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Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get two free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and enter the code [00:01:00] “testing”.
Hey everyone. I am back talking about our journey through a private pay transition. What does that mean?
We transitioned, Gosh, at this point, it’s been over a year since we started this transition, but we have been making the move off of some insurance panels. I’ve been talking about this journey since we started. So, there are four other episodes in this series. If you want to check them out, go to The Testing Psychologist website and search private pay transition.
Today is the 5th episode and I am just checking in. We are now six months post-transition of dropping our largest insurance panel for testing, and I’m giving a little update. So if you are thinking about dropping insurance or in the middle of dropping insurance, this could be a good episode for you.
If you’re a practice owner and you would like some support, some business coaching, some [00:02:00] consultation on building your practice, scaling your practice, or streamlining your practice, I’d love to help you out. I should maybe, hard to project in the future, but should have 1 or 2 individual consulting spots open starting in April. You can go to thetestingpsychologist.com/consulting and check that out.
All right, let’s talk about dropping insurance. Everybody’s favorite topic.
All right folks, as you will recall, or perhaps not if you haven’t listened to the previous episodes, but you might recall that I am working through this transition using the Stages of Change model. Most of us are [00:03:00] familiar with the Stages of Change.
We checked in last time in, I believe it was August or September of 2023. We were one month post Blue Cross Blue Shield dropping. Our drop date was July 1st. I checked in about a month after that and we are in the Action phase. Today, I am happy to say that we have officially moved on to Maintenance in the Stages of Change model.
What does that mean?
In the Maintenance stage, “People have sustained their behavior change for a while, defined as more than six months, and intend to maintain the behavior change going forward. People in this stage work to prevent relapse to earlier stages.” This very much describes us.
Again, for background, we chose to drop Blue Cross Blue Shield, our lowest paying highest pain in the ass panel in July 2023. [00:04:00] 2023. We started this process in January of 2023 to give ourselves a long on-ramp. Here we are over six months after the change, and we intend to maintain it. And I’m grateful to say that we are not working to prevent relapse. We have no intention of going back to insurance or adding more panels.
General thoughts and reflections on what this has been like.
The process has generally been very smooth. A lot of the work came in that 3 to 6 months before our drop date as we prepped our clients, prepped our admin team and generally set up the processes in our practice to do this. But as a check-in, just for data’s sake, we all love data. So we went from nearly 0% private-pay evals before the transition. We’re at the point where Blue Cross Blue Shield was approximately 30% of [00:05:00] our evaluation referrals. So our biggest testing payer and thereby pretty scary to think about dropping. But I’m happy to say that we are here six months later, and we have 10.9% private pay eval intakes scheduled in the coming months. So even though not every Blue Cross Blue Shield client converted to private pay, it’s still a big improvement.
I did the math beforehand to figure out what kind of an impact this would have on our finances and I was prepared. There was only upside to be prepared for, honestly because Blue Cross was paying so low, but it’s nice to have some models to work from for that prediction.
So I built models. That’s a glorification. I didn’t build any model. I ran some numbers on a spreadsheet, but I looked at projections for what would happen if we got 0% [00:06:00] private pay and filled in those evals with our existing panels. I looked at what would happen if we had about 10% private pay. And then I looked at what would happen if all of those Blue Cross clients converted to private pay at about 30% of our evals. So I had a range to look at and that helped. We fell right there in the middle between 0% and 30%. We’re sitting at about 11% and that continues to go up over time, which is great.
Otherwise, let’s see. This is a boring episode folks. There’s not a lot to complain about. Things have generally been very smooth.
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All right, let’s get back to the podcast.
Let’s start with the conversion ratio. This is always a concern. When you go to private pay, the conversion ratio of your incoming leads tends to be much less than if you’re insurance-based, right? Well, our conversion ratio has stayed strong. It’s around 80% or above some weeks [00:09:00] and has gone up on average since we dropped Blue Cross Blue Shield. A little bit surprising, but I am not going to complain.
We’re certainly getting folks opting to not schedule. So there’s been some coaching with the admin team to try and convert those clients and challenge their objections. And then on the flip side, we have to deal with the frustration or “sense of failure” from not converting those clients. So this is hard for our admin team.
We have a really good scheduling team and they are used to having pretty high conversion ratios. Even though the actual ratio is still higher on average, it’s more obvious to them when someone is declining because of being out of network. And so we had to do some coaching with them that were we’re doing this for the [00:10:00] improvement of the practice, it’s in everyone’s best interest, and we’re not corporate titans or overlords for going out of network.
So we had to do some coaching around that. And ultimately, I think it’s just, our schedulers want to help people. And it was challenging to know that some folks were opting not to schedule because they couldn’t afford it or they thought they couldn’t afford it.
I will say though, that was much stronger over the first 2 to 3months. That whole process with the scheduling team has certainly lessened over the last 3 to 4 months.
I will say that the decrease overall in administrative burden from chasing those denied or rejected Blue Cross Blue Shield claims has truly been amazing. Morale has improved as we see the insurance aging go down because Blue Cross testing claims are a big part of that. [00:11:00] It’s also freed up more time to work on other projects. It’s also helped save time on collecting co-pays and cash flow because we charge their cards versus double checking the client’s responsibility or waiting on insurance reimbursement to get figured out. So overall, it’s improved our admin team and has made a big difference.
Other things to keep in mind. We’ve had to make sure that our communication is super clear about out-of-network services and the clients are aware of the charges. We do this at many different points throughout the client journey. I’m not going to detail those right now, but rest assured that there is a lot of informed consent throughout this process. We are informing them at many different points that this eval will be out of network and what that means. Put it in writing, say it out loud, many different points starting from the very beginning. So we’ve just had to double down and make sure that that is super clear.
[00:12:00] The last thing that I want to throw out there is that we haven’t moved in this direction yet, but I have been heavily researching using some software like Mentia, which you may have heard of. There are two other options that I am forgetting all of a sudden. I hate it when that happens. These are software options that check out-of-network benefits and help clients get reimbursed for out-of-network services.Another one is called Reimbursify. And then there is a third one that I actually can’t remember. Mentia is the one that I’ve been looking at the most. It helps clients submit for out-of-network reimbursement. There’s no cost to the practitioner. They pass the fee to the client which I like. It’s very inexpensive as well. It’s maybe $5 or $10 per claim. And if we’re talking about thousands of dollars in reimbursement, I think it’s worth it.
But at the least, even if you don’t want to sign your [00:13:00] clients up and get them into that system, Mentiah gives an easy out-of-network benefits checker feature for only $30 a month for the practitioner. I demoed it. It works well. It’s super easy and worth looking at. If you do a lot of out-of-network work, you can easily check out network benefits and give people an estimate of what they’ll get reimbursed.
So again, that’s Mentiah. I’m not sponsored or taking money from them or anything. I think it’s a good product and has worked well on the times that I’ve demoed it. So I’ll include a link to Mentia in the show notes as well.
As far as moving forward, like I said, we are in the Maintenance phase. I don’t see any relapse happening. So I’m thinking ahead.
For the future, we are holding tight with dropping other panels. The remaining panels are relatively easy to work with and they pay relatively well [00:14:00] for insurance. I do foresee dropping more panels over time selectively.
If there’s another one at the top of the list, it is Optum or United simply because they are giving us a lot more trouble than I would like to deal with in terms of submitting claims. They require that you submit all of the dates of service on the same claim for the purposes of bundling testing codes with thinking time and feedback codes. And at this point, I’m honestly at a place where I’m not trying to increase any hassle in this practice. I’m looking at anything that increases friction in this business is first up on the chopping block and Optum is certainly at the top of that list as far as testing claims.
All in all, we are holding tight. We’re doing well. I have [00:15:00] no regrets about going off Blue Cross Blue Shield. I wish we’d done it sooner, frankly. And from what I can tell, it was right in time. I’m hearing a lot of stories of folks around the country getting audited by Blue Cross. I keep getting letters. They haven’t touched testing yet, but I know it’s only a matter of time as far as Blue Cross digging in and trying to audit our evaluation claims.
I also recognize that we’re fortunate to be able to do this living in a relatively high-income area. Some folks have a much harder time going off insurance panels, but I think looking at it through the lens of where is the friction is worthwhile. There may be more room to drop some panels than you think. You don’t have to go all in. It’s not black and white. You don’t have to go from 100% insurance to 0% insurance. [00:16:00] You can drop the lowest paying panel, the least frequent or least populated panel, the one that makes up the fewest number of your clients.
Just remember the stages of change model, which is what I have worked through for our process. This can be a lengthy process. It doesn’t happen overnight. So if you’re in pre-contemplation or contemplation, that is okay. Everybody goes at their own pace. I found for myself that I stick in contemplation for a long time, but when I’m ready, I move through preparation to action very quickly.
Either way, I hope that these episodes are providing some insight and perhaps some reassurance to those of you who are considering getting off insurance panels. [00:17:00] I highly recommend it and am happy to support you in that journey if you ever need it.
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 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, Spotify, or wherever you listen to your podcast.
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, 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 [00:18:00] 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 is 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 treatment.
Please note that no doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the [00:19:00] host or guests of this podcast and the 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 expertise that fits your needs.