What should you know before choosing insurance or private pay? How do insurance panels decide who gets accepted? Why is it crucial to ask, “What does my market support?” when expanding your practice?
In this podcast episode, Brandon Shurn offers you critical questions to answer on expanding your practice: will you be private-pay or insurance-based? | Part 2
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In This Podcast
- Insurance basics
- Private pay pros and cons
- Advice to listeners
Insurance basics
There are lots of things to know about insurance, including the fact that you may apply to be on an insurance panel, but you could be declined by the company
One of the primary reasons that an insurance panel would decline to allow you and/ or your practice onto the panel is because they have enough of that particular type of provider. (Brandon Shurn)
Some of the things that you would need to consider if you are an insurance-based practice are the following:
- The reimbursement is dictated by the insurance companies
- To an extent, you can benefit from built-in marketing by being listed as an in-network provider with that insurance company
Private pay pros and cons
On the private pay side, most of it seems to be positive because you get to set your own rates … which is in stark contrast to the reimbursement or the rate being dictated by the insurance company. (Brandon Shurn)
With private pay, you have a lot more agency in the fees that you can set for yourself, your staff, and the practice in general.
You can have a flat-rate or offer tiers or a sliding scale, depending on what you envision for the practice as well as your clients’ affordability.
However, you may spend more on marketing, because you won’t benefit from in-network marketing with insurance companies. Therefore, it is up to you, because there are pros and cons either way. It depends on what your goals and preferences are.
The biggest thing that you want to ask yourself is, “What does my market support?” Take an inventory, especially if you are in a physical location. That means you have a geographical reach, or sphere … around your practice, where people are willing to come and drive to your practice. What does that market bear? (Brandon Shurn)
Advice for listeners
If you want to be private pay, check the pockets in your area, whether you are virtual, hybrid, or physical. What does your customer base prefer, what do your clients need, and what can they afford?
If you are leaning towards insurance, check which panels you want to be on and how much their reimbursement rates are, because you want to be on panels that reimburse you an amount that makes it worth the potential hassle!
Check out these additional resources:
- The Importance of Saying “Yes”to the Right People with Liz Frost | GP 292
- Practice of the Practice Network
- Group Practice Launch
- Group Practice Boss: www.practiceofthepractice.com/grouppracticeboss $149 a month
- PoP Group Practice Owners Facebook Group
- Free resources to help you start, grow, and scale
- Work with us
- Practice of the Practice Network
Meet Prof. Brandon Shurn
Brandon Shurn, Ph.D., LCPC, LMHC, AFC®, NCC, is a licensed clinical professional counselor and the founder of EmPower Me Holistic Counseling, a fully virtual Maryland-based practice. He’s also a full-time professor in Seattle University’s online Clinical Mental Health Counseling program. With extensive experience launching and directing university training clinics, Brandon now focuses on helping therapists design and grow impactful, sustainable practices. Outside of his work, he enjoys fitness, yoga, Wing Chun, golf, reading, and spending time with his family and dogs. Visit Empower Me Counseling, and connect with Brandon on Instagram and LinkedIn. Email him at: [email protected]
