When starting a private mental health practice, a critical decision is whether or not to take insurance. On the one hand, taking insurance means expanding the pool of people you can help. Many people can’t afford to pay for therapy out-of-pocket. Deciding to take insurance means giving access to treatment to those who many times need it the most. On the other hand, no one just decides to take insurance. Insurance companies get to decide who to sign contracts with. Many times, insurance companies don’t accept new therapists into their networks. Depending upon how difficult it is to become in-network with the most popular insurers in an area, some therapists in private practice may have no choice but to only accept private pay. Regardless of why, deciding to build a self-pay psychotherapy business isn’t easy. How can you do it?
Even though building a private pay business isn’t easy, the principles to follow are simple. They are:
If you are a generalist, it’s very difficult to stand out in the field. Not only are there lots of therapists who will be able to do what you do who also accept insurance, but you will be competing against them for general keywords when people are searching for someone for psychotherapy.
Imagine the first scenario where your website targets things like anxiety and depression. Every therapist in your area will also be offering to help with those concerns. If someone searches for “anxiety therapist near me,” your profile will be competing against every therapist web site in your area. It will be very difficult to stand out. Beyond that, when it comes to marketing, it will be difficult for journalists to find your story interesting and even find you if they are writing a story on mental health. Sending out a press release that announces your new therapy business offering to treat anxiety and depression will be a tough sell, no matter how well written the press release is.
Now imagine a second scenario where you are a psychotherapist who specializes in treating recent retirees. There will be very few, if any, therapists in your area who are also providing your exact services. Note: before choosing your specialization, make certain there are enough people in your area that need that service. Specializing in treating airline pilots in an area without many airline pilots probably won’t be fruitful. Also, if people search for keywords like “psychotherapy transitioning into retirement,” it will be your website that likely comes up at or near the top.
A perfect way to specialize is to attract clients who aren’t native English speakers. If you speak Spanish, Chinese, Italian, French, etc. well enough to conduct therapy, consider focusing your marketing and web site on those people. You might want to make a version of your web site in whatever language you are targeting. Make certain that the quality is high-enough though. You can’t take for granted that people will want to work with you just because you are offering to speak their native language. You want to make sure that you can communicate clearly in writing in that language.
Since cash clients are more difficult to come by, you should be prepared to be flexible when scheduling. Maybe your dream private practice operates Tuesday - Thursday from noon until 4 PM, but you might have to give that idea up early on when building up your private pay clients. If a client can only meet on Saturday, it might be necessary to accommodate. Same goes for evenings and early mornings. Make yourself available.
This doesn’t mean be flexible with your boundaries. If you have a no-show, or late cancellation fee policy, being flexible doesn’t mean not enforcing it. You still need to conduct therapy with the same boundaries and policies you normally would with people using third-party payers.
Being flexible also means offering multiple types of sessions. Maybe some people don’t want 53-minute sessions. Be willing to meet people halfway if you can and offer shorter sessions for a smaller fee. If you really can’t do a proper therapy session in that amount of time, for example if you are doing EMDR, then don’t. But if you can be flexible it won’t hurt to give private pay cash clients more options.
Being flexible might also mean offering teletherapy. Since COVID-19, most therapists have done at least some amount of teletherapy. Heck, some are never going back to in-person sessions. Even if you don’t like doing teletherapy, being flexible for clients who want to pay cash and don’t want to be inconvenienced with driving, parking, etc. will help you and them. Again, only be flexible with this if it doesn’t interfere with your approach. If you are body-centered and being in-person is a pre-requisite for your work, don’t sacrifice that. You have to be true to yourself. But if your approach isn’t impacted by doing teletherapy, try to offer it.
Even if you aren’t accepting insurance, it can help your clients if you are willing to submit superbills to their insurance. For many people, having your sessions count against their out-of-network benefits is an added incentive to work with you. Plus, once their out-of-network deductible has been met, you will be reimbursed at your full fee. This could save your clients thousands of dollars each year and it doesn’t affect your bottom line at all.
What’s good for the goose is good for the gander. We ask our clients regularly to make S.M.A.R.T. goals. We can benefit from the same when it comes to making our private pay business a reality. I know we all studied S.M.A.R.T. goals, but just in case you need a quick reminder, S.M.A.R.T. goals are:
“Specific” means to spell out exactly what you are accomplishing. For example, make a non-English, Chinese version of my web site. “Measurable” means it can be measured in a concrete way. For example, “by translating my homepage and main navigation pages,” is measurable. “Achievable” means it’s possible to do. If you don’t speak Chinese and don’t have a way to do the translation, it’s not achievable. “Realistic” means that you’re being honest with your ability to accomplish the goal in the time you’re giving yourself. The goal has to be considered in the context of the timeframe. Maybe doing the translation in one week isn’t realistic, but maybe doing it in three-months is realistic. Realistic means realistic for you, not for anyone else. If you’re balancing a lot of things, be generous with your timelines. If your practice is your life, by all means be more aggressive! “Timebound” means committing to timeframe.
The final S.M.A.R.T. goal in this example would be “I’m going to make a non-English, Chinese version of my web site by translating my homepage and main navigation pages in three-months.”
Now it’s your turn. Figure out your ideal audience and how you want to specialize. Then start making some S.M.A.R.T. goals to get yourself there.
There’s no need to have all-or-nothing thinking when it comes to your goals. Maybe you are accepting insurance right now, but you want to make a switch. Maybe one S.M.A.R.T. goal is to not renew one insurance contract each year. If you are in-network with five payers, you can then taper your business over five years until it’s completely a cash business.
If you’re just getting started, doing it gradually might mean something else. Maybe it means having a part-time job and reducing hours each time you increase your client base. Regardless of the situation, prioritize what you need the most and work on the most important goals first.