Insurance Rates, HelloAlma, and Other Private Practice Questions!

[PX1985]

Hi all!

I'm a (fortunate) postdoc working in New York City in a private pay, group practice with relatively good compensation, benefits, and work-life balance. Although I enjoy the work, the owner of the practice takes too-much of my income so I would like to start my own practice. I get to transfer my caseload over when I start (yay!), and would like to hear other peoples' opinions/experiences.

First, I'm interested in signing up with HelloAlma--the consultant I spoke with mentioned that I could get credentialed with their practice (Aetna) and receive $200 per 52-minute, individual psychotherapy session. Would you consider that rate competitive with other insurance companies? It is the best I've seen thus far.

I'm also interested in advertising to recruit private-pay patients (less headache than dealing with insurance), but I don't know where to start. A few of my old supervisors mentioned they could refer some people to me, but not sure how reliable that flow would be.

Paneling with an insurance seems like a safer route (HelloAlma supposedly removes much of the headache regarding billing and reimbursement), so I'm strongly considering this route.

Please chime in with whatever you find helpful!

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[AcronymAllergy]

I'm not sure RE: competitive therapy rates, but if you're wanting to do any self-pay work, you will probably want to strongly consider opting out from Medicare. If you do also see patients with insurance, you'll of course also want to review your contract(s) with the insurance(s) with which you're paneled to see what restrictions they have.

You'll also definitely want to look into the No Surprises Act, which is going to be aimed squarely at the type of practice you're anticipating (i.e., primarily or solely self-pay).

 

[PsyDr]

Your location is an oddball variable. The non-facility reimbursement for Medicare in Manhattan is ~$115, with an additional limit that allows about $10/hrs copay. So the telemedicine with Aetna is a ~60% increase in reimbursement. That fee probably comes with some Aetna specific rules on # of sessions, or treatment requirements, or whatever.

Advertising is only useful if you can answer "why would a patient come to you?". Do you have a specific skill set, unique aspect of your business, a subspecialty that is in demand, price point, etc. What is the realistic increased benefits of seeing you, relative to the cheaper option of a $30 out of pocket co-pay at Columbia, or going to someone on 5th Ave? Answer that, and you know who to advertise to, and how to sell your services. Otherwise, people usually get their client base through word of mouth (i.e., slowly).

Be careful with people trying to sign you up for telemedicine panels. They benefit from being able to say, "we have a kajillion providers" AND they benefit from not letting those providers do their work. If you're not paying for something, you are the product.

 

[foreverbull]

I don’t know a lot of folks who charge $200/session as early career psychologists in their first year of private practice, so I’m very curious about how HelloAlma can offer such a lucrative rate. That does mean that you must charge $200 or higher for cash paying clients outside of HelloAlma as well or else it’s considered fraud with HelloAlma.

If clients will pay it, sure. That said, in my area, most folks build up to that fee after awhile, not necessarily start there.

Is that a typical session fee where you are for early career psychologists?

And yes, definitely get ready to give yourself a crash course on the No Surprises Act and how to be in compliance since the law is already in effect.

Any other specific questions you have?

 

[PX1985]

I don’t know a lot of folks who charge $200/session as early career psychologists in their first year of private practice, so I’m very curious about how HelloAlma can offer such a lucrative rate. That does mean that you must charge $200 or higher for cash paying clients outside of HelloAlma as well or else it’s considered fraud with HelloAlma.

If clients will pay it, sure. That said, in my area, most folks build up to that fee after awhile, not necessarily start there.

Is that a typical session fee where you are for early career psychologists?

And yes, definitely get ready to give yourself a crash course on the No Surprises Act and how to be in compliance since the law is already in effect.

Any other specific questions you have?

Yes! Many of my colleagues started charging around $200-$300 (most around $250) right out of postdoc (keep in mind, they are working in/around Manhattan, so this might skew things a bit).

No other specific questions right now!

 

[PX1985]

Your location is an oddball variable. The non-facility reimbursement for Medicare in Manhattan is ~$115, with an additional limit that allows about $10/hrs copay. So the telemedicine with Aetna is a ~60% increase in reimbursement. That fee probably comes with some Aetna specific rules on # of sessions, or treatment requirements, or whatever.

Advertising is only useful if you can answer "why would a patient come to you?". Do you have a specific skill set, unique aspect of your business, a subspecialty that is in demand, price point, etc. What is the realistic increased benefits of seeing you, relative to the cheaper option of a $30 out of pocket co-pay at Columbia, or going to someone on 5th Ave? Answer that, and you know who to advertise to, and how to sell your services. Otherwise, people usually get their client base through word of mouth (i.e., slowly).

Be careful with people trying to sign you up for telemedicine panels. They benefit from being able to say, "we have a kajillion providers" AND they benefit from not letting those providers do their work. If you're not paying for something, you are the product.

This is really good feedback. I have never submitted claims to insurance companies before, but are mental health services usually covered? I.e - do patients need to meed an in-network deductible before getting reimbursed? I've only ever been out-of-network.

 

[PX1985]

I'm not sure RE: competitive therapy rates, but if you're wanting to do any self-pay work, you will probably want to strongly consider opting out from Medicare. If you do also see patients with insurance, you'll of course also want to review your contract(s) with the insurance(s) with which you're paneled to see what restrictions they have.

You'll also definitely want to look into the No Surprises Act, which is going to be aimed squarely at the type of practice you're anticipating (i.e., primarily or solely self-pay).

That is very helpful!

 

[WisNeuro]

This is really good feedback. I have never submitted claims to insurance companies before, but are mental health services usually covered? I.e - do patients need to meed an in-network deductible before getting reimbursed? I've only ever been out-of-network.

Depending on their insurance plan, yes, they will need to meet deductible, and many will have co-pays per session. And, some insurance plans will have limits on sessions per year. Which, you may be able to exceed, but you will need to formally appeal for medical necessity.

 

[PX1985]

Depending on their insurance plan, yes, they will need to meet deductible, and many will have co-pays per session. And, some insurance plans will have limits on sessions per year. Which, you may be able to exceed, but you will need to formally appeal for medical necessity.

Thank you so much!

 

[PsyDr]

This is really good feedback. I have never submitted claims to insurance companies before, but are mental health services usually covered? I.e - do patients need to meed an in-network deductible before getting reimbursed? I've only ever been out-of-network.

1) mental health services are covered, unless the patient has an EXTREMELY old insurance plan.

2) you get paid regardless of their deductible status. You submit the insurnace form, insurance sends you back payment or an explanation of why they didn’t pay. In the case of a deductible, you send the insurnace form in, they tell you to bill the patient, you send the patient a bill and then you get paid. If the patient refuses to pay you, you send them to collections.

 

[PX1985]

1) mental health services are covered, unless the patient has an EXTREMELY old insurance plan.

2) you get paid regardless of their deductible status. You submit the insurnace form, insurance sends you back payment or an explanation of why they didn’t pay. In the case of a deductible, you send the insurnace form in, they tell you to bill the patient, you send the patient a bill and then you get paid. If the patient refuses to pay you, you send them to collections.

Sorry for the delay, but thank you!