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[00:00:00] Hello everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

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Hey everyone, welcome back to another episode. Today’s episode is a business episode and another installment in the private pay transition series that I’ve been doing over the last eight months. Back in January 2023, our practice decided to drop [00:01:00] an insurance panel for testing, a major insurance panel, Blue Cross Blue Shield. They were responsible for about 22% of our testing referrals. This was a big decision. So I’ve been chronicling our journey through that process over the last eight months.

In today’s episode, I’m talking from the perspective of one one-month post-drop date. On July 1st, we terminated our contract with Blue Cross Blue Shield, and here we are about a month in, and I am going to chat about what that’s been like. So this is interesting to you if you’re thinking about dropping insurance. I would love to share our perspective and hope that it’s helpful for you.

If you’re a practice owner and you would like to get some support, maybe in a group setting, I offer three levels of masterminds for beginner, intermediate, and advanced practice owners.[00:02:00] And would love to support you with that. These are group coaching experiences where we provide support and accountability and spotlight sessions for each of the members to discuss whatever is on your mind. Whatever problem you’re trying to solve in your practice, you get support from the rest of the group and some accountability or homework to move yourself forward. If that sounds interesting, you can check it out at thetestingpsychologist.com/consulting and schedule a pre-group call.

Okay, y’all, let’s talk about dropping some insurance.

All right, let’s dive right into it as usual. If you haven’t listened to the previous episodes on this insurance transition or the private pay transition, just a little [00:03:00] refresher, I am walking through this journey using a stages of change model because that really resonated with me as we went through this process.

I had to move from stage to stage. And now that we have actually taken some pretty significant action, we are, well, we’re firmly in the action stage and that’s what I’m going to be talking about today. J

ust to define that stage, it says, in this stage, people have recently changed their behavior defined as within the last six months and intend to keep moving forward with that behavior change. People may exhibit this by modifying their problem behavior or acquiring new healthy behaviors.

This really resonates. Like I said, we have changed our behavior and I think we have acquired new healthy behaviors. That is not taking Blue Cross Blue Shield for testing. [00:04:00] Just for context, Blue Cross Blue Shield was our lowest paying, highest administrative burden insurance panel for assessment.

And back in January, we decided that we were going to drop them. We gave ourselves about a seven-month runway and July 1st was our termination date. So here we are, like I said, about a month or so after the termination date, and I am happy to say that this episode I think will be relatively short because things are just working. All of the preparation that we made over the last 7 or 8 months has really paid off.

Once we hit the July 1st deadline, we had already let our clients know what to expect and our admin team knew what to do as well. Since then, it’s simply been a matter of executing that strategy and seeing how things play out. So like I said, largely everything has gone well. [00:05:00] The actual contract termination was easy.

So in our state, Anthem, which is the administrator for Blue Cross Blue Shield here in Colorado, they have an electronic form available on their website that you complete and submit to request termination for your providers. You do have the option of terminating the group contract or terminating their individual contract, and you can also terminate your group contract entirely if you would like.

In this case, I specified that we wanted to terminate their individual contracts and terminate them from the group. We did not want them to be considered in network at all for the work that they did at our practice.

You get to specify the date of the requested termination. In our case, they emailed back to confirm. [00:06:00] This happened within 24 hours. I wrote back to confirm their confirmation and received another confirmation within 24 hours that the request had been approved or executed. So this was a relatively quick process and I was actually surprised. I’ve heard some horror stories about getting off of insurance panels, but this one was relatively quick.

As I mentioned before, we still have a good number of Blue Cross Blue Shield evaluations booked over the next several months. They’re just booked as out-of-network evaluations. I’ll talk more about that in just a bit.

I do want to talk about the parts that have been a little more challenging. There were two hiccups. One of them is that we had to remind our admin team to change these settings in our EHR, we use TherapyNotes, so that the Blue Cross Blue Shield claims for [00:07:00] specific clinicians were marked as out of network. This is relatively easy to do in TherapyNotes, but it’s a thing that we had to remember to do. And we did have a few claims sneak through that were still billed as in-network when they should have been billed as out-of-network.

We had to remind the billing team of the new fee structure that even though these clients were going to show up as having Blue Cross Blue Shield, these were out-of-network evaluations and that we needed to collect the private pay rate for these evals. So we had to reinforce that again, we had a few sneak through where we just charged the typical copay or co-insurance a deductible amount as if they were in-network. We’re in the process now of going back to Blue Cross Blue Shield and trying to rectify that situation. So I will hopefully have an update on that next [00:08:00] time that we talk about this.

Let’s see. What else? Other little hiccups. Some clients forgot that they would be out of network by the time their evaluation rolled around. But as I’ve talked about before on the podcast, we provide a quote of coverage about two weeks before all the intake appointments for testing. And that really helped clear things up. Many clients reached out to clarify their charges. The vast majority stuck around and kept their appointment.

I’ve also heard stories of others who got out of network with Blue Cross Blue Shield and their claims were still being processed as in-network. This has not happened to us yet, but we are absolutely vigilant for that error. Again, I’ll provide some updates in another two months to see if that has given us any trouble.

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All right, let’s get back to the podcast.

A few interesting points just to touch on. Our conversion ratio for our intake, our evaluation screening calls has actually gone up, even though we dropped a major insurance panel. This was surprising to me. Honestly, I just assumed that the conversion ratio would go down because that’s how it goes with private pay. It’s pretty well established that conversion ratios [00:10:00] for private pay clients are lower than insurance clients. So this was a really nice surprise that our conversion ratio has actually gone up.

I was talking with a colleague and trying to figure out why that is. And I’ll be honest, I don’t have a great reason for it. It may be that the folks who call are more committed to the evaluation and if they know that we don’t take their insurance, which we share during the screening process when they’re signing up for the call, if they know that going into it, then they’re extra committed if they’re going to take all those steps to actually schedule a call. That may be it, but I’m still digging into the data, trying to figure out exactly what happened there and try to replicate that, but it has been steadily increasing even since we stopped taking this panel.

[00:11:00] Other good news is that, like I said earlier, several Blue Cross Blue Shield folks are still scheduled and want to try and use out-of-network benefits. So we’re not just replacing those folks with other insurance panels. When I did the financial modeling to determine if this was a good choice for us, I modeled it out based on essentially redistributing all the other insurance panels into the Blue Cross Blue Shield spots, but what we’re finding is a lot of these Blue Cross Blue Shield folks want to stay on the schedule and just use out of network benefits.

So we’re essentially replacing a lot of those evaluations with with a private pay evaluation without having to attract pure “private pay client”s. So I think there is a market for using out-of-network benefits. This is something that I’ve seen in other practices [00:12:00] many times over the years, but it’s again, just a nice validating experience to see it come to life in our practice. I think there’s definitely a market if you share that clients can use their out-of-network benefits. I think it’s important to emphasize that as you make this transition.

So where are we headed from here? I’m already thinking of dropping another insurance panel. The next one may be a little bit of a tougher choice. It’s both tougher and easier to make the choice because Blue Cross Blue Shield was a clear outlier in terms of both reimbursement and administrative burden. It was easily the most pain in the ass panel that we were a part of. And so, the only hard thing about making that choice was that they were such a large percentage of our evaluation referrals. Like I said, 22%.

The remaining panels that we [00:13:00] are on pay very similarly, and they’re relatively easy to work with. So it’s not quite as easy to decide which one should go. But on the other hand, that may make it pretty straightforward. I’m still working through this clearly, but it may make it fairly straightforward that we would just pick the least common insurance panel for our clients as a next easy step. So, one of the panels with the lowest percentage of referrals or share of our evaluation business.

So I’m already thinking about that. It’s given me a lot of confidence about going out of network and still maintaining the volume of testing that we need to maintain to keep our providers afloat.

So I will absolutely check back in, in a few months with an update on how everything is going. I foresee this to be, like I said, [00:14:00] an ongoing series. My inclination is that as we get used to going off insurance panels that it may be addictive like getting a tattoo or something. Once you have one, you want more. And in this case, we might want to drop more.

So if you are out there and you’re dropping insurance or considering going out of network, you can write a note, post in The Testing Psychologist Facebook Community, and let me know how it’s going. We can share in this journey. And if you’d like to learn more about this process and how to go off insurance while still maintaining access for clients who may need it, there was a great podcast episode from two years ago with Dr. Annie VanSkiver where she talks about her practice’s journey and moving from [00:15:00] totally insurance based to totally private pay or contract based and the success that she’s had with that. I’ll link that in the show notes if you’re interested. As always, thank you for listening and happy testing.

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 in the show notes. So make sure to check those out.

If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcasts.

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 [00:16:00] have support, 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.

The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional psychological, psychiatric, or medical advice, diagnosis, or [00:17:00] treatment.

Please note that no doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with an expertise that fits your needs.

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