To Take or Not to Take Insurance: Navigating the Group Practice Conundrum

To take or not to take insurance, that is the question: Deciding whether to accept insurance as a group practice owner is a pivotal choice that intersects accessibility, revenue, autonomy, and client relationships. In this thought-provoking episode, we delve into the considerations, pros, and cons of embracing insurance and how it shapes the landscape of your practice.

Jamie (she/her) guides us through the multifaceted dimensions of this decision. We explore the accessibility insurance offers to a broader client base and the potential increase in client volume. Our discussion takes us into the complex realm of reimbursement rates and coverage, with a focus on their impact on your practice's financial health.

The episode uncovers the administrative burden associated with insurance paperwork and billing, posing questions about your practice's capacity to manage these intricacies. We address the trade-off between a steady revenue stream and potential limitations on clinical autonomy, as well as the credibility and patient retention that can result from being in-network with insurance providers.

Listeners gain insights into the hybrid model – a strategic blend of insurance and private pay options – as a means to accommodate diverse client needs. [Host's Name] underscores the importance of research, financial evaluation, and networking within the field before making a decisive choice.

As the episode progresses, Jamie introduces three thought-provoking questions that encourage listeners to delve deeper:

1. Strategic Alignment and Client Focus:
   How can the decision to accept insurance align with your practice's mission and values, and what impact might it have on tailoring services to your target client demographic?
2. Financial Resilience and Diversification:
   How can you strike a balance between the security of steady insurance reimbursements and the potentially higher revenue of private pay, enhancing your practice's financial resilience in changing economic climates?
3. Top Action Steps:
   • Investigate insurance options within your energy and time constraints.
   • Assess the needs of your clients and evaluate your current flow of inquiries.

This episode deepens the understanding of the pivotal decision to accept insurance as a group practice owner. Whether you're a seasoned professional seeking to revamp your strategy or a newcomer navigating this complex landscape, the insights shared here will help you make a well-informed choice that aligns with your practice's mission, values, and financial goals.

Join us as we unravel the intricate web of insurance acceptance, guiding you through the maze of accessibility, autonomy, and adaptability.

Transcript

Speaker 1: 0:00

Welcome to Blissful Biz Adventures, succeeding without sacrificing happiness, ready to discover the path to success and fulfillment, join a vibrant community of dreamers excelling in both realms. I'm Jamie, a CEO and multi-business owner leading a growing group practice of 12-plus dieticians. Let's embark on a transformative journey where contentment and success go hand in hand. Okay, let's dive right in. This one is going to be a fun one. I have a love-hate relationship with this whole topic For real. It's been an experience taking insurance, for sure, and also I am so glad I do take insurance for so many reasons, and we're going to talk about all those considerations today.

Speaker 1: 0:46

Deciding whether to take insurance is a very common question that people come across and it's a significant decision and it evolves at the same time. A lot of considerations. So we're going to talk about the key factors, as well as the pros and cons, considerations to make and some questions and planning that you yourself can take on to really assess and see if taking insurance is right for you, your clients, your business, your future and your goals. Okay, so, diving right in, let's go ahead and talk about the different considerations that I would highly suggest considering as you're moving forward with deciding if you want to take insurance or not. So, whether you are a solo practitioner or if you are a group practice owner, these are really important to consider. So the first one is going to be client accessibility. Accepting insurance can, of course, make your services a lot more accessible to a broader range of clients who have insurance coverage, and this can, of course, help many more folks. So if you're wanting to be that accessible group where you don't have to turn clients away and say, no, I can't help you, this is, of course, taking insurance is going to create more accessibility. I know there is a lot to this and there's other ways to create accessibility, like by providing free services, reduced services, for sure, absolutely, and I also hear the argument a lot that this system is messed up and so we don't want to be part of the problem. However, I really argue against that and say, well, we need to get into it then, to fix it from within and advocate from within, and our clients unfortunately, I mean and us, we all do rely on insurance at this point of time. So that's what we have, that's what we have to work with, and we really don't want to punish our clients for that reason. And again, there's a lot of considerations here. So, as we're moving forward, I really don't want to say I'm on one team or the other or say there's a right or wrong, good or bad. There's just considerations, pros and cons, and you need to make this decision for yourself and assess where you're at, what you can do, what you want to do, and, yeah, there's just so much to assess. So there's no right or wrong. I don't want anyone to come away thinking that you are not doing a good job or the right thing if you do one or the other. So, anyways, of course, considerations is going to be client accessibility.

Speaker 1: 3:44

The next thing you want to consider is going to be reimbursement rates and coverage. This is really important to do your research about the type of coverage that insurance carrier can provide and the reimbursement rates that it offers, and so you want to look at all possible insurance companies that you are considering taking that your clientele has, because they're all going to be very different and they also are very state to state. So some plans might offer lower rates compared to private pay rates, while some may do equivalent, some may do a bit higher. It just really depends on the insurance company and the state you are in the contract you get and all of that. So what I would suggest here is to go to your local providers and see if they are willing to tell you a little bit more about the not only the coverage. Will they cover what you see? So if you see eating disorders, like I see, your questions you're going to want to ask are with this specific insurance plan, do they cover eating disorders? Do they cover all types of eating disorders? How many sessions do they cover? If you're working virtually, you want to ask do they cover virtually?

Speaker 1: 5:05

You really want to get the ins and outs of what it's like to take that insurance and what the coverage is going to be like. Because if you move forward with the process of taking that insurance only to find out that they don't cover what you see, well then this was pointless to do so. And the other thing you want to consider is reimbursement. If you do not, if you find out that reimbursement rates are so poor that if you take that insurance, it's going to really hurt you and hinder your practice and just you're going to go under because you're taking that specific insurance and you can't pay expenses, you can't cover expenses and all of that, that's going to be a huge problem, right?

Speaker 1: 5:49

And so you really want to find out well, is this reimbursement along with the other? You want to take everything into mind, right? Like if you're going to take private pay and a few different insurances, you want to see, well, what's my average? Can I take this insurance? Will I be okay? Will I will? I? Will this support my, my practice? Okay, so important questions you want to ask and again, like I said, I would go to providers near you and ask them a bit more my experience, I'll give a little bit of my experience in all of them.

Speaker 1: 6:23

Again, initially going getting insurance contracts with these different insurance companies, I didn't know about reimbursement and I didn't know about coverage because I didn't know about insurance. I just thought this means I can take their insurance. I'm sure it will be, it will be appropriate rates. I just had no idea. So you really want to save yourself that time, energy, headache, all that strain by doing that research for first and really, again, it really varies between the different insurance companies. Some reimburse fairly well, some are very close to private pay rates, and then there are some that are just plain awful, that you will not want to take if you want to survive, because you will have to cap that and it's really hard to cap how many clients who have this type of insurance that you take, right, okay, so next one.

Speaker 1: 7:19

The next one is going to be the administrative burden. What is it going to take for you to be able to take insurance and deal with insurance paperwork? Do the billing, do the authorization process, check benefits, right, all that comes with billing I personally and then who's going to do that billing to right? Do you have someone? Are you going to get a bill? Or that administrative burden Then is really time consuming. It can be confusing and complex. There are a lot of folks who do their own billing and they are they accelerated. It doesn't take a long time and you can absolutely do your own billing, but I would consider whether you have the resources and the time, or if you've been want to have to manage that administrative part of it because you want to ask yourself do I want to do this? Am I going to do this effectively? Do I know what I'm doing? Do I have the bandwidth to learn about it? Because, again, it's time consuming, it is complex, it's a learning curve. I myself, right when I started taking insurance, I also found a bill or two to help me because it was a lot. Another part of it is if you want to do it yourself.

Speaker 1: 8:35

What's tough is you're going to have to have hard conversations with clients whether that might be that their insurance told them the incorrect thing and they actually don't have coverage and now they owe for X amount of sessions. That's a really hard conversation to have to do. It's hard to hold your boundaries when you're speaking to someone and you really want to do all you can to help them out right. You need I needed, and I would really highly consider you or urge you to consider having a barrier, having boundaries around your work in the billing department, whether it's for you and your dieticians. It's helpful to have a separate billing department dealing with that kind of stress, because it is stressful. It is stressful. I would absolutely say that, in addition to that time consuming nature of insurance, the complexity of insurance and taking insurance, it also can create an emotional toll. When you are trying to be that person who is the middleman, you're just taking the insurance right, but you're not the insurance company. But when the insurance company does wrong or doesn't give you the right information or is being extremely frustrating. You're going to get you're going to hear a lot of that and many times that the practice is blamed by clients often, especially if they're just not familiar with using their insurance, depending on the age of the in demographic of your clientele.

Speaker 1: 10:13

Okay, so I'm going into pros and cons a little bit. I'm not trying to, I'm trying to just give you the considerations. But the next consideration is going to be network participation. So you're really, when you are participating with insurance companies, they might require an adherence to specific guidelines, regulations. For example, you need to make sure your chart notes look a certain way in case you are audited. So you'll want to really be familiar with what does it mean to be an in network provider? What do I need to adhere to comply to? What are these regulations that I have? Okay, and that's important too, when you're getting into working across state lines, where does the provider need to be in order to see someone virtually in a different state?

Speaker 1: 11:02

All of the ins and outs of the insurance contracts, which they do provide that information in the contracts, yeah, so next one is going to be financial stability. This is going to be very important because if you're taking insurance, you have to consider that there might be changes in reimbursement, changes in coverage, delayed payments all that can impact your practice's financial stability. Additionally, I said some of the things that make it hard to take insurance financially. Where there are changes, there is there can be a slowdown or a delay and I want to say you can absolutely put things into place to help you with that, to cushion that, to make sure you are stable when those things happen and to be able to deal with that. But also there's a lot of financial stability in the pro, on the pro side of things, which is going to be. You do get to say yes to a lot more clients and you do have, you know, a lot. You have a population who will be most likely able to see you for longer because they can use their insurance. And again, if the reimbursement is really low, that won't matter, because you can't cover, you won't be able to cover expenses, it won't matter. But if you have a variety of insurance companies that all average out to a pretty decent amount to be able to continue to provide services, have profit in the business, do the things you want to do, then that creates a lot of financial stability, especially in rough times.

Speaker 1: 12:39

So, specifically right now, the economy is tough and there are a lot of people struggling. So it's really tough right now and clients can. They're not able to prioritize things they may have once been able to prioritize, including medical, mental health, physical health, just in themselves. They have to do the necessity. So being able to invest maybe in therapy or in eating disorder recovery or substance abuse recovery, whatever it might be that might be put on the back burner because they just cannot afford those services. However, if they have insurance that covers and they might just have a small copay or no financial they don't have to pay anything to get those services then during rough times your business is going to be a lot more stable because it can still see clients, can still take insurance and so it can still have its doors open and continue to serve maybe the same amount of clientele in a harder time than they were able to do in a time where the business was thriving a bit more because the economy was good. So things you really want to consider right now it is a rough time taking. Most clients are using their insurance about 90% of our clients right now and although a mixture of private pay and insurance is going to what I have seen, do the best for us and help us offset some costs with taking insurance. We are still able to stay open. We're still able to do the things that we need to do, like take care of our dietitians and pay our expenses right. Although hard at some times, we're still able to do that, so it can really help you to be stable as well.

Speaker 1: 14:39

And look, I went into pros and cons and I was just trying to do consideration. So last consideration, and then I'm going to go into the nitty-gritty of pros and cons. So the next consideration is client relationships. Of course, being able to take insurance and I guess this would fall under accessibility but you're able to be able to continue seeing them. If they are able to continue seeing them continue seeing you because you take insurance, so you'll have the client retention is there. The next thing, though, with client relationships you want to consider is some clients might prefer their privacy and the flexibility of private pay, and that is something that is to something to consider. Clients are going to feel differently about you taking, about wanting to use insurance versus not. Depending on the privacy they want, the flexibility, they want the savings, they want with insurance coverage and all of that. So it will impact your client relationships to a degree.

Speaker 1: 15:44

Okay, now let's get into the pros and cons. We're going to swap this. Let's first talk about the cons so we can end with the pros, just to end on a positive note Again, no right or wrong, but just to end on a positive note here. So, cons of accepting insurance Now we're going to go into the common insurance barriers in a different episode. What are the most common barriers that people that take insurance hit? What are the problems that they face, the things to be prepared for and that's going to be another episode, so stay tuned for that.

Speaker 1: 16:22

But going into the cons of accepting insurance, the first one is going to be lower reimbursement rates. So insurance companies often reimburse at lower rates than private pay and that's potentially or definitely going to affect your practices revenue. So you have to consider what you are able to do, where's your line? What do you need to make sure you get for that that amount of time you're providing that service, like what is your number, to make sure you're doing okay and go for those insurance companies. Don't do that insurance company. That is going to put you under Right. So you have to consider that there are going to be lower reimbursement rates than if your private pay and your private pay rate you get to decide. So if you're 100% private pay, you can count on what you created, what you decided to be your private pay rate. Now again, there's pros and cons to that, because if you're not able to see as many clients or they're you're not as accessible, or your clientele needs to use their insurance, you're in trouble if you're just doing private pay. So what I so the cons is lower reimbursement rates, but what I would say is that you can absolutely consider which insurance companies you go for, which can be great.

Speaker 1: 17:46

The next con is, as mentioned, for the consideration is that administrative burden I'm just going to so. It's time consuming, it requires staff, it requires resources, it requires problem solving. There is definitely an administrative time, energy burden. I mean, just this year we have taken so much time up trying to figure out problems we had with a certain insurance company which really affected cash flow, which upset clients, and it really had nothing to do, absolutely nothing to do with us as providers, with our group practice, and it was a surprise, it was all of a sudden. We're having a lot of problems with this specific insurance company. They keep denying claims, they're asking for money back and the clients are then getting upset with us, leaving us bad Google reviews, no matter how much we communicate, no matter how much we try, and it just created a lot of extra work for me and our billing team. However, when you go through those hard things and this was the first I would say this was the biggest thing that affected us with insurance so far the biggest barrier, the biggest time suck. But we came out of it stronger, with more boundaries, understanding what can happen, what we need to do to protect ourselves against it if other insurance companies have a similar issue and we're experiencing the same thing. So out of the fire always comes something really good. But you do wanna consider the administration burden because you do need to pay a bill or you do need to spend more time. You do have more problem solving billing is more complicated, it takes more time, it takes our longer amount of time.

Speaker 1: 19:34

Next one is gonna be limited autonomy. Again, insurance can really dictate treatment plans, session frequency, other aspects of care, and that really limits your clinical autonomy. And that's really hard to deal with because when, for example, us seeing eating disorders and the insurance company is saying, hey, no, we don't cover eating disorders, we cover only diabetes. Right? We're like that's so frustrating you won't even consider covering this condition. That is. So it's so necessary to have weekly sessions and to get that continued support and it's not on your radar or not of importance enough to cover. That's extremely frustrating. So you're having this limited autonomy where insurance companies who are unaware of those needs do not, you know, may have no awareness around. What is an eating disorder? What is coverage for an eating disorder? Why do we need this? How do people all of that right? They have no idea, but they're dictating treatment plans, how often a client can be seen in other aspects of care. So that one's a really tough one.

Speaker 1: 20:47

Next one is gonna be the credentialing process. It's not too too tough, but it does require some time and sometimes it could be a while. Sometimes they don't accept you, sometimes they will just elongate the process. One time we had a dietician who was in the process of getting credentialed for over a year Now. This is not typical and guidance on this. Get support with this from someone who's done it before. Really, with all of this, get support. But it's not too tough, but there is a process you have to go through that is time consuming and energy consuming.

Speaker 1: 21:28

Next one is gonna be delayed payments, and I kind of alluded to this before as a con. There can be some significant delayed payments. Usually it's you're behind on cash flow for sure, because it takes a while to submit the claim, to get the claim back, sometimes, if it's denied, resubmit the claim and it takes some time for the insurance company to go through that and approve it and for you and the client to get EOBs back which are explanation of benefits Saying what the copay is, what the benefits are if it was covered, and you can check this. But it's really you don't really find out what it actually is until you get that EOB back. So it can affect your cash flow, cause it is delayed, and we experienced it where we were behind on insurance payments for like eight months. It took eight months for them to accept a large amount of claims or deny a large amount of claims and of course that's going to really affect the practice, really affect you and affect the clients who then may have to pay, finding out way later that although they were told they have benefits, they do not have benefits.

Speaker 1: 22:40

So delayed payments I'm probably scaring you all, but remember, I take insurance. I take insurance and I wouldn't have it any other way. I contribute a lot of our success with being able to help a wide range of clients, more clients and our success and stability as a practice to taking insurance. So I just want to put that in there, because I'm probably scaring you by starting with the cons, maybe I should have started with the pros. Okay, the next one is going to be privacy concerns. I again I mentioned this a bit, but insurance requires sharing client information for billing purposes, potentially impacting client confidentiality. I won't speak too much to that just because we haven't had problems with that, or on our end or from the clients then. So I haven't seen anything around that. But that is a con. That is a con for sure. Okay.

Speaker 1: 23:37

So now let's talk about the pros. Get into the more positive aspects of taking insurance and, like I said, I view it as very positive. It's tough, but tough doesn't mean not good, it just means sometimes it's uncomfortable and hard and you have to roll up your sleeves and get into it. Okay. So the pros, of course accessibility, increased client base. You can, you don't have to say no as often. You don't have to say no, sorry, I don't take that insurance, or no, sorry, we're unable to help you because we're not in network. You can help more people. You can be more accessible to a larger range of clients. And what is better than that? We want to help as many people as we can. We don't want to turn our services away. We don't want to hinder someone's eating disorder recovery. We want to be able to be there and help them out. So, being able to even assess the five different top insurances in your area If you can take a couple of those awesome You're able to help more people and attract more clients. So you're going to be getting a lot more phone calls. You're going to be able to build client loads faster, right. So accessibility increased client base is definitely a pro, definitely something that contributed to our growth at our group practice as well. Another thing is going to be and this is under accessibility too. I kind of put these together, but that's a regular stream of clients. So then you're going to get more referrals from other network providers. So doctors, therapists who take that insurance, who know that their client needs that, to have a provider who takes that insurance, that therapist can refer to you as the dietician in network with that insurance company. Okay, so that all lump together.

Speaker 1: 25:44

The next thing is going to be patient retention, client retention. So, of course, if your client is able to use their insurance, they're more likely to continue to stick it out with their provider through the tough times because they know it's going to be covered by their plan, leading to increased client retention. Now, this, there's a lot to say on client retention. That's a whole other multiple episode which definitely will add to the list. But when it comes to taking insurance and client retention, if someone's not ready, it doesn't matter if they have insurance or not. However, it definitely helps if someone's on the edge and they're not sure if they want to move into recovery, if they want to get help and support. Yet they're more likely to at least try it out and see how it goes if they know they can use their insurance. Because, of course, insurance allows you, your group, to be more resilient in rougher economic times when a client is unsure. Yeah, I mean, that's pretty self-explanatory right there.

Speaker 1: 27:00

The next thing is going to be steady revenue stream. So I talked about, in rougher economic times, what happens when your business depends on self-pay patients and I'm seeing it right now. I'm seeing people really struggle, closing their doors because they can't have that consistent revenue stream to keep up with expenses because they're depending on self-pay clients and their self-pay ratio has the amount of self-pay clients has gone way, way down during these economic times. So 100% of their practice are able. They see self-pay, but now only 25% of those clients can do self-pay. Well, now you just cut your revenue by 75%. That's really tough. So insurance can also provide that steady revenue stream. Although there are cash flow issues, it's not always steady.

Speaker 1: 27:52

There are hiccups in that as well to consider, like we chatted about when we talked about, when we spoke about the cons and I really sped through those pros there it sounded like there were more cons than pros, because I'm ending the pros a bit earlier. But those pros that I mentioned accessibility, regular stream of clients, quicker growth, which I didn't mention, but I'm going to mention now quicker growth if you are trying to grow your practice Easier payment for clients, patient client retention, steady revenue stream those are significant pros that really create resiliency, stability in the practice and I would absolutely say the tough parts of taking insurance are worth it for, of course alone, accessibility clients being able to help as many people as we can but for the strength of your business, it is absolutely worth those tough times in taking insurance. So huge, huge, huge pillars, I would say, of your practice. I mean, it's a pillar to have your client retention is a pillar of your practice, your accessibility is a pillar. Right the way you're, those are probably two of the top five pillars of the success and stability of your practice. So I'll end the pros there by saying that, although I didn't speak as long, again I take insurance. These are huge, huge benefits that really can impact your practice in a really positive way.

Speaker 1: 29:28

So now I want to end here with a few thought provoking questions, after we have considered the considerations, the pros and cons. These are questions to ask yourself whether or not to understand and decide if it is good for you, if it will be good for your practice, your clientele, to consider taking insurance, or if it's not a good idea take, take insurance. So these are some questions you can ask yourself to get closer to that answer for you. The first one is going to be how can the decision to accept insurance align with your practice's mission and values, and what impact might it have on tailoring services to your target demographic? Okay, so look at the needs of your clients, look at your current flow of inquiries, look at what your mission is in your practice and ask yourself how can taking insurance align with the needs of my clients, with my mission and my values? What impact is it going to have? The second question is going to be about financial resilience and diversification. So, building on the idea of a model where you are taking both private pay and insurance, how can you strike a balance between the security of your steady insurance reimbursements and also, maybe, higher revenue from private pay, and how can they work together to not only enhance your practice's financial resilience in the changing economic climate, but how can it help you to serve a wider variety of people, a larger amount of people, grow your practice a bit quicker and meet the needs of the community?

Speaker 1: 31:28

Now there's a few action steps I want to give you as we are concluding today's episode, and that is, I invite you to just have a conversation with a provider in your area who accepts insurances. Ask them if they're happy with their decision. Ask them what parts are tough in that decision to take insurance. Next thing is look at your own energy and time to ask yourself is this a good time to take on this endeavor? Do I have the energy or do I need to outsource what am with what I am going to be getting myself into? Am I able to at this point of my business, with the energy and time I have and the resources I have? So those are the two action steps I want to leave you with today. Remember these questions and this conversation.

Speaker 1: 32:21

These action steps can really help you to explore deeper the implications of accepting insurance on the operational, the values, the all of these different aspects of your group practice and its success for your clients and for your practice. So let me know if you have any questions. I'm happy to chat more. This conversation can go on forever. I love having this conversation with my business coaching clients and see and I love to see just the all the knowledge, understanding that grows and how empowered they are to either stay solid in their decision to only take one specific insurance or to not take insurance at all, or to open their practice up to taking a ton of different insurance insurances and able to just see themselves thrive when they make one or the other decision.

Speaker 1: 33:19

But it's just important to really have that assessment, do that research and to consider this. I know so many people who heard some of the tough things about taking insurance and they didn't look any further into it. They just said no. And not only is that hurting their their client population, but it's also could very much be hurting their business and they don't know because they don't know what it can do for their clients and for themselves as a business. So I hope this was helpful. Let me know if you have any questions and I will see you next time. Thanks for joining. Blissful Biz Adventures, succeeding without sacrificing happiness. Stay connected with our vibrant community by subscribing Together. We'll uplift and support each other on this blissful journey. Until next time. Always remember that in your business you have the potential to not just survive but to truly thrive.