Why being in-network is NOT a good idea in Private Practice
I am in the middle of a saga with Blue Cross Blue Shield right now (more about that in a later newsletter; be sure to get it by signing up here) and it made me think about how grateful I am to be in the position I am right now AND about the biggest mistake I ever made in private practice. And because I eventually figured out how to run a rock-solid private practice through making mistakes and having to self-correct, I now teach therapists how to skip the mistakes and cut directly to doing what works. Part of how I teach this is through sharing my own experiences. So, today, I thought I’d share with you this huge mistake I made.
Back when I started my private practice, I signed up for every insurance panel I could find. I figured that if my services were pretty much paid for, people would have no objections to seeing me as a therapist. Besides that, I was a semi-experienced therapist and did solid clinical work. I was right in some ways; potential clients who called me, pretty much always ended up working with me. But the positive aspect of being an in-network therapist ended there.
In the end, it turned out that being in-network had far more drawbacks than positives (and this is being reaffirmed right now as BCBS of Montana is asking in-network therapists around the state to pay back significant portions of reimbursements that BCBS issued from July 2013-July 2014, but more on that later). The drawbacks for me of being in-network were:
- I had no control over what I charged for my services (and when a few years ago the reimbursement rate DROPPED, in-network therapists had absolutely no say in the pay-cut they received).
- I could not effectively charge or collect fees for additional therapeutic services I knew were key to patient progress (i.e. coordinating care with their other providers, phone support, etc).
- I was sometimes limited by the number of sessions I could have with a client in a calendar year.
- I was always limited on session length (which didn’t work so well if I was doing EMDR with patients).
- It was hard to collect fees for last-minute cancellations or no-shows, and impossible to collect from Medicaid patients who were my most frequent no-show clients.
Not to mention that being in-network and listed on insurance websites did not = adequate marketing. So my actual flow of potential clients was inadequate to say the least.
But that is all ancient history now since I left the networks almost three years ago and my business is going better than ever and I think my clinical work is much stronger now than it was when I was allowing myself to be told how long sessions could be, how many I could do and what other services I could offer by people who never went to grad school to be therapists.
Stay tuned for the details on this crazy saga with big ol’ BCBS.