Any way to see insurance reimbursements locally?

[aquatic ape]

Considering starting solo PP. anybody have any resorurves for seeing local reimbursement rates? I’ve read that companies like headway and amwell might be able to give quotes early on in the process of talking with them?

Mulling over cash vs insurance, and hoping to have some numbers to help

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[Ironspy]

If you schedule a call with Headway or Alma they will show you their rates during that call which will give you some idea about local rates

 

[clausewitz2]

Considering starting solo PP. anybody have any resorurves for seeing local reimbursement rates? I’ve read that companies like headway and amwell might be able to give quotes early on in the process of talking with them?

Mulling over cash vs insurance, and hoping to have some numbers to help

Reach out to anyone you know in private practice in your area. They should be able to give you at least a rough idea if they are getting more than Medicare, less than, etc. Then you look up the local medicare rates which is public information and calculate a range of reasonable assumptions from there.

As far as setting rates for cash look at others' websites or call people up as if making an appointment to ask what the private pay rate is.

 

[ObsequiousAplomb]

what region are you looking?

I've noticed that where I am there's such an absurdly wide spread of cash rates that it hasn't been helpful looking at what others charge. Anywhere from $200 to $2000 per hour here. People seem to just choose their own rate and I haven't seen a rhyme or reason for why one person should charge a particular rate, just what people claim they are worth and what other people pay them.

 

[aquatic ape]

Coastal mid Atlantic. Cash rates seem to be anywhere between $150-300/ hour, but little rhyme or reason. Older established psychiatrists who are well respected have lower rates and seem to not have raised them. Tele NPs have some of the higher rates and flashier websites. Definitely not the higher end of cash rates that I’ve seen in more metropolitan areas. Which makes me wonder if insurance is the way to go, instead of trying to price at the top of the market

 

[aquatic ape]

If you schedule a call with Headway or Alma they will show you their rates during that call which will give you some idea about local rates

Thanks, wasn’t sure if they were that forthcoming or if they would want me to be further a long in the process before disclosing

 

[FlowRate]

Coastal mid Atlantic. Cash rates seem to be anywhere between $150-300/ hour, but little rhyme or reason. Older established psychiatrists who are well respected have lower rates and seem to not have raised them. Tele NPs have some of the higher rates and flashier websites. Definitely not the higher end of cash rates that I’ve seen in more metropolitan areas. Which makes me wonder if insurance is the way to go, instead of trying to price at the top of the market

Even if you take just medicare, you can assume (before expenses, collection/show rate, etc.) that you will be billing around $200 (90792 or 99205 once per hour) to around $400 (two encounters of 99214+90833) per hour.

That's why I decided, if I ever go PP, it would either be insurance (rates >= Medicare) or cash rate of around $350.

 

[ObsequiousAplomb]

We're in the same market area (coastal Mid-Atlantic), but maybe different cities. The rates in this city for cash are as we both said above. I charge $350/hour for therapy, $200 for a 30-minute follow-up, and $400-500 for an intake, whether for 90 or 120 minutes. I am constantly told I'm severely undercharging by my patients.

For the one insurance I accept, these are approximate the rates:

99213: $90
99214: $120
99215: $165
90833: $80
90836: $100
90838: $130
90792: $188
99204: $131
99205: $173

 

[aquatic ape]

Spoke w/ Amwell, and rates were low IMO. About $240/ hour if seeing 4 patients an hour, although it does seem like they do a lot of work behind the scenes for you. Maybe an okay gig if you wanted to see that many patients.

We're in the same market area (coastal Mid-Atlantic), but maybe different cities. The rates in this city for cash are as we both said above. I charge $350/hour for therapy, $200 for a 30-minute follow-up, and $400-500 for an intake, whether for 90 or 120 minutes. I am constantly told I'm severely undercharging by my patients.

For the one insurance I accept, these are approximate the rates:

99213: $90
99214: $120
99215: $165
90833: $80
90836: $100
90838: $130
90792: $188
99204: $131
99205: $173

So looks like even your 1 insurance is probably about the same or less money, but assuming more work, but more patients? Any thoughts about going primarily to cash only?

Also another question I've been wondering: anybody know how much their patients are reimbursed on average for out of network charges?

 

[ObsequiousAplomb]

Spoke w/ Amwell, and rates were low IMO. About $240/ hour if seeing 4 patients an hour, although it does seem like they do a lot of work behind the scenes for you. Maybe an okay gig if you wanted to see that many patients.


So looks like even your 1 insurance is probably about the same or less money, but assuming more work, but more patients? Any thoughts about going primarily to cash only?

Also another question I've been wondering: anybody know how much their patients are reimbursed on average for out of network charges?

I would love it if I could get anywhere near the volume of cash patients as I have been able with insurance. I'd switch in a heartbeat. I have found that a subset of the insurance patients are incredibly entitled and demanding. They treat me as a pez despenser for their self-diagnoses. They also tend to have a very narrow and incorrect view of what psychotherapy entails, and interpret my psycho education as an assault on their personhood.

 

[comp1]

I'm sure everyone in every specialty would love to have the same volume of cash paying patients as insurance paneled patients...

 

[clozareal]

You can ask to be contracted with the large volume insurances in your area and then they'll send you the rates, at which point you can try to negotiate (not all will).

You'll need to consider the factors that may lead to higher reimbursement rates when comparing with other practices, such as group practices which tend to have higher rates due to negotiating power, subspecialization (child, addiction, etc), and location (i.e., supply/demand). Not sure if time in practice, whether telehealth or in person, training prestige, or if you are part time/volunteer faculty at an academic institution matter.

There's a website where you can search Medicare rates in your area.

Scour PsychologyToday, Talkiatry, Zocdoc, Zencare, or any other psychiatrist directory and then go to their website to see if you can find their cash rates. Sometimes you have to download their patient agreement form to see it rather than being easily found on their website.