Out of Network Transition

[Dr. Pookie]

Hello all. For those in outpatient private practice, I have been accepting insurance for a while and was considering transitioning to out of network, as I'd like to be able to set my own fees (and not deal with all the admin associated with insurance) and I notice that many psychiatrists (and NPs) around me are all OON. I'm feeling a bit nervous about transitioning, as I imagine I will lose most of my insurance caseload in the process. I wanted to see if anyone who has started out with insurance and then transitioned to OON has any advice on easing the transition and how it went for you. Perhaps some things I should consider as I make this shift? Thanks very much.

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[PikminOC]

Hello all. For those in outpatient private practice, I have been accepting insurance for a while and was considering transitioning to out of network, as I'd like to be able to set my own fees (and not deal with all the admin associated with insurance) and I notice that many psychiatrists (and NPs) around me are all OON. I'm feeling a bit nervous about transitioning, as I imagine I will lose most of my insurance caseload in the process. I wanted to see if anyone who has started out with insurance and then transitioned to OON has any advice on easing the transition and how it went for you. Perhaps some things I should consider as I make this shift? Thanks very much.

Have a lot of money saved up as it takes time to build up an oon practice

 

[Sushirolls]

I cut out one insurance, that was about ~23% of my panel. A larger national one, that was also relatively cheaper for businesses to acquire.
I'd estimate only 10% converted to cash pay and stayed. But my former area was also saturated with Psych, so it had an impact on that conversion, too. If you want a more reflective number, it's buried some where in the 'Private practice in progress' thread.

In summary, I am an N of 1 who says 10% conversion.

 

[michaelrack]

I guess it is possible to bill insurance out of network, and this is done sometimes in specialties like ER.
I don't see the advantages for a psych practice. Just stop taking some or all insurances (after properly terminating contracts).
The charge patients cash. You could give them a superbill they can submit to their insurers if they wish.
On the other hand if they're is a particular insurer where you think it would be financially worthwhile to bill out of network, I guess you could do that but I don't think it would make sense to do an entire OON practice

 

[Sushirolls]

I discourage submitting bills to insurance companies as OON.

Submit claims if in network, and everyone else is cash pay. Provide the cash pay a super bill they can submit themselves if they request.

I say this, because I have sampled submitting to some insurance companies I knew I was OON or didn't know I was OON for. There are some that submit an EOB to you and the patient saying the patient owes nothing, you can't collect anything, and they won't pay you anything. Of course, you are OON and they can't say that, but on the chance the patient reads that EOB and gets snarky, do you really want that headache?

Keep it simple. Those you are in network with submit per usual to the insurance company. Everyone else gets the cash pay rate (and superbill only if they request it).