Several months ago I wrote a post titled, "Why I Broke Up With Managed Care" that stirred up some passionate discussion! While I understand that it's not the route for every private practitioner, I have continued to build a private practice free of managed care and recently hired my 12th therapist.
While we don't bill insurance directly, we do give a superbill to clients so they can seek reimbursement from their health insurance so they can still use their benefits. As I've continued to write this blog, I've come across several therapists who have also "broke up" with managed care and asked them why they decided to build a fee-for-service therapy practice. Here's what they had to say:
Increased Reimbursement Rate
I've been in private practice for over 15 years. So, I experienced the first major transition of health care to "managed" care. I had friends and colleagues who began working in the managed care industry, and it quickly became clear to me that despite all the rhetoric about the necessity for evidenced-based care (which can be a very useful model of care), managed mental health care was really about making corporate the work of individual psychotherapists.
I also did the math. The last time I checked, insurance reimbursement was the average rate charged by psychotherapists in the 1980s. Today, I can afford to have two additional office hours available for new clients, by taking just one fee-for-service patient. This also allows me more discretion in seeing clients who are needing a low fee. Will Courtenay, PhD, LCSW "The Men's Doc"
Control Over Therapeutic Work
I wanted the freedom to determine, along with parents, the course and length of treatment and felt managed care would impede on that. Pam Dyson, LPC, RPT
My training is in social work, which is the source of the old adage "start where the client is at." That's my barometer for treatment, not where an insurance company believes my client and I should start or end our work. Will Courtenay, PhD, LCSW "The Men's Doc"
Increased Client Commitment to Therapeutic Process
Being a Christian counselor, by law I cannot bill insurance, even if I could I think private pay gives each person responsibility in the therapeutic efforts. When people have to pay it makes them take their therapy more seriously. Natalie Davis
No Diagnosis Required
My services are specialized in that I will work with children as young as three, something many therapists in my area will not do. The problems child clients present with are often not clinical but rooted in the parent-child relationship. I feel strongly that young children do not need a diagnosis on their permanent health record. Pam Dyson, LPC, RPT
More Time With Clients (Less Time Doing Paperwork)
I had worked in a managed care setting in the past, and I decided that in my practice that I want to avoid the incredible amount of paperwork, defending sessions, and over-diagnosing. I also think it provides clients with more privacy. Sara Levitsky, LMSW, Birmingham Counseling For Women
Paperwork was the other major decision (in building a fee-for-service practice). I put a great deal of time and energy into my work with clients outside of our scheduled hours, including receiving professional consultation on a consistent basis. I have no time or patience for administrative busywork. Will Courtenay, PhD, LCSW "The Men's Doc"
More Flexibility To Offer Reduced Fees
Like Dr. Courtenay mentioned earlier in this article, when his practice is doing well financially, he has more (not less) time to devote to seeing clients at a reduced fee. I have found the same to be true. As my practice grows I am able to offer more free community workshops and do more pro bono work.
Do you run a fee-for-service mental health therapy practice? What led to your decision?
You're in the mental health field because you want to make a difference and make a living, right? Technology and new media now allow therapists to educate and interact with worldwide audience and to talk directly to 
“Who do you want to work with?” was the question I asked workshop participants in a recent private practice workshop at a local university. For many workshop participants, this was the first time they’d ever even considered asking themselves which clients they wanted to see in their clinical practice.
Shrinking funding, crowded managed care panels, and a saturation of therapists have left private practitioners feeling desperate to fill their schedules with anyone who is willing to see them. However, based on my personal experience of nearly a decade in private practice, “Who do I want to work with?” is one of the most important questions a clinician can ask themselves.
As healers, we genuinely like to do our work. Guiding clients through the therapy process and seeing them make progress is why we do what we do. But if you're in private practice, you know there's a lot going on in the back end and that it's crucial to run an efficient and organized business.