How to Begin Fee for Service Private Practice

July 7, 2019
Anna Jankowska, LCPC

By Anna Jankowska, MA, CEAP, SAP, LCPC

Anna Jankowska is a mental health, addiction, and substance abuse counselor with over 17 years of experience and has specialized training and skill in working with individuals, groups and communities to improve mental health outcomes. NPI number: 1598843526

Many therapists dream of having a fee for service private practice but are hesitant to venture into it.

Some rely too heavily on insurance reimbursement and do not believe that they can generate enough income by charging clients directly. Others do not think that they possess specific skills that are needed to attract the type of clients who are willing to pay out of pocket.

I assure you that there is a smooth transition into fee for service private practice and it doesn’t have to be all or none. In the beginning, it could be just a simple addition to your currently existing practice, and with time and experience, you can ultimately transition into it when you evaluate the finances, the time and the effort you are investing into insurance billing.

There are two ways we can start thinking about generating income where clients can begin paying us out of a packet.

The first one is to evaluate your existing practice and the clients and ask yourself a question. Who are most of my clients? Can they afford to pay out of a packet? What type of specialty do you already have? Are you seen as an expert in this specific area? Do you like working with some specialty more than others? Do they value your expertise enough to stay with you if you transition to fee for service private practice?

Fee for Service Private Practice

These are only some of the questions, but they are crucial because they will give direction to your transition process. You might not realize, but your existing practice in the specific community is already providing you some guidance on your cash generating possibilities.

Just imagine you see clients from a variety of backgrounds, but they come to you predominantly for depression and anxiety issues. Let’s assume a majority of them are women with young children. You see them bimonthly making $ 80 a session through insurance reimbursement, but you have high absenteeism due to their kids getting sick. You can ask these clients if they are willing to participate in a support group for women on a weekly basis. You can always choose to bill insurance in which case you will receive about $20 per person per session, or you can ask clients for cash payments. If you have ten clients, it is $200 per session. If some clients do not want to pay out of a packet, you can bill their insurance. You can create a group consisting of both types of clients. Those paying out of a packet and those who are paying with insurance. Also, you are eliminating the problem of not getting paid at all due to high absenteeism. With a group of even a few clients, you might get some who will come in for their group sessions and continue as your individual clients. Additionally, community service agencies often lack resources for individual counseling and will be happy to refer clients for group counseling to you especially if the fees are below $20 per session. In many situations, they will even pay for the client’s counseling sessions.I have found this to be true with many of my clients, and I work with predominantly lower socioeconomic status clients. The idea of group counseling in one area of your expertise might often lead into other areas unexpectedly.

Just imagine that while running your depression/anxiety group you find out that some women struggle with parenting issues. You might then offer a parenting group. There are many possibilities, and they are only determined by your willingness to work hard in marketing yourself.

What I have described is just one of the ideas that might work for you or might not. It depends on your particular community and the needs of the clients.

The second idea about generating income with a fee for service is to create an area of practice that does not get paid by insurance. These could be any of the following: forensic psychology, seminars on any topic, infertility, adoption, court mediation, couples therapy, coaching, motivational speaking, giftedness, chronic diseases, divorce, career, life transitions, etc. You can become more creative and more purposeful in choosing a niche that is open to your interpretation and possibilities. You need to do some research in the specific area of your interest and decide which clinical specialty you enjoy working with and which one makes the most sense in your particular community. I have always known that I would have fee for service private practice specializing in forensics since I observed other people being successful in it. I was very purposeful in my endeavors after researching the educational and bureaucratic requirements, and I dove right in. It took me a few months to get certified in a few areas such as addictions, domestic violence, etc. and I got myself a job performing assessments and counseling for the courts. At that time, I was still in graduate school, but I already knew what I wanted to practice.

Take your time and do your research. Find out what drives you and how you want to help your clients. You might even create a practice out of something very unusual but still beneficial to your clients.
Only you know your passions and talents, and with the right planning, you can see yourself prosper.

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