IMG_1975In this ever-changing economic climate it has been more challenging for some Licensed Couple and Family Therapists than others to navigate establishing an hourly rate for private practice that keeps us within reach of our target demographic while enabling us to collect wages that are reflective of our education level, extensive training, and the hard work we do with and for our clients.  To some extent, the geographic location of our practice, our operating costs, our preferred client population, our gender, and even our racial and ethnic background can impact how we determine a client rate that keeps a steady flow of business moving in our direction. In my 10+ years of experience, with 7 being in some form of private practice, I have found this to be a delicate and ongoing process.

In addition, many of us are faced with the decision to accept insured clients or not. Whether our practices are located in an area where potential clients can easily afford to pay our preferred rate consistently and also see the value in the services we provide, or it’s not as important for some of us to maintain a full practice to ensure our economic stability, the question of including the portion of the population that only has access to mental health treatment if they are able to use healthcare insurance benefits to cover a greater portion of the cost is perhaps an ethical one that we grapple with. Like most business owners who have a primary goal of remaining profitable, CFTs in private practice must juggle the viability of our business with our passion for helping. The hard truth is that some who need our help the most simply can’t afford to pay our rate without the help of insurance. For clinicians who have endured the healthcare insurance paneling process, we know of the huge discrepancy that exists between what our time and clinical skills are worth and the rate at which insurance companies are willing to reimburse us. This poses a huge dilemma: If we decide not to accept insured clients can we still feel good about our efforts to reach those we set out to help? If we decide to accept insured clients and it leaves us undercompensated in ways that affect our livelihood and our professional self-worth, have we achieved our goals as business owners and clinicians?

I want to normalize the angst that can flare up periodically for all CFTs in private practice who have to make this tough decision. Based on all of the factors involved, choosing to accept or exclude insured clients is a very personal decision, and one that can change over time. Even the most seasoned clinician with a thriving practice full of private-pay clients can be periodically reminded of their desire to reach more people who are unable to afford their rate. I’ve been fortunate to serve so many clients who value and can afford my services. I have also remained paneled with one healthcare insurance company. This has been a gift for many reasons. First, the sheer volume of calls I’ve received from insured potential clients reminds me of how great the need is for what we provide, and that more and more insurance companies acknowledge a need for mental health treatment. Also, it is a rewarding feeling knowing that I have helped a client experience a life change that may not have occurred if their insurance company had not referred them to me and subsidized their out-of-pocket expense. Instead of focusing on the lower reimbursement rate, I choose to focus on my positive impact through my personal sacrifice. This provides balance for me. Since our work is a form of advertising, I have also gained clients from working successfully with insured clients. Lastly, I’ve enjoyed having a full practice over the years, and serving insured clients consistently has helped me to maintain that at times when the economy has put a severe strain on individuals and families who need help.  While this choice may not work for every clinician, it could be a precious gift to many potential clients as well as the giver.

Weena Cullins, LCMFT

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