Could you not structure additional cash fees for additional work. If insurance only reimburses the initial evaluation why not just charge FFS for the rest? In this way you could have a hybrid insurance/cash practice. Or has this conveniently been regulated out of possibility? I know a few CAP that do cash only and charge for all this, needless to say they cater to the more affluent. But couldn't a hybrid practice cater to more middle class? I don't see how this would be unethical if the pricing structure was discussed up front.
Because of insurance, most outpatient CAP falls into a few categories:
1) Academic or large non-profit health care systems that take Medicaid and provide good care - these are getting overrun with demand, huge waiting lists and places are moving towards never having permanent patients (stabilize for a few visits and return to PCP)
2)Community NP's, possibly "supervised", likely not, likely without any peds psych experience, to take most or all insurance
3)Private insurance CAP (actually relatively small group for the reasons mentioned here with billing), may be in a behavioral health group for cost-sharing, supervisor revenue stream, and referral streams
4)Cash pay CAP
With the increasing demand, limited increase in CAPs to meet the demand, there will be an increasing fissure of #2 for medicaid, #3 for working class with decent insurance and #4 for upper-middle and upper class who are fine spending some money to get the best care for their children. If you know anyone who needs care and doesn't have good insurance options, get on the wait list for any academic place ASAP as many are around a year out.