Cost per visit

[hypoman]

Interested in starting private practice after residency. Can anyone shed light on how much insurance pays for visits? Both first encounters and follow ups please. Thanks in advance to anyone who can share some info!

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[splik]

the answer will vary widely depending on the type of insurance and the geographic location. In general you won't find out how much an insurance company will pay you until you get on the panel which is part of the problem and one of the reasons why many people choose not to take insurance. however it is a myth that people cannot make money by taking insurance, or that you cannot do psychotherapy. it's really a choice of how much you want to make, how much of a hassle it is to deal with billing at the like. but in the overwhelming majority of places in this country patients expect to be able to use their insurance to see a psychiatrist which makes it difficult to go out of network unless you are in specific areas.

also if you google some insurance companies will put the lists of what they pay for a given CPT code in that area but this is uncommon. Here is an example from the fee schedule from some years ago (so it would probably be higher now) for Blue Cross Oregon. Note that oregon is probably the best in the country for psychiatrist insurance reimbursement so it could be considerably lower in a different state.

 

[PikminOC]

Interested in starting private practice after residency. Can anyone shed light on how much insurance pays for visits? Both first encounters and follow ups please. Thanks in advance to anyone who can share some info!

You're just a tadpole. Long way to go as you are premed.
No rates here will help you.

 

[hypoman]

You're just a tadpole. Long way to go as you are premed.
No rates here will help you.

I'm actually a 3rd year med student, just never updated my profile info

 

[hypoman]

the answer will vary widely depending on the type of insurance and the geographic location. In general you won't find out how much an insurance company will pay you until you get on the panel which is part of the problem and one of the reasons why many people choose not to take insurance. however it is a myth that people cannot make money by taking insurance, or that you cannot do psychotherapy. it's really a choice of how much you want to make, how much of a hassle it is to deal with billing at the like. but in the overwhelming majority of places in this country patients expect to be able to use their insurance to see a psychiatrist which makes it difficult to go out of network unless you are in specific areas.

also if you google some insurance companies will put the lists of what they pay for a given CPT code in that area but this is uncommon. Here is an example from the fee schedule from some years ago (so it would probably be higher now) for Blue Cross Oregon. Note that oregon is probably the best in the country for psychiatrist insurance reimbursement so it could be considerably lower in a different state.

Thanks for the information!

 

[hypoman]

the answer will vary widely depending on the type of insurance and the geographic location. In general you won't find out how much an insurance company will pay you until you get on the panel which is part of the problem and one of the reasons why many people choose not to take insurance. however it is a myth that people cannot make money by taking insurance, or that you cannot do psychotherapy. it's really a choice of how much you want to make, how much of a hassle it is to deal with billing at the like. but in the overwhelming majority of places in this country patients expect to be able to use their insurance to see a psychiatrist which makes it difficult to go out of network unless you are in specific areas.

also if you google some insurance companies will put the lists of what they pay for a given CPT code in that area but this is uncommon. Here is an example from the fee schedule from some years ago (so it would probably be higher now) for Blue Cross Oregon. Note that oregon is probably the best in the country for psychiatrist insurance reimbursement so it could be considerably lower in a different state.

So just to clarify, those numbers are they payouts to the doc? I imagine private practice would fall under the facility setting?

 

[splik]

pp is non-facility, but yes thats what they pay out (or say they do). As I said blue cross is one of the best insurances and oregon is (one of) the best for mental health so numbers would otherwise be lower, sometimes considerably so.

 

[PistolPete]

I still don't understand how a 90791 pays more than a 90792... hopefully that changes soon.

Since a 99204 pays much more than a 90792, doesn't it makes sense to bill a 99204 or 99205 for an initial visit, which will almost assuredly be comprehensive enough to warrant that level?

 

[PistolPete]

Damn parity.

 

[PikminOC]

:troll:

I'm actually a 3rd year med student, just never updated my profile info

So you joined in May 2015, were premed then, and only have a handful of comments. I think you are none of those things.
Probably a patient trolling for fees or someone trying to fix prices.
Illegal.
Goodbye.

 

[TexasPhysician]

Those rates are above normal in Oregon link.

 

[hypoman]

:troll:

So you joined in May 2015, were premed then, and only have a handful of comments. I think you are none of those things.
Probably a patient trolling for fees or someone trying to fix prices.
Illegal.
Goodbye.

Haha nope, I'm a third year medical student. Currently on my EM rotation, just wrapped up psych last month. Enjoyed it thoroughly and I'm strongly considering going for it. Appreciate your kind words, and thanks to the other folks here who provided me with helpful information. All the best!

 

[Thewonderer]

Those rates are above normal in Oregon link.

Agree. Those rates are way too generous. If those rates are prevalent, I doubt any of us would do cash-only practice.

 

[Doctor Bagel]

Agree. Those rates are way too generous. If those rates are prevalent, I doubt any of us would do cash-only practice.

That might explain why cash only is a rare thing in Oregon. Private practice folks often really limit the insurance plans they accept though -- it's not uncommon to only accept bcbs, moda and Aetna for example.

 

[PistolPete]

Anyone know how California rates compare to those of Oregon?

 

[TexasPhysician]

Anyone know how California rates compare to those of Oregon?

I'm not sure how accurate anyone can be. Where I practice, insurance rates can vary by 20+% within the same metro area.

 

[notdeadyet]

I'm not sure how accurate anyone can be. Where I practice, insurance rates can vary by 20+% within the same metro area.

Ditto this.

Also, keep in mind, some of the variance comes from negotiating with the insurance panels. Out where I am, folks have been able to do this. I'm in a California metro area that has plenty of psychiatrists and many of whom do cash-only. Don't know if that factors in.

 

[hypoman]

What sort of rates do you guys typically see then?

 

[Shikima]

Too variable. Depends on the billing code you use. Get into residency and get some time under your belt.

 

[PistolPete]

Damn, +/- 20% within the same metro area? Crazy. Thanks for the responses.

 

[psych2009]

http://maryland.valueoptions.com/provider/claims_finance/PMHS-Reimbursement-Schedule.pdf

 

[Shikima]

Dang, value options there pays more than by me. I R Sad.

 

[F0nzie]

99214 + 90833 for a 30 min follow up. x 2 = $312 per hour. Not bad at all.

I wonder if insurance will make a comeback...I definitely feel the pressure when a new insurance practice pops up.

 

[smalltownpsych]

99214 + 90833 for a 30 min follow up. x 2 = $312 per hour. Not bad at all.

I wonder if insurance will make a comeback...I definitely feel the pressure when a new insurance practice pops up.

You guys do a much better job with your lobbying efforts is all I can say.
I noticed that they won't even pay for a one hour psychotherapy session. Taking a page out of UBH's playbook. The research is clear that exposure therapy can't be rushed. About 70% of my patients (90% of the adults) are being seen from about 50-55 minutes yet they will only pay for a 45 minute session. They also want to pay $74 for that session. My plumber charges $100. I have no problem with a psychiatrist making more, after all they have to deal with medication issues that can really increase risk and the PITA factor, but $312 compared to $74 makes you wonder who is making the rules and why.

 

[daru1]

99214 + 90833 for a 30 min follow up. x 2 = $312 per hour. Not bad at all.

I wonder if insurance will make a comeback...I definitely feel the pressure when a new insurance practice pops up.

You guys do a much better job with your lobbying efforts is all I can say.
I noticed that they won't even pay for a one hour psychotherapy session. Taking a page out of UBH's playbook. The research is clear that exposure therapy can't be rushed. About 70% of my patients (90% of the adults) are being seen from about 50-55 minutes yet they will only pay for a 45 minute session. They also want to pay $74 for that session. My plumber charges $100. I have no problem with a psychiatrist making more, after all they have to deal with medication issues that can really increase risk and the PITA factor, but $312 compared to $74 makes you wonder who is making the rules and why.

I wonder who makes the rules as well. When I look at whether I want to sign on with an insurance panel, I immediately think 99214 + 90833 because I always have 30-minute appointments in my practice for both the cash-pay patients and insurance-covered patients that I see. There wouldn't be a need to do this kind of calculation if the reimbursements weren't arduous to keep up with. To suggest that psychiatrists are "making the rules" to benefit themselves only is disingenuous and serves no more purpose than to divide what should be a unified front.

 

[smalltownpsych]

I wonder who makes the rules as well. When I look at whether I want to sign on with an insurance panel, I immediately think 99214 + 90833 because I always have 30-minute appointments in my practice for both the cash-pay patients and insurance-covered patients that I see. There wouldn't be a need to do this kind of calculation if the reimbursements weren't arduous to keep up with. To suggest that psychiatrists are "making the rules" to benefit themselves only is disingenuous and serves no more purpose than to divide what should be a unified front.

Not what I meant to say. I do believe that physicians have historically been better at keeping their compensation high and that is a good thing. I really don't understand who makes the rules and what their agenda is. Makes we wonder if my more paranoid patients have a point with some of their conspiracies about the Federal Reserve, the Illuminati, or whoever else is running the show.

 

[Shikima]

You guys do a much better job with your lobbying efforts is all I can say.
I noticed that they won't even pay for a one hour psychotherapy session. Taking a page out of UBH's playbook. The research is clear that exposure therapy can't be rushed. About 70% of my patients (90% of the adults) are being seen from about 50-55 minutes yet they will only pay for a 45 minute session. They also want to pay $74 for that session. My plumber charges $100. I have no problem with a psychiatrist making more, after all they have to deal with medication issues that can really increase risk and the PITA factor, but $312 compared to $74 makes you wonder who is making the rules and why.

It's a matter of priorities you're setting in your clinic and with your clients. They obviously aren't invested in their care if they want a reduced rate. Perhaps upfront expectations of payment and what treatment is may be helpful? I don't know the specifics or dynamics nor would I presume to preach to you, but there is a clear disparity in your example. One suggestion through discussion with other psychologists in my area is to make a hourly rate for cash/billing, and the ones in my area range from 120-160/hour. Not sure if this is helpful?!

 

[smalltownpsych]

It's a matter of priorities you're setting in your clinic and with your clients. They obviously aren't invested in their care if they want a reduced rate. Perhaps upfront expectations of payment and what treatment is may be helpful? I don't know the specifics or dynamics nor would I presume to preach to you, but there is a clear disparity in your example. One suggestion through discussion with other psychologists in my area is to make a hourly rate for cash/billing, and the ones in my area range from 120-160/hour. Not sure if this is helpful?!

In a cash pay setting, then we could have these discussions. In my current setting, we have contracts with insurers and they set the standards. What ends up happening is there is pressure to treat patients differently depending on what their insurance covers. I could try and say that I don't let that affect my treatment decisions, but that would be denying a lot of social psychology that indicates otherwise. Nevertheless, I will say that in my current setting we bill quite a bit more than in that example and it is more in the range of the cash practices. I personally would aim to set my rate even higher whenever I do go into my own practice. Mainly because I think that many psychologists just don't ask for enough. We tend to be too nice.