Private Practice BEYOND Insurance Panels
If you've been in private practice more than a few years, you've probably noticed this pattern: insurance panels aren't getting easier to work with, they're getting harder.
Rates are getting renegotiated in the payer's favor, not yours. Associate and intern billing has turned into a genuine legal maze that shifts by state and by payer. And every year, a few more conditions get attached to what you're "allowed" to do in order to get paid for the work you're already doing.
Here's the part most therapists haven't clocked yet: other corners of healthcare already ran into this exact wall, and built their way around it.
Direct primary care physicians did it first, charging a flat monthly fee instead of billing insurance at all. Dental offices have done it too. Telehealth platforms have their own version , a defined package of sessions and messaging, paid for directly, no claims involved.
It's not a new idea. It's a proven one, running at scale, for over a decade.
There are even some mental health practices, including psychiatric focused practices that are doing this in their own way. But unfortunately, these practices are few and far between, so if you’re thinking about it for yourself, you’re probably stuck in the trying to figure it out phase.
And that’s not your fault. This is legitimately an area where specific guidelines and legal statutes vary from state to state and there is a lot being left up in the air.
Each state makes its own laws regarding insurance, and in most states there are built in protections for physicians that allows them to build a model that could replace the functions currently carried out by insurance companies. But in other states it’s less clear. The laws that protect a direct primary care physician from being treated like an insurance company were written for physicians providing primary medical care, not for licensed counselors, therapists, or social workers providing psychotherapy. That gap matters. Building this the way a family doctor would isn't the same as building it the way a licensed therapist should.
There's a version of this that's low-risk, clearly scoped, and genuinely appealing to your ideal client, including the ones with a $10,000 deductible they're never going to hit anyway. And there's a version that gets you a call from your state insurance board. The difference is entirely in how it's built.
I did some research, and put together a FREE guide that walks through both, what this model actually looks like for a licensed practice, who it's appropriate for (and who it isn't), and the handful of decisions you need to make before you ever say the word "membership" or “concierge” to a client.