post my prices online.  Cultivating success in private practice means transparency:  be upfront and honest with you potential clients and let them know the investment they are making in their own mental health. 

By avoiding insurance companies in private practice, you can be transparent about pricing, collaborative with patients, and straightforward about what’s possible.  That way you’re never locking patients out of the care they need.

Insurance is a Bet Against Yourself

Fear of the what if’s is one of the biggest reasons people buy insurance, despite our collective health being better than any time in history. The thought of disaster terrifies us, and buying insurance is a bet against our fear.

At Simply Psych, we believe that “everyone should have a therapist and every therapist should have quality help.”

We provide the administrative, operational, financial, and marketing support for mental health practices because we recognize that cultivating happy therapists support happy clients.

We’ve entered a new era.

Mental health is more important than ever and for the first time in decades, we’re talking about mental health in an open and accepting manner.

America (and subsequently the world) needs a strong safety net of refreshed, thoughtful, and savvy mental health entrepreneurs to meet the growing need.  Simply Psych exists to scale each private practice, reconnecting therapists directly with the people who need them.

Join the growing movement of happy mental health clinicians.