Center Institute

What I learned about therapy by being out-of-network

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.