Entry level psychologist salary

[AbnormalPsych]

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This is fascinating. Is this where you ended up? It looks like a 60m therapy hour (90837) is billed at $127-$159 depending on modifiers. Is that what Medicare/Medicaid will pay?

Search the Physician Fee Schedule | CMS

www.cms.gov

Yes, then adjusted for my region.

 

[Therapist4Chnge]

I have excel spreadsheets with all of the codes I could bill that will automatically calculate how much I am billing for with Medicare as a benchmark. Always good to have your RVU and ballpark billing figures for possible negotiations. Particularly if you work in a hospital system, aside from the VA.

For any ECPs, this is also a great thing to do in PP bc you want to know how various insurance companies compared against each other. After a year, you can have real data about your various payors and decide who to renegotiate with and/or drop.

 

[beginner2011]

I'm surprised that people in independent practice are taking in $100 for 38-52m sessions with insured clients in major metro areas. Am I understanding that correctly? Seems low.

Bit of a digression, but it'll be interesting to see what happens with all this post COVID. I would imagine there will be a spike in demand for mental health services and also a reduced ability for people to pay out of pocket -- and probably a reduction in % population with health insurance. There's probably some very favorable math in there somewhere for an industrious/ambitious/entrepreneurial psychologist.

 

[foreverbull]

I'm surprised that people in independent practice are taking in $100 for 38-52m sessions with insured clients in major metro areas. Am I understanding that correctly? Seems low.

Several insurers in my area pay anywhere from around $75-90 per full session, per my colleagues (I don't take insurance). I've had local medical insurers/companies reach out and ask me if I'll see their overflow of clients for $60/session.

 

[AbnormalPsych]

I've had local medical insurers/companies reach out and ask me if I'll see their overflow of clients for $60/session.

Curious, how'd they find and pick you?

 

[Therapist4Chnge]

Those rates are crazy. I forget how poorly we are viewed and treated by insurance companies. I don't consider anything less than $200 for 45min of my time for anything. You can't come out the gate charging these rates, but that doesn't mean accepting <$100 for a session should be viewed as acceptable for a doctorally trained clinician.

 

[foreverbull]

Curious, how'd they find and pick you?

I got a letter in the mail at my business office from the company. I’ve gotten a few of those in the past year from different companies. Not sure how they found me, but I’d imagine it’s the same way that most clients do (my online presence)?

 

[Sanman]

Several insurers in my area pay anywhere from around $75-90 per full session, per my colleagues (I don't take insurance). I've had local medical insurers/companies reach out and ask me if I'll see their overflow of clients for $60/session.

Those rates are crazy. I forget how poorly we are viewed and treated by insurance companies. I don't consider anything less than $200 for 45min of my time for anything. You can't come out the gate charging these rates, but that doesn't mean accepting <$100 for a session should be viewed as acceptable for a doctorally trained clinician.

$75-90 does seem in line with what many insurers are offering. $100-120 seem to be what some of the higher end insurances are offering for 90834 compensation. $60 seems like they would be shooting for more master's level providers.

 

[foreverbull]

Those rates are crazy. I forget how poorly we are viewed and treated by insurance companies. I don't consider anything less than $200 for 45min of my time for anything. You can't come out the gate charging these rates, but that doesn't mean accepting <$100 for a session should be viewed as acceptable for a doctorally trained clinician.

This why I don’t take insurance, but I turn away more people than I can count as a result because they can’t pay full fee. I’d estimate that probably only ~1/3 to 1/4 interested in seeing me end up being able to pay out of pocket in my community. That is one reality of private practice that many private practitioners will find that they have to contend with—practice close to home for convenience and risk clients not being able to pay in a middle class community, or practice in a wealthier area but longer commute times and less time at home plus costs of transit and/or higher office fees.

 

[Fan_of_Meehl]

Those rates are crazy. I forget how poorly we are viewed and treated by insurance companies. I don't consider anything less than $200 for 45min of my time for anything. You can't come out the gate charging these rates, but that doesn't mean accepting <$100 for a session should be viewed as acceptable for a doctorally trained clinician.

It seems ridiculous when hourly rates for plumbers beat out those for applied doctorates but--hey--it's what the market will bear.

 

[Fan_of_Meehl]

The salary is good but the perks sound amazing.

Lawd have mercy.

 

[Sanman]

It seems ridiculous when hourly rates for plumbers beat out those for applied doctorates but--hey--it's what the market will bear.

Except it is not a free market. Providers cannot band together and refuse to accept insurance, but insurance companies can peg their payment to medicare in lockstep and that is not considered price fixing.

 

[allantois]

It seems ridiculous when hourly rates for plumbers beat out those for applied doctorates but--hey--it's what the market will bear.

yea but you don’t need to see you plumber for 20 sessions

 

[allantois]

Except it is not a free market. Providers cannot ban together and refuse to accept insurance, but insurance companies can peg their payment to medicare in lockstep and that is not considered price fixing.

Sure you could refuse to accept insurance, the issue then is how many people will be able to afford your fees

 

[Sanman]

yea but you don’t need to see you plumber for 20 sessions

Nope, but you might need them to do 20 hours of work, which is the same thing, and they round up for the hour.

 

[Sanman]

Sure you could refuse to accept insurance, the issue then is how many people will be able to afford your fees

Can I get together with colleagues in my geographical area and we all refuse the insurance? Plumbers can.

 

[allantois]

Can I get together with colleagues in my geographical area and we all refuse the insurance? Plumbers can.

Why couldn’t you? I feel like most psychologists near me don’t accept insurance, so it seems rather common. Plumbers take insurance?

 

[Sanman]

Why couldn’t you? I feel like most psychologists near me don’t accept insurance, so it seems rather common. Plumbers take insurance?

Because it is generally against the law for psychologists to collectively bargain. Refusing insurance only works if the guy next door does as well. The Plumbers and Pipefitters Union is one of the strongest in the country. Anyone trying to pressure prices down would get no work done anywhere in the country.

 

[Fan_of_Meehl]

Couple of years ago my water heater went out. Looked up local prices to have a plumber come out and hook up a new unit. Was gobsmacked. Spent an hour on YouTube tutorials for DIY and saved hundreds of dollars. Probably some price-fixing going on there.

 

[foreverbull]

Because it is generally against the law for psychologists to collectively bargain. Refusing insurance only works if the guy next door does as well. The Plumbers and Pipefitters Union is one of the strongest in the country. Anyone trying to pressure prices down would get no work done anywhere in the country.

Off topic, but this came up in a therapists group I belong to. We created an online shared document (only visible to us psychologists/therapists) for the purpose of maintaining an accurate and current referrals list that includes our credentials, specialties, rates, insurances, etc. (and includes a psychiatrist or two), and one colleague said they were told by another psychologist that this could be considered price-fixing because we could all see each others' rates. That said, the going rates are advertised publicly on the Psychology Today website and on some therapists' business websites, so ANY therapist could adjust their rates based on others in their area at any time.

Anyone want to weigh in on whether this is an actual ethical issue or whether this is splitting hairs?

 

[Therapist4Chnge]

Except it is not a free market. Providers cannot ban together and refuse to accept insurance, but insurance companies can peg their payment to medicare in lockstep and that is not considered price fixing.

It's only legal because of lobbying. We need to get rid of insurance companies full stop. There will always be a private cash market and prob some add-on insurance-like options (akin to Rx programs that are negotiated plans but are not classified as insurance). Providers will always be outgunned against trad insurance companies, so we need to be smarter in how we interact with them and we need to find alternative opportunities so we are not dependant on them.

The dirty secret of insurance companies are they *do* pay some providers significantly more than others, but you need to do your homework first. It also helps to work in niche speciality areas and expand your offerings.

When I took insurance, I negotiated to take 5-6 plans, all had to beat Medicare rates. After a year or so I renegotiated. I dropped all but 3, and negotiated higher rates. I since relocated and built up a new practice that doesn't rely on insurance for cases or income.

There are sometimes options to do one-off contracts. For instance, I did some one-off contracts for my cash rate bc they didn't have in-network (neuro) providers in my area and they were desperate. I did this with a few smaller plans that were covering satellite offices.

Often companies will buy "access" to an existing network to cover workers in satellite offices geographically far away w/o coverage from the primary network. If you can identify these businesses, you can often negotiate your own deal bc a lot of networks offer junk coverage and/or lack local resources.

HR ppl and in-house legal have consistently been great contacts bc they often can push right past cost if you can fix their problem. EAP, fitness for duty, return to work, etc. Doctorally-trained clinicians have a lot to offer, you just need to know how to return skills and package it to prospective parties.

 

[Therapist4Chnge]

Sure you could refuse to accept insurance, the issue then is how many people will be able to afford your fees

There are plenty of opportunities to earn income outside of trad insurance reimbursement.

 

[Sanman]

Off topic, but this came up in a therapists group I belong to. We created an online shared document (only visible to us psychologists/therapists) for the purpose of maintaining an accurate and current referrals list that includes our credentials, specialties, rates, insurances, etc. (and includes a psychiatrist or two), and one colleague said they were told by another psychologist that this could be considered price-fixing because we could all see each others' rates. That said, the going rates are advertised publicly on the Psychology Today website and on some therapists' business websites, so ANY therapist could adjust their rates based on others in their area at any time.

Anyone want to weigh in on whether this is an actual ethical issue or whether this is splitting hairs?

Are you openly discussing rate setting or comparing insurance reimbursement contracts? No, then I fail to see who would have cause to sue you or how anyone would find out even if they did. Those laws are pretty much explicitly so you can't go to an insurance company and say the practice next door is getting $10 more a session than you and try to renegotiate.

 

[Sanman]

It's only legal because of lobbying. We need to get rid of insurance companies full stop. There will always be a private cash market and prob some add-on insurance-like options (akin to Rx programs that are negotiated plans but are not classified as insurance). Providers will always be outgunned against trad insurance companies, so we need to be smarter in how we interact with them and we need to find alternative opportunities so we are not dependant on them.

Don't disagree, but how do you suggest we remove a multi-billion dollar industry from the market? United Healthgroup alone took in $60.9 billion dollars last year. That's a lot of lobbying power.

 

[Therapist4Chnge]

Don't disagree, but how do you suggest we remove a multi-billion dollar industry from the market? United Healthgroup alone took in $60.9 billion dollars last year. That's a lot of lobbying power.

I'm hopeful we can move towards a one-payor system, but that will require a change in the Whitehouse and significant and persistent pressure of citizens. This pandemic may be part of that pressure. Best realistic scenario...it'll take 2-3 years to implement and I expect insurance to find a way to stick around for wrap-around and/or add on services. I'm not super concerned about it either way because I'm purposefully moving away from direct care services, but as a field I worry about the current and next generations of psychologists.

 

[beginner2011]

Does anyone know if APA's stats on median salaries for ECPs are counting postdocs? Median salaries for new psychologists are static

I would assume so. I can't imagine why they don't have t+5 years data as well. I find first year salaries to be not particularly useful information due to the prevalence of post-docs.

 

[Fan_of_Meehl]

Does anyone know if APA's stats on median salaries for ECPs are counting postdocs? Median salaries for new psychologists are static

These do look rather low. I think we have secretaries/clerical at the VA who make more than that, esp considering the benefits package. There was a recent job listing for an admin asst position (admittedly, for the medical director) that was a GS-13. I love how they say later in the report, 'The good news is that psychologists should have no problem finding jobs...'

LOL, at those prices, I should think not.

 

[foreverbull]

Are you openly discussing rate setting or comparing insurance reimbursement contracts? No, then I fail to see who would have cause to sue you or how anyone would find out even if they did. Those laws are pretty much explicitly so you can't go to an insurance company and say the practice next door is getting $10 more a session than you and try to renegotiate.

This makes a lot more sense if it only applies to insurance reimbursement.

So are psychologists/therapists supposed to be prohibited from sharing basic info about how much their insurance reimbursement is to other therapists just generally speaking?

Edit: at the time we discussed the referrals, no, there wasn't a comparison of insurance rates (the vast majority of us didn't take insurance anyway).

 

[Sanman]

This makes a lot more sense if it only applies to insurance reimbursement.

So are psychologists/therapists supposed to be prohibited from sharing basic info about how much their insurance reimbursement is to other therapists just generally speaking?

Edit: at the time we discussed the referrals, no, there wasn't a comparison of insurance rates (the vast majority of us didn't take insurance anyway).

Language varies with all contracts you sign, but if you shared info with another psychologist and they went to the insurance company and spilled the beans in the course of negotiations, an insurance company would have cause to sue you both for price fixing. They could also sue you if everyone happens to ask for the same amount more money. How else did you all know? I can't think of any other instance where reimbursement is not publicly available and anyone would have cause to do so.

 

[Therapist4Chnge]

This makes a lot more sense if it only applies to insurance reimbursement.

So are psychologists/therapists supposed to be prohibited from sharing basic info about how much their insurance reimbursement is to other therapists just generally speaking?

Edit: at the time we discussed the referrals, no, there wasn't a comparison of insurance rates (the vast majority of us didn't take insurance anyway).

This issue comes up on various list serve probably once or twice a year. The vast majority of psychologists don't consult a lawyer, but instead are overly worried about it and discourage talk of salaries and reimbursements. It's not only organizing to share specific information about rates, but...wait for it....then to go on to agree to set a fee for the geographic area in an effort to artificially inflate pay. Reverse it w. the insurance companies and it's legal. In user agreements most/all insurance companies say the rates are proprietary and protected information you agree not to share. They can usually boot you if you break that contract, but that's a lot different than organizing to price fix for services. It's rigged in case that wasn't obvious.

Realtors seem to be really organized and have the same fees. Same for a lot of other groups, but if healthcare tried....the world would end. Ironically, the world could end w/o us and our colleagues in medicine, but that's a discussion for another day.

 

[beginner2011]

I know of a fairly large group practice that I believe collectively bargains with insurance companies for rates in some fashion. Is this one way to address the imbalance of power? My understanding is they have a relatively minor nominal fee associated with renting space in the loosely formed "group practice", which I assume is partly what allows them to collectively bargain in this fashion.

 

[Sanman]

I know of a fairly large group practice that I believe collectively bargains with insurance companies for rates in some fashion. Is this one way to address the imbalance of power? My understanding is they have a relatively minor nominal fee associated with renting space in the loosely formed "group practice", which I assume is partly what allows them to collectively bargain in this fashion.

I don't see why not. Hospitals do this all the time. They just keep the money for themselves.

 

[foreverbull]

Language varies with all contracts you sign, but if you shared info with another psychologist and they went to the insurance company and spilled the beans in the course of negotiations, an insurance company would have cause to sue you both for price fixing. They could also sue you if everyone happens to ask for the same amount more money. How else did you all know? I can't think of any other instance where reimbursement is not publicly available and anyone would have cause to do so.

This issue comes up on various list serve probably once or twice a year. The vast majority of psychologists don't consult a lawyer, but instead are overly worried about it and discourage talk of salaries and reimbursements. It's not only organizing to share specific information about rates, but...wait for it....then to go on to agree to set a fee for the geographic area in an effort to artificially inflate pay. Reverse it w. the insurance companies and it's legal. In user agreements most/all insurance companies say the rates are proprietary and protected information you agree not to share. They can usually boot you if you break that contract, but that's a lot different than organizing to price fix for services. It's rigged in case that wasn't obvious.

Realtors seem to be really organized and have the same fees. Same for a lot of other groups, but if healthcare tried....the world would end. Ironically, the world could end w/o us and our colleagues in medicine, but that's a discussion for another day.

Thanks, this is helpful as someone who has never taken insurance.

So Medicare publishes their rates for all to see, but all other insurance companies can legally keep providers in the dark about how much they reimburse for set services--correct?

Certainly psychologists and therapists have shared a range of rates that they are reimbursed for certain insurances in casual discussion, but it sounds like this is a gray area and can become punishable if any therapist hears the rate, then argues that another gets the rate if they are offered less. That really does sound like a way to silence the providers and limit negotiating power, for sure.

So can any psychologist just ask how much their services are worth in a given region with a simple phone call to insurers, or do providers not find out until they're paneled or in the process of being paneled how much they will earn?

 

[Therapist4Chnge]

They will want you to sign up and then send an "updated fee schedule" or some BS like that, often not even entertaining that rates could be negotiable. Clinicians are mostly poor business people because of a lack of training in that during graduate school, so I'm not surprised that many just sign whatever is put in front of them, and taking whatever poor reimbursements are being offered. One things that chiropractors do better than any other health profession is business. Biz courses are part of their curriculums. I don't know the specifics, but every Chiro I've talked to has told me that they had at least one class about how to run a private practice and handle the biz end of things. I've lectured on some related topics in the past, but I have yet to see the APA or programs make any significant improvements to include these types of skills.

 

[R. Matey]

They will want you to sign up and then send an "updated fee schedule" or some BS like that, often not even entertaining that rates could be negotiable. Clinicians are mostly poor business people because of a lack of training in that during graduate school, so I'm not surprised that many just sign whatever is put in front of them, and taking whatever poor reimbursements are being offered. One things that chiropractors do better than any other health profession is business. Biz courses are part of their curriculums. I don't know the specifics, but every Chiro I've talked to has told me that they had at least one class about how to run a private practice and handle the biz end of things. I've lectured on some related topics in the past, but I have yet to see the APA or programs make any significant improvements to include these types of skills.

I took a class like this in my master's program. It was really informative.