Private Practice Insurance Rates

[jbomba]

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[clausewitz2]

Something between 200 and 250 an hour is not uncommon with two E&M+psychotherapy add-ons as an effective rate including accounting for no-shows.

 

[Sushirolls]

-If doing IP you will need to be paneled with Medicaid and Medicare; that's a long story and has implications with an outpatient PP
-Some parts of the country you could be getting a rate that is lower then medicare because the private insurance companies pay less then medicare. Medicare rates are public, and you can look those up online for the geographic area of interest
-If you have better paying insurance you can potentially yield more per hour then inpatient rates.
-inpatient places are likely to not do an old school set up where you do your own billings at your own rates, in part because some insurance do lump sum payments for the IP stay, and now your negotiating with the hospital to get your cut of the lump sum, good luck with that contractual black void.
-inpatient contracts are like casinos, the 'housepital' always wins
-hourly insurance rates can vary widely in a private practice (180-300), the bigger issue is overhead, and surpassing your overhead, each practice will have a point where patient volume will not only exceed overhead, but also hourly rate of the usual local jobs and actually be more lucrative. Could be at 10 hours of clinic time, or 20, or 30, or 35. Just depends.

 

[TexasPhysician]

Pgy3 here who has been thinking about a mix of pp and inpatient once I'm out. Trying to get a feel for what my income might look like. I know insurance reimbursement varies dramatically based on location. If you're comfortable, can you share what the hourly rate a psychiatrist in your area can generate from private insurance and the # pts per hour that requires?

Very broad question. $100-400/hr and the # varies as well depending on complexity, therapy only, therapy + meds, etc.

 

[NJWxMan]

Typical carrier contracted rates around $125-175 for initial psychiatric eval. Follow-ups (15-30 min) range from $65-95. In my community, most psychiatrists are dropping their insurance contracts and opting for cash only.

 

[TexasPhysician]

Keep in mind that insurance rates can vary highly based on negotiation strategies, # of physicians in the practice, patient volume, the side of the street that you are located, etc.

 

[Candidate2017]

From a quick perusal of the CMS fee schedule for Medicare, the ranges for different localities appear to be: simple visits $70-75, moderately complex $105-110, new $140-160, supportive add-on $70.

 

[finalpsychyear]

From a quick perusal of the CMS fee schedule for Medicare, the ranges for different localities appear to be: simple visits $70-75, moderately complex $105-110, new $140-160, supportive add-on $70.

1. medicare will only pay 80% of those rates and good luck with most of those patients without supplements collecting the rest. Also if you take medicare you'll probably get a few medicare/medicaid where you cannot bill them for the 20%.

2. In my area medicare is not only the highest payer but higher by about 15% from the next highest commercial assuming you got the full allowed amount.

3. the kicker is if you amass a certain number of medicare you must partake in MIPS which is very tedious and you get penalized pretty well for not which in my area most people stay away from medicare patients.

 

[finalpsychyear]

Keep in mind that insurance rates can vary highly based on negotiation strategies, # of physicians in the practice, patient volume, the side of the street that you are located, etc.

Its too bad those who accept insurance don't band together and have a 5-10 physician groups more often where they could get in theory much better rates for the same exact work.

 

[dl2dp2]

Its too bad those who accept insurance don't band together and have a 5-10 physician groups more often where they could get in theory much better rates for the same exact work.

This is interesting.

Though I suspect everyone is acting rationally. Total cost may be CHEAPER for insurance companies if they have a narrower provider network, since people who can't get access just decrease utilization. There's no mandate for how broad the network needs to be at the moment--only that the rate needs to be equalized for medical vs. behavioral health.

Meanwhile, given the fact that nobody's banding together means that in reality people are charging much higher rates.

 

[finalpsychyear]

This is interesting.

Though I suspect everyone is acting rationally. Total cost may be CHEAPER for insurance companies if they have a narrower provider network, since people who can't get access just decrease utilization. There's no mandate for how broad the network needs to be at the moment--only that the rate needs to be equalized for medical vs. behavioral health.

Meanwhile, given the fact that nobody's banding together means that in reality people are charging much higher rates.

I wouldn't call healthcare in the us rational in any sense of the term. Its all a scam. Every entity is about the money plain and simple camouflaged with some lingo about "patient care comes first." The one thing protecting socialization of medicine is the billion dollar pharma and private insurance keeping votes in their best interest.

One of my drives to reach FI is so i can basically do charity care only.

 

[Sushirolls]

Meanwhile, given the fact that nobody's banding together means that in reality people are charging much higher rates.

Or that its just a pain to work with a bunch of independent minded doctors. Or some one will be on vacation, or out of the office, or forget to file, or another will super scrutinize and have their lawyer re-draft a clause that everyone else agrees on, etc, etc.

 

[dl2dp2]

Or that its just a pain to work with a bunch of independent-minded doctors. Or some one will be on vacation, or out of the office, or forget to file, or another will super scrutinize and have their lawyer re-draft a clause that everyone else agrees on, etc, etc.

That's true, but it seems that in almost every other specialty people band much more. I'm guessing due to lack of equipment/overhead makes the field much looser. In my area, practices that take insurance are having problems recruiting new psychiatrists, and academic programs have either stopped taking insurance altogether or have specific carveouts that reimburse 2-3x Medicare rates. Talking to colleagues, this seems to be the trend on the coast, where there's significant demand but also a bifurcation of supply: insurance companies are willing to negotiate with large provider networks for behavioral healthcare, but these departments have problems expanding, presumably because they are STILL not paying enough.

In your current practice, at some point, what if you start charging a membership retainer for things like answering e-mails, etc.?

 

[TexasPhysician]

Or that its just a pain to work with a bunch of independent minded doctors. Or some one will be on vacation, or out of the office, or forget to file, or another will super scrutinize and have their lawyer re-draft a clause that everyone else agrees on, etc, etc.

There are groups that do this. Pros - higher reimbursement and some groups add things like PHP programs for additional revenue. Cons - someone in the group must be good at overseeing a centralized billing process, advertising, managing payments, problems, etc. You lose some autonomy as the group must have some things equal to work.

 

[dl2dp2]

Hot off the press! Insurance companies create fake parity by narrowing networks! Exactly what I said two posts above quantified.

Cost-Sharing Disparities for Out-of-Network Care for Adults With Behavioral Health Conditions

This cross-sectional study evaluates the cost-sharing payments for out-of-network care for insurance plan enrollees with mental health conditions, alcohol use disorders, or drug use disorders compared with those with congestive heart failure or diabetes.

jamanetwork.com

 

[Sushirolls]

In your current practice, at some point, what if you start charging a membership retainer for things like answering e-mails, etc.?

I would only consider that if doing cash only practice, but suspect I would have built into my fee structure a rate that would cover the extraneous rather then a separate fee - simple is best.

Currently most of the time when patients call or email its for a good reason, problem based, and that usually triggers, a "come on in and lets take care of that in the office" type response.

Forms/letter, I already bill out my time for, unless able to complete during the office visit.

 

[Sushirolls]

One of my drives to reach FI is so i can basically do charity care only.

At times I've chinned stroked and contemplated this type of future. But I've seen enough patients in Community mental health type settings who have no desire to effect change in their life, or more well off people who dump money into snake oil with Natruopaths and other remedies but balk at spending money on more efficacious interventions. Seeing these behaviors is pushing me away from the belief of charity care.
At least here in the US. World traveling experiences, yeah, there are some very legitimate needs for charity care.

 

[dl2dp2]

I wouldn't call healthcare in the us rational in any sense of the term. Its all a scam. Every entity is about the money plain and simple camouflaged with some lingo about "patient care comes first." The one thing protecting socialization of medicine is the billion dollar pharma and private insurance keeping votes in their best interest.

One of my drives to reach FI is so i can basically do charity care only.

I enjoy psychiatry and do well with it as a job in [almost] every aspect. I can't imagine a future where I would do charity care because I already made enough money. As a day to day job this job beats almost every other job, and to me is more interesting and engaging than many leisure activities.

You misunderstood also what I said. Insurance companies don't care about narrow networks because they realized that it's cheaper to reimburse at some OON fee schedule than increase network size because the former is cheaper as it decreases utilization. I never for one minute thought insurance cares about patient care.