- "The cost of doing business is increasing, so even if the dollar amount of income hasn't changed, there is still a decrease in real income."
- "We have to continue to work harder for less money. Insurance companies are less antagonistic, but still cautious in giving money."
- "Tricare has reduced their rate of pay, which has counteracted my increased business."
- Comment: "Only my pie-in-the-sky wish that insurance would use the same universal pricing and forms and processes. And that it would be a reasonable fee. Sigh."
- I have considered going to a cash payment only, letting the clients complete the insurance paperwork, to decrease my time doing paperwork and billing, but I'm not sure doing this would work. I could reduce my fees this way and simplify my practice, leaving more time for therapy hours. In terms of pricing, I don't really have a standard fee since insurance plans pay differently. I reduce my fee for people who are financially strapped and I also do some pro bono work."
- "Transportation has been a large issue for low income clients, which means cancellations and 'no shows.'"
- "I do some pro bono (work) and also lower my fees for those without insurance, so I really don't have a "standard" rate, nor have I calculated my average fee."
- I would hope that APPT and others across the nation would stand up to managed care companies and let them know with our education and licensing, we do not deserve to be paid less than our mechanics working on our cars!! Even the heating/plumbing tech and the man who cleaned our carpets made more than we as LIMHPs make per hour! Pretty sad, huh?"
- Nebraska has a new law regarding not reimbursing provisional psychologists have made it nearly impossible to attain enough hours or income (forced to take sliding scale as low as $10!) to remain a psychologist in Nebraska.
- "I think it would help if fees were standardized somehow. Also, it would be great if there were some way to provide services for those who are low income or uninsured that did not put us at risk for claims of insurance fraud. We really need some way to have a legal and appropriate sliding fee scale when in private practice."
- "Tricare rates have plummeted the past two years and are now below the reimbursement level for both Medicaid and Cigna."
Comments About Pricing
On the survey of private practice therapists related to pricing/fees, we also asked therapists to share their comments about the topic. Here were some of the responses:
APPT Pricing Survey
Want to know what other private practice therapists in Nebraska charge? The Association of Private Practice Therapists conducted a survey of its members between July and September 2008, receiving 48 responses.
To give you an idea of the background of those responding, 30 percent of therapists have been practicing for 1-5 years; 20 percent for 6-10 years; and 17 percent for 11-15 years. Another 17 percent have been in practice more than 25 years. Please note that survey responses may be skewed towards younger, more technologically savvy therapists, as the survey was administered online.
The majority of therapists who completed the survey are masters degreed therapists -- 76 percent practice as a LMHP, LCSW, LMFT, or LIMHP. Another 14 percent have a Ph.D. but practice as a LMHP. Four percent practice as a Ph.D., while 6 percent are provisionally licensed.
The size of practice environments represented in the survey responses were quite diverse:
Despite declining insurance reimbursement rates, therapists continue to rely on managed care and insurance for the majority of their practice income. Eighty-eight percent of therapists report that less than a quarter of their income is from private pay. Only one therapist derives more than 75 percent of his/her income from private pay sources.
Therapists reported an average fee of $107.34 for an individual session. Fees ranged from a low of $60 to a high of $150, with $95 as of the most-cited fee (23 percent).
When asked the highest fee they are paid by an insurance or managed care company for an individual session, the average was $97.69 (91 percent of the average "standard" fee).
With insurance or managed care, therapists report an average "lowest fee" of $53.05 for an individual session, just under half of the average "regular" session fee.
The "lowest" fee paid by an insurance or managed care company was reported to be $30, with $60 the most often-cited lowest fee.
When it comes to couples/family sessions, the average "standard" fee is $119.02, with a low of $65 and a high of $210.
The responses for the highest fee reimbursed by managed care sessions for couples and family sessions ranged from $65 to $175, with an average of $102.42 (86 percent of the standard fee).
The lowest managed care fee for a couple or family session was $59.45, with lowest fees ranging from $30 to $110.
Therapists were asked to describe changes that affected their change in income. Among those citing an increase in practice income, taking on more clients ("working more!") was the most often-given reason. To attract new clients, therapists report doing more consulting/supervision, incorporating in "niche" treatment options, doing more work in the legal system (especially DUIs), networking more, and generating EAP referrals.
For those who reported a decrease in practice income, higher operating expenses and lower reimbursement rates are the key factors, although variability in client load, an increased number of clients who are unable to pay copayments or deductibles (or without insurance entirely), and fewer private pay clients were also cited by numerous respondents. Other factors were therapists who were out of the office with an illness for a period of time and those who decided not to accept new Medicaid clients.
Other relevant statistics:
Number of hours (on average) therapists report seeing clients and performing administrative tasks:
© 2008, Association of Private Practice Therapists. Please contact the APPT Administrator at (402) 393-4600 if you would like permission to reprint these results. For membership information, visit privatepractice.org.
To give you an idea of the background of those responding, 30 percent of therapists have been practicing for 1-5 years; 20 percent for 6-10 years; and 17 percent for 11-15 years. Another 17 percent have been in practice more than 25 years. Please note that survey responses may be skewed towards younger, more technologically savvy therapists, as the survey was administered online.
The majority of therapists who completed the survey are masters degreed therapists -- 76 percent practice as a LMHP, LCSW, LMFT, or LIMHP. Another 14 percent have a Ph.D. but practice as a LMHP. Four percent practice as a Ph.D., while 6 percent are provisionally licensed.
The size of practice environments represented in the survey responses were quite diverse:
- 27 percent are solo practitioners
- 25 percent are in a group of 1-3 other therapists
- 17 percent practice with 4-6 therapists
- 27 percent practice in a group of 7-10 other therapists.
Despite declining insurance reimbursement rates, therapists continue to rely on managed care and insurance for the majority of their practice income. Eighty-eight percent of therapists report that less than a quarter of their income is from private pay. Only one therapist derives more than 75 percent of his/her income from private pay sources.
Therapists reported an average fee of $107.34 for an individual session. Fees ranged from a low of $60 to a high of $150, with $95 as of the most-cited fee (23 percent).
When asked the highest fee they are paid by an insurance or managed care company for an individual session, the average was $97.69 (91 percent of the average "standard" fee).
With insurance or managed care, therapists report an average "lowest fee" of $53.05 for an individual session, just under half of the average "regular" session fee.
The "lowest" fee paid by an insurance or managed care company was reported to be $30, with $60 the most often-cited lowest fee.
When it comes to couples/family sessions, the average "standard" fee is $119.02, with a low of $65 and a high of $210.
The responses for the highest fee reimbursed by managed care sessions for couples and family sessions ranged from $65 to $175, with an average of $102.42 (86 percent of the standard fee).
The lowest managed care fee for a couple or family session was $59.45, with lowest fees ranging from $30 to $110.
Therapists were asked to describe changes that affected their change in income. Among those citing an increase in practice income, taking on more clients ("working more!") was the most often-given reason. To attract new clients, therapists report doing more consulting/supervision, incorporating in "niche" treatment options, doing more work in the legal system (especially DUIs), networking more, and generating EAP referrals.
For those who reported a decrease in practice income, higher operating expenses and lower reimbursement rates are the key factors, although variability in client load, an increased number of clients who are unable to pay copayments or deductibles (or without insurance entirely), and fewer private pay clients were also cited by numerous respondents. Other factors were therapists who were out of the office with an illness for a period of time and those who decided not to accept new Medicaid clients.
Other relevant statistics:
Number of hours (on average) therapists report seeing clients and performing administrative tasks:
- Fewer than 10 hours - 6 percent
- 11-20 hours - 10 percent
- 21-30 hours - 27 percent
- 31-40 hours - 21 percent
- 41-50 hours - 21 percent
- More than 50 hours - 13 percent
- Other - 2 percent
- No change - 27 percent
- Decrease of 1-25% - 23 percent
- Decrease of 25-50% - 6 percent
- Decrease of over 50% - None
- Increase of 1-25% - 38 percent
- Increase of 25-50% - 6 percent
- Increase of over 50% - None
- $90 - 9 percent
- $95 - 23 percent
- $100 - 11 percent
- $110 - 19 percent
- $120 - 9 percent
- $125 - 9 percent
© 2008, Association of Private Practice Therapists. Please contact the APPT Administrator at (402) 393-4600 if you would like permission to reprint these results. For membership information, visit privatepractice.org.
Magellan Announces Provider Changes
In June, Magellan announced changes to their provider contracting system primarily affecting provisionally-licensed therapists. Here is the text of that letter:
Dear Provider:
As you are aware, Magellan Behavioral Health* (Magellan) manages mental health and substance abuse services for Nebraska Medicaid Managed Care Plan (NMMCP) members. In collaboration with the Division of Medicaid and Long-Term Care, Magellan is implementing changes in policies regarding the inclusion of provisionally licensed clinicians for the NMMCP provider network. These changes are applicable to provisionally licensed psychologists, provisionally licensed mental health practitioners (PLMHPs), and provisionally licensed alcohol and drug abuse counselors (PLADCs).
Effective July 1, 2008, we will implement the following guidelines regarding the inclusion of provisionally licensed clinicians for the NMCCP provider network:
Dear Provider:
As you are aware, Magellan Behavioral Health* (Magellan) manages mental health and substance abuse services for Nebraska Medicaid Managed Care Plan (NMMCP) members. In collaboration with the Division of Medicaid and Long-Term Care, Magellan is implementing changes in policies regarding the inclusion of provisionally licensed clinicians for the NMMCP provider network. These changes are applicable to provisionally licensed psychologists, provisionally licensed mental health practitioners (PLMHPs), and provisionally licensed alcohol and drug abuse counselors (PLADCs).
Effective July 1, 2008, we will implement the following guidelines regarding the inclusion of provisionally licensed clinicians for the NMCCP provider network:
- Provisionally licensed clinicians who are currently NMMCP network practitioners in private or group practices will be "grandfathered in" and will remain in active status in the NMMCP network for up to two years, or July 1, 2010. As of July 1, 2010, practitioners must be fully licensed to continue network participation in private or group practices.
- Provisionally licensed clinicians who are employed by an NMMCP-contracted organization will continue to be accepted for network participation. However, provisionally licensed clinicians who terminate their employment from an NMMCP-contracted organization will not be eligible for network participation in group or private practices until such time they become fully licensed.
- Provisionally licensed clinicians who are not currently credentialed and contracted for the NMMCP provider network will not be accepted for network participation in private or group practices.
- In order to remain in active network status, existing NMMCP network practitioners in private or group practices who have a provisional license due to expire prior to July 1, 2010, must become fully licensed prior to the expiration of their initial provisional license. Practitioners will not be allowed to continue network participation on a renewed provisional license.
APPT Survey: After-Hours Emergency Policy
Recently, the Association of Private Practice Therapists conducted a survey of its members to determine if there is a local standard for how after-hours emergency calls are handled.
The survey was commissioned by the APPT Board of Directors in response to an insurance/managed care company's request for a therapist's after-hours emergency policy.
The full results of the survey will be reported in the October 2008 issue of The Compass, the newsletter of the Association of Private Practice Therapists. Beyond the results, however, it appears as if therapists may be struggling with their ethical requirement to serve clients with the practical applications of after-hours service -- of particular issue with sole practitioners.
"We have maintained the cost of a 'company' cell phone and a live answering service for many years," one therapist writes. "We have begun to question the need and utility of this, and will likely drop this soon. At the end of the day, if someone has a crisis that is life-threatening, talking to us just delays going to the hospital."
The survey was commissioned by the APPT Board of Directors in response to an insurance/managed care company's request for a therapist's after-hours emergency policy.
The full results of the survey will be reported in the October 2008 issue of The Compass, the newsletter of the Association of Private Practice Therapists. Beyond the results, however, it appears as if therapists may be struggling with their ethical requirement to serve clients with the practical applications of after-hours service -- of particular issue with sole practitioners.
"We have maintained the cost of a 'company' cell phone and a live answering service for many years," one therapist writes. "We have begun to question the need and utility of this, and will likely drop this soon. At the end of the day, if someone has a crisis that is life-threatening, talking to us just delays going to the hospital."
Magellan Health Offers Online Learning Tools
Magellan Health Services Inc. is offering therapists a new online learning center designed to reinforce resiliency and recovery principles. The Magellan Resiliency and Recovery e-Learning Center enables consumers, families, and providers to effectively apply the principles of hope, choice, empowerment, and education to help achieve individual behavioral health goals.
The e-Learning Center offers broad access and greater convenience than traditional on-site learning programs, and without the expense. It's a free resource that currently hosts 10 interactive "e-courses" in Spanish and English, offering in-depth strategies and techniques for promoting resiliency and recovery. The e-courses include testimonials of personal experiences that provide motivation and each can be completed in 30-45 minutes.
Magellan providers are able to receive Continuing Education Units (CEUs) for completing the e-courses. Magellan is approved as a continuing education provider/sponsor by the American Psychological Association, Association of Social Work Boards, National Association of Alcohol and Drug Abuse Counselors, and the National Board of Certified Counselors.
The e-Learning Center offers broad access and greater convenience than traditional on-site learning programs, and without the expense. It's a free resource that currently hosts 10 interactive "e-courses" in Spanish and English, offering in-depth strategies and techniques for promoting resiliency and recovery. The e-courses include testimonials of personal experiences that provide motivation and each can be completed in 30-45 minutes.
Magellan providers are able to receive Continuing Education Units (CEUs) for completing the e-courses. Magellan is approved as a continuing education provider/sponsor by the American Psychological Association, Association of Social Work Boards, National Association of Alcohol and Drug Abuse Counselors, and the National Board of Certified Counselors.
August 15, 2008 Meeting Agenda
Conversation with Medicaid/Magellan for Private Practice Therapists:
What the LIMHP means to you, Documentation and other Requirements,
Impact of LIMHP on other Insurance Panels, and More
Mahoney State Park
August 15, 2008
8:15-12:15 PM
8:15 – 8:45 Networking and check-in
8:45 – 10:00 Medicaid/Magellan speakers
A. LIMHP versus LMHP
B. Definition of “supervision” versus “consultation” in private practice
C. Documentation and bookkeeping requirements for Medicaid/Magellan
D. Definitions unique to Medicaid (ie. family therapy)
10:00 – 10:45 question and answers
10:45 -- 11:00 Break
11:00 – 12:00 Erickson & Sederstrom: Legal issues
A. Medicaid Federal Audits
B. What does the LIMHP status mean for private practitioners in Nebraska
C. LIMHP versus LMHP and provider panels
D. Good Documentation
12:00 – 12:15 Q & A
Don't Need Any New Clients?
Congratulations. You don't need to read this post.
For everyone else, you may already know that as soon as you stop seeing new clients, your practice begins to stagnate and die.
Even if you have clients who are committed for life -- things change. People move. People die. People are "cured" and no longer need your services. Natural attrition is reason enough for you to continually seek out new prospects for your services.
Your success as a private practitioner depends on five things. They are:
For everyone else, you may already know that as soon as you stop seeing new clients, your practice begins to stagnate and die.
Even if you have clients who are committed for life -- things change. People move. People die. People are "cured" and no longer need your services. Natural attrition is reason enough for you to continually seek out new prospects for your services.
Your success as a private practitioner depends on five things. They are:
- Your ability to assess the needs of your clients.
- The ability to provide services that meet your clients' needs.
- Skill in communicating the benefit of your services.
- Providing follow-up to keep a loyal and satisfied clientele.
- Developing and maintaining a professional network as a referral and support system.
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