One of the most common questions that private practice therapists ask me is “How do I get off of insurance panels?” This question just came up today in my Private Practice Toolbox Facebook Group so I thought it would be a great topic for a blog post.

In previous posts I’ve written about why I broke up with managed care (part 1) & (part 2), but this post will focus on how to do it.

The thought of letting go of the comfort of being on insurance panels can create a lot of anxiety for private practice therapists. After all, if we don’t have clients, we don’t get paid. Find comfort in knowing this equation. You only need about half the number of clients in a self-pay practice to make the same income (or more) than you made in an insurance based practice. Once I realized this fact, I felt a lot more comfortable resigning from insurance panels. Let’s do the math…

Are you unsure about how much to charge for psychotherapy in private practice? I’ve blogged recently about signs it’s time to raise your fees and how to talk to your clients about raising your fees, but what about setting your fees in the first place?

One thing to consider in setting your psychotherapy rates is what other therapists with equal experience and training are charging. While average fees vary greatly depending on your location, your degree, level of experience, and many other factors, I thought it would be fun to poll who read this blog so you can see where you fall on the continuum to give you a general sense of what other therapists are charging.

Last week I blogged about 5 signs that it’s time to raise your fees. Once you’ve decided to raise your fees, the next steps are notifying your clients about this change, explaining your rationale and preparing to manage your client’s varied responses. During my 10 years in private practice I’ve raised my fees three times. I’ve also consulted and coached many therapists on how to handle fee raises.

Here are a few tips to help you feel more confident talking to clients about increasing your psychotherapy rates.

1) Raise your fees at milestones

I’ve found that it’s easier to tell clients about a fee increase around natural milestones such as the beginning of a new year, the beginning of summer, or the beginning of a new school year. Professional milestones such as a new degree or certification are a also a great time to raise fees.

It’s common for therapists in private practice to have anxiety around money issues like how much to charge per session, how to ask clients for payment, and when to raise your fees. Getting comfortable talking about fees with clients is crucial to private practice success.

After all, you own a business. In general, I think therapists charge too little for their services.

Several years ago, I resigned from managed care and I raised my psychotherapy fees at the same time. Fortunately, my practice didn’t suffer financially from those decisions. What surprised me most about raising my per session fee was that the perceived value of my services went up. “You don’t take insurance and charge a lot? You must be really good,” was a sentiment that I heard frequently from potential clients.

Interestingly, I’ve found that clients tend to invest more in the therapy process because they are investing more money out of their own pocket for treatment.

A common private practice question is whether a therapist should join a group practice or venture out on their own as a solo practitioner. The answer is different for everyone depending on your strengths, goals, personality, financial needs, and many other factors.

There are also other options in between solo and group practice, like sharing an office space with other practitioners while maintaining your own practice. “There are numerous ways of forming a group practice including cost/office sharing, partnership, and employment as associates under a licensed provider,” according to Kansas Psychologist Wes Crenshaw PhD, ABPP of Family Psychological Services, LLC.

To help make your decision easier, here are some of the benefits and drawbacks of joining a private practice group.

Hiring an office employee, especially if it’s the first time you’ve done so, can feel scary, overwhelming and stressful. Where do you find trustworthy employees? How do I know they’re doing the billing correctly? Isn’t it less personal if clients have to talk to someone other than the therapist?

Many therapists in private practice are reluctant to hire office support for a variety of reasons. The two most common reasons that I hear in my consulting practice are: 1) cost – “I don’t want to pay out more money” and 2) control - “I don’t want to give up control.”

I had to overcome these two common barriers before I hired my first office manager.

Continue reading… »

(cc) photo by khawkins04

Last week’s post How To Get Paid For No Shows prompted some excellent discussions and follow up questions about how to enforce cancellation and payment policies. One comment in particular, posted by “Paul” brought up a valid concern.

Do your policies go both ways? How do you handle the situation when you, the therapist, no show for a session due to a scheduling error, inadvertently double book a session, or cancel a session at the last minute due to illness? Here’s what he wrote: