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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.

8 Responses

  1. Aneesa BHimani-Trimble says:

    I’m ready to make the leap into private practice, but keep being told that I need to be paneled to be successful. I really don’t want anyone else dictating care, and this blog spoke to me this morning! Thanks for sharing :-)


    • Evan Center says:


      Don’t listen to all the nay-sayers saying you need to be on insurance panels. You are right to stick to your gut feeling that you don’t want insurance companies telling you how to do therapy. It is totally possible to build a thriving business as an out-of-network therapist. The one thing I would say about that is you WILL need a plan in order to be successful. You’ll need to know who you are as a therapist and who your ideal clients are and then you’ll need a solid marketing and sales plan. And finally, you’ll need to own your value as a therapist. I talked to a therapist last week who is charging $50/ session because they are out of network and they didn’t believe they could get more than that. Not true at all. But you do need to understand the value of what you are offering. Good luck to you and let me know if you’d like any help with a plan! -Evan

  2. Jennifer says:

    You are absolutely right. I recently got off the panels after three years. I should say attempted to get off because it is still a nightmare after many months. Another thing to note is some claims are paid within a couple weeks and others may be paid in180 days or not at all. It is the poorest system for someone trying to make ends meet. You also don’t get the $ for the time you spend on the phone with the companies, being transferred constantly after three months (years) of paying for that client then they stop paying for unknown reasons-claim denied. It is the most frustrating thing I have had to deal with in a professional setting. I am also thriving. I honestly expected to lose half of my clients at least. I only lost about 10%. I was shocked and thrilled but if you have built a name for yourself and are a good clinician, people will seek you out regardless of insurance status. Good luck everyone!

    • Evan Center says:

      Thank you for sharing your story and encouragement for others. I’ve found that now that I’ve figured out the business end of being out-of-network, the biggest thing for me has been to get really clear on how many clients I actually want to see (and what I want to earn) so that I don’t overwork myself. I’ve talked to several therapists who tell me they don’t need any help with their practices because they are too busy with clients already. I hope you’ve found that balance, because the beauty of being out-of-network is that you don’t have to see a kazillion clients a week to make it work financially.

  3. Elaine says:

    I want to add 2 more big IFs about getting private pay clients: If people are referred to you by those they trust, and if you offer something they don’t think they can get under their insurance plans – you need to distinguish yourself. I made the transition 3 years ago, and for me the key was developing a specialty in sex therapy. For the most part, my colleagues who are generalists are struggling to establish a self-pay practice.

  4. […] population. I’d stopped accepting insurance (more on that here if you’re interested – and I’d decided that my ideal clients were teens and young adults whose parents were wanting to be […]

  5. Peg Griffith says:

    Thanks for this post. I am in private practice, with a fully licensed and experienced LPC, but currently cannot join panels (LAPC – 4 months or so to go!) but in a major metro area I am told it does not help at all. Out in the country, where people are poorer, I am told it does help. So I guess it depends on where one is located? But I thoroughly agree with you that being limited to duration, number of visits, and methodologies used is a major inhibition, and makes me hesitant to join a panel. Advice from all welcome. – Peg

    • Evan Center says:

      Hi Peg,
      I agree that it is often much easier to be an out-of-network therapist in a big city – but even that depends on the particular city and the culture/ attitude within that city. I have worked with therapists from large metro areas and from more rural and suburban settings and I’ve found that it can work well in many areas. The real key is making sure that you establish yourself in a way so that potential clients feel it is worth their investment to work with you. That is what makes all the difference – urban or rural.