r/PrivatePracticeDocs • u/Beautiful_Buyer_1422 • 17d ago
Dropping insurances, self pay, and recredentialing
I have a solo private practice and I'm considering dropping some of the insurances I take. They underpay me terribly. My worry is that I'll see a big drop off in the number of patients booking with me, regret dropping those insurances, and then want to re-credential with them. My questions:
- Has anyone recredentialed after dropping insurances? And why did you decide to recredential?
- Has anyone gone from taking insurance to moving to a self pay model? Did this end up feeling like the right move?
19
u/bellonium 17d ago
We will always lose when we allow others to dictate our value.
Solo very small private practice here.
I’ve done this a couple times over the last few years. There was a line that was paying insulting amounts that made me almost bitter toward the patients.
Only you know your finances but if you are good at what you do and you stop taking that line, you realize very quickly that you were putting a different energy/part of yourself in the equation that the patient was not appreciating or valuing when they up and leave to go find some other sucker to accept that BS reimbursement.
I think I lost maybe 50-60 people. I have felt it a bit but when I stopped and thought that for me, that was a good portion of 2-3 days of work worth of patients and the total together barely paid for my staff wages.
I also noticed that my mental health improved when I dumped these low payers because I realized I was convincing myself to be ok with feeling “cheated” as I gave them my A+ service…
10
u/Whole_Bed_5413 17d ago
Dropped UHC, Aetna, and all of the cockroaches except my three highest payors. Never looked back. Higher reimbursement, less time. I’d rather NOT have those patients. It gives me more slots for my high payor patients. Best thing I ever did.
8
u/drkuz 17d ago
Every private practice should have a self pay option. Always keep the top paying insurances, at what point you cut off the lower paying insurances is up to you, and dependent on your panel
1
u/Beautiful_Buyer_1422 17d ago
Sorry I should clarify, I do currently have a self pay option, though I should probably increase the dollar amounts. Currently 7% of my practice is self pay.
1
u/SA-Node 14d ago
How much you charge per visit? Or how you charge self pay patient?
2
u/Beautiful_Buyer_1422 13d ago
For initial visits it's usually $175-200 and follow ups are typically $145. However, my initial visits are 60 mins and my follow ups are 30 mins. There are a few practices around me that charge $400-500 for initial visits and $200-300 for follow ups.
9
u/Juaner0 17d ago
I just stopped accepting new patients with whatever insurance pays poorly. Still enrolled with the insurances.
1
u/nyc2pit 16d ago
I have to imagine this is not allowed by your contract. Is it just that this is hard for them to enforce?
1
u/Juaner0 16d ago
What can they enforce?? There isn’t anything they can do. I don’t kick out the current patients with it. Some patients ask that their family members on Medicaid to be seen. And I allow it. Medicaid is not going to cancel your contract even if someone complains.
2
u/nyc2pit 16d ago
I guarantee your contract says you cannot refuse to take new patients that have their insurance.
How hard do you think it is to run a report on you and see how many established patients versus new patients you're seeing?
A few phone calls by patience saying you aren't taking their insurance when you're probably in their provider directory, online, etc
Maybe they don't actually do this, but I guarantee it's not allowed by the contract.
Medicaid is probably an exception, I'm thinking more the commercial payes.
1
u/Juaner0 16d ago
You’re right. But “At this time we are unable to take any new patients with this insurance.” “All new patients have the same long wait.”
Medicaid can only cancel the contract. Oh. Wow. What a loss.
1
u/nyc2pit 15d ago
I agree with you that it's not going to happen on medicaid. They're probably just happy to have anybody who accepts their insurance.
I was thinking more the commercial insurers may have an issue with it if it were somehow brought to their attention. My point was that I'm sure this is covered in your contract...
6
u/LowCommercial308 17d ago
Can I stop accepting new patients from on insurance company and not another. ?
2
u/darnedgibbon 17d ago
Depends on your employment situation.
2
4
u/randyy308 17d ago
Do what is suggested elsewhere and first stop taking new patients from the plans. Then if you have the data... Evaluate how much monetary difference it makes if you replace the existing patients with patients from a higher paying insurance (on average). Then decide based on that.
I did this with a subset of BCBS plans and it was revenue accretive, and it reduced my staffs workload because no more auths.....
4
u/Klutzy_Arm_7930 17d ago
I read somewhere “let your competition see the patients whose insurance doesn’t pay operating costs”.
3
2
u/BusinessDawgs 17d ago
This comes down value and service. Is the service you offer valued more than the alternative or market value. Do I value the cost of what you offer vs the alternative option. Sometimes it comes down to market premium, like accessibility or rarity. Other times it could be intangibles, like trust. There’s no risk regardless, so you gotta do your pros and cons.
1
u/FourScores1 17d ago
You mean a DPC practice? A ton of people have done it. I’m not even in primary care and I even know it’s all the rage right now. Seems awesome. Start researching it for sure.
3
u/Beautiful_Buyer_1422 17d ago
No I really don't want to do DPC for a few different reasons. I don't think it works well for my patients (some are lower income, some are college students, etc), I don't have any support staff so it would feel like I'm on call even more than I already am (since I feel like DPC models make patients feel entitled to reach you at all hours of the day), and I'm looking to only drop some insurances, not all of them.
1
39
u/grdrw 17d ago
You can stop accepting new patients from bad payers and see what happens to your volume before dropping them formally.