all cash practice

[boston DO]

i was curious find out how easy or difficult it would be as a psychiatrist to have an all cash practice, meaning no private insurances. i've seen it mentioned here before but how common is it and does anybody have any experiences with it?

thanks.

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[PublicHealth]

i was curious find out how easy or difficult it would be as a psychiatrist to have an all cash practice, meaning no private insurances. i've seen it mentioned here before but how common is it and does anybody have any experiences with it?

thanks.

They're probably as common as DOs in Boston.

 

[prominence]

 

[Anasazi23]

I know of a few psychiatrists in the New York area and on Long Island that are cash-only, and even more that are mostly cash, large "less hassle" insurance company payors also. Some of these psychiatrists hold attending positions in hospitals full-time, and see cash-only in their off hours. Others are strictly cash only in private practice.

 

[purpledoc]

i was curious find out how easy or difficult it would be as a psychiatrist to have an all cash practice, meaning no private insurances. i've seen it mentioned here before but how common is it and does anybody have any experiences with it?

thanks.

It definitely can be done. How easy or hard it is depends on how many psychiatrists are in the area, how much managed care penetrance there is, and what the general attitudes about psychiatrists are. In both NYC and SF there is an overload of psychiatrists and therapists, but an all-cash practice is common because so many people there have enough money, want to see the "best" psychiatrists, and aren't ashamed of this. On the other hand, in areas where there is a shortage of psychiatrists and you'd think it would be easy to have an all-cash practice, people may think all therapists are alike, won't see any mental health person anyway for help unless it's the very last option, or won't (or can't afford to) see anyone outside their managed care plan. You can still develop an all-cash practice there because of the shortage, but it takes more work.

How quickly you can do this in any area also depends on if you trained there. If you trained there, your teachers/mentors/etc with full practices can refer patients to you. If you didn't, it's much harder to get your referral sources lined up. In other words, it's still "who you know." You can also aggressively market yourself in a niche specialty area. Just bear in mind that it's getting harder and harder for people to afford to pay well for psychiatric visits out-of-pocket unless you are in a major metropolitan area. Nonetheless, an all-cash practice with patients that don't pay as well is still often preferable to getting higher fees but having to jump through hoops with insurance companies to get paid.

In summary, it can eventually be done almost anywhere in the U.S. It's just a matter of how long it may take and how much you'll end up making.

 

[boston DO]

thanks for input. since you mentioned insurance companies, how much do they tend reimburse for office visits. i hear the number keeps going down as in most specialties.

 

[purpledoc]

thanks for input. since you mentioned insurance companies, how much do they tend reimburse for office visits. i hear the number keeps going down as in most specialties.

It varies tremendously. Not only that, but technically, doctors aren't even allowed to talk about what they charge, because it can be considered "price fixing." Plus, insurance companies often won't even tell you what they'll pay if you're not on their panel!

Never mind that insurance companies can talk about "usual and customary rates" that are at least 25% below what any reasonable doctor would charge...

I don't know if it's going down right now, but it certainly isn't going up.

 

[kchan99]

I know a psychiatrist who has a part time cash only practice at UCSF. She is with the Osher Center for Integrative Medicine. All health care providers there are cash-only. Hint: Some insurance companies don't pay for complementary medicine.