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Hey everyone, welcome back. Today is another episode in the ongoing series of our private pay transition process.
If you haven’t checked out the first episode, definitely go back and look that one up. It was, I think, published in late January 2023. Today is the second episode in the private pay transition [00:01:00] series, and this is just my attempt to chronicle in near real-time my practice’s journey as we try to move away from some insurance panels. We’ve taken insurance for nearly 15 years and we are ready to drop some of those panels because it’s no longer sustainable.
So today I’m talking about some concrete actions that we took to move the direction of private pay. And if you didn’t hear in the first episode, I’m using the stages of change model to describe this process. Last time I talked about pre-contemplation and contemplation. Now we are moving a little bit into preparation or determination, and we’re starting to take some small steps. So listen in. I hope that you take a lot away from this episode.
[00:02:00] Okay. Let’s dive into this process. So this has been very interesting to have this meta-observation going on as we do this private pay transition, knowing that I’m going to try and translate this into podcast episodes. We’re moving throughout the process. We’re going through our stages of change.Today, I’m talking about the preparation/determination stage, which is described as “this is taking small steps toward behavior change and believing that these changes will lead to a healthier life.” Well, I think this totally fits where we’re at as a practice. I absolutely believe these changes will lead to a healthier practice.
So what steps did we take? [00:03:00] There are seven steps that we took, probably more than that but I have tried to distill them into digestible bite-size steps. So I’ll run through those and give you some insight into how we are going about getting off these panels.
As I said in the previous episode, we have already gone through the process of deciding we’re going to do it. Now we’re actually doing things to move in that direction.
First step, I contacted our insurance panels to figure out the contractual obligations and process for terminating our contracts. If you don’t know about this, insurance contracts are relatively or can be relatively difficult to get out of or terminate. So to avoid any strange retaliation or, I don’t know, the insurance panels [00:04:00] not sending people to us over the next few months before we depanel, I framed it as if practitioners were leaving our practice and we just needed to terminate their contract.
So I reached out to our provider reps for each of the panels and asked how we might terminate a contract for a practitioner who was no longer practicing with us. One thing that emerged that many of you might know, but it’s important to provide clarity here is that many insurance panels require a 90-day notification before the contract can be terminated. So if you are thinking about getting off insurance panels, give yourself at least three months lead time because you can’t just drop a panel and then stop taking their patients the next day. That’s a violation of the contract.
One interesting note here is that at least one of our panels specified that we were contractually obligated to continue [00:05:00] seeing their clients as in-network even when we were outta network unless we provided referrals to providers who were actually in-network. Let me say that again. One of our panels contractually obligated us to continue seeing their clients as in-network at the in-network rate unless we provided referrals to providers who took that insurance. So this is just a note that you’ll want to start developing a really nice referral list of folks who are in network with the panels you’re going off.
The second step that we took was that we set a stop date of July 1st, 2023. This is the date after which we are no longer scheduling clients with those insurance panels, or we’re happy to schedule them. They’re just going to be private pay. So this gave plenty of time for our [00:06:00] administrative team and clinical team to adapt to the news and strategize a bit.
We also picked July 1st, at that point, it gave us 6 to 7 months lead time, maybe more, maybe 8. It helped our current clients who were already scheduled, as I mentioned, and I think like a lot of you, we are booked out I think almost a year for evals. So this gave us at least the 6, 7, 8 months lead time to practice good client care and not surprise people with this news when they have already been on our waitlist for quite a while. So, some of you may say this is too much lead time, but like I said, we wanted to balance client care with the financial benefits of going out-of-network work.
The third thing that we did is that we strategized how to handle the clients who were scheduled out past the stop date- so anyone scheduled after July 1st. [00:07:00] In our case, we decided to prioritize these clients for cancellation spots over the next few months. So basically between January and July, any cancellation spot would be prioritized for the clients whose insurance we were not going to accept any more.
So we put those folks at the top of the cancellation list so that we could still accept their insurance and would be able to honor the original pledge that we made when we scheduled them, which is that we were in network.
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All right, let’s get back to the podcast.
The fourth thing that we did is we put more time and energy into the out-of-network or private pay billings SOP. SOP stands for standard operating procedure. We have quite a few SOPs on the billing side, and we certainly have a phone script like I’ve talked about before on the podcast. So we put more time and energy into developing that private pay billing SOP.
The big concern here was just making sure our admin team wasn’t apologetically offering out-of-network services. That can be a concern when the admin team assumes that people want to use their insurance and the way that they talk about private pay is [00:09:00] is apologetic like it’s a lesser than option. So we tweaked the phone script and just made sure that it was really dialed in and played up the benefits of going out of network or private pay and help them become a little bit more of a salesperson on those calls to really communicate, again, the advantages and benefits of private pay and making sure it didn’t sound like it was a less preferred service.
We also trained them on the details of out-of-network billing and what that entails. For our practice, we decided to continue offering benefits checks, and out-of-network claim submission to reduce the friction for private pay clients and make it appear as close to in-network as possible.
A lot of folks who do private pay will provide superbills. That’s totally fine. There are services out there now that help [00:10:00] clients process superbills and get reimbursed, but we chose, again for client care, to continue to treat out-of-network clients identically to in-network clients and that we’re still going to do benefits checks and claim submission, and then just make sure that the claim submission is set to reimburse the client instead of the practice because the client is going to be paying us directly. So any out-network benefits that they have will get paid directly to them as a reimbursement.
The next thing we did is that we walked backward from our stop date to determine when to formally terminate the contract. So, we set a reminder on the calendar. This will be on April 1st. That is when we will send out, well, in some cases, it’s send an email, and in some cases, it’s login to a portal, but that is when we will be sending the message to terminate our contracts and start the clock ticking for that 90-day [00:11:00] waiting period.
The next thing that we did is that we have started prioritizing scheduling for out-of-network or private pay spots and our contracts that pay our private pay rate. So as soon as was feasible, we had our testing clinicians open one spot a month for contracts and private pay evals so that we can give those entities a little more VIP treatment. They can get earlier appointments and increased access so that there’s a little more of a benefit to going private pay. So this is just a clear big investment in building these non-insurance payer sources and making sure that they feel taken care of.
The last thing that we did that I’m going to talk about is that we set a [00:12:00] ROCK in EOS language, so a quarterly priority to monitor some key metrics to track the impact of going private pay.
The two things that we’re looking at are the conversion rate from our phone calls and the percentage of private pay clients. So between those two metrics, the hope is that we will keep a finger on the pulse of this change and we’ll be able to track the impact. So we’re keeping a close watch to see if our conversion rate is going down now that we are not taking as much insurance. And of course, we’re looking to see what percentage of our clients are private pay clients.
So those are, like I said, a few concrete steps that we have taken. They’re happening. They’re in the works except for the ones that have to happen in the future, like the actual termination of the contracts. But these are just some things that we [00:13:00] are doing. If you’ve had this experience, I’m curious. I would love to hear any comments about other action steps and things to do as you are going off insurance panels, but this is where we’re at as a practice.
Stay tuned as I keep talking about this process. The next episode, I’m guessing will happen after our contract termination date. It’ll be sometime in April as we quickly approach our stop date of July 1st. I will check back in with you with any updates moving on through the stages of change from preparation or determination to action and let you know where we’re at.
All right, y’all, thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed [00:14:00] in the show notes, so make sure to check those out.
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And if you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development: beginner, intermediate, and advanced. We have homework, we have accountability, we have support, and we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you.
Thanks so much.
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