1. The middle of the year is a natural break in the action from your practice and a time to take stock of your finances. Figure out the actual net income from your practice in the categories of insurance vs. non-insurance. Decide which clients would continue with you in the absence of insurance. This step requires an honest conversation with your clients explaining the limitations of taking insurance and why you are leaving the plan. This may require a compromise in payment and creative financing. Many clients are paying a copay of 50% of the usual and customary fee. If you slide your fee to accommodate their copay with an additional charged amount, that may do the trick.

  2. There is safety in numbers! If your client numbers are edging up to 20 per week, you may be in the perfect zone to drop insurance companies. Let’s do the math. Even if the majority of your clients are insurance based, it is safe to assume two things: Some will convert to private pay with accommodation for a period of time and some have become a referral source for non-insurance clients. If you have approximately 20 clients, you can probably afford to lose a portion, accommodate some, and convert others. Yes, there will be a dip in income as you change your financial strategy but if you have consistent numbers, the income will soon rise.

  3. This next strategy takes discipline and six good months of practice income! Set aside 10% of your take-home pay for 6 months. At the same time, go off your least favorite carrier. Your saved income should help reduce the deficit from the dropped company. Repeat every 4 to 6 months as you continue to save. Sometimes the process of just seeing what you can do without helps the process of letting go.

  4. Comfort in marketing is the key to a successful private practice. For our purposes, though, you only need one strategy that has paid off to insure you can repeat it time and time again. An example: Rosalind received many referrals while affiliated with three insurance companies. She also conferred with multiple primary care docs who have been a part of her clients’ treatment plans. Deciding to make the jump away from an insurance-based practice, she let the medical practices know what she was charging for full fee. She also gave them a heads up about her timeline so as not to leave them in a lurch with their patients. Finally, she secured three new referrals (still insurance-based) and let them know her timeline for ending her work with insurance. One caveat: She asked her referral sources to include her as an option AFTER the date she was opting out, and promised the same standard of care they had always enjoyed. While she did lose some referrals, Rosalind was a known entity of successful treatment and her colleagues enthusiastically endorsed her to their patients.

  5. I am a big believer in always having sliding slots in your practice. I think it promotes the reason we went into this business in the first place, and there is a tremendous need, always, for those who cannot afford therapy. That being said, I also believe it’s important to know your own income needs. When I reached the point in my practice when I could easily slide three to five slots, I also knew it was time to stop taking insurance. Why? I was confident enough to know that I was offering quality therapy at a fair price that happened to be a higher premium than insurance would allow. By consistently keeping my fee at the higher number, I then had more slots to slide. I had a weekly income target that was met, which gave me the luxury of giving back.

  6. Finally, after a few years of becoming an expert in my niche, cementing my referral relationships, and becoming comfortable with two or three different marketing techniques, I knew my worth. And it was about 30% more than my best insurance payout. I had my sliding slots available for those clients who needed them, and I had a thriving practice that was consistently filled. I left one insurance company after another over a period of 2 years, all the while letting my insurance clients know my timelines and creative payment options. When I became truly comfortable knowing my worth, I left my last insurance company behind.