Just moved? Just graduated? Looking to jump-start a private practice that bills insurance?

I don’t know your financial situation, but here’s what I do know: A) It generally takes 3-4 months for a licensed provider who’s been in the insurance system/CAQH to re-apply to be paneled with insurance companies. I’ve heard it may add 1-2 months for unlicensed associates who haven’t been in that system before, but I’m not sure on that point. B) once paneled by an insurance company, a counselor can then start marketing themselves as being covered by a potential client’s insurance (i.e., on $30/month Psychology Today, and on insurance company listings). 

An insurance biller typically takes in 2-5% of your income, or $150/mo, whichever’s smaller.

I do not know of any independent, solo practice associates who are able to bill any insurance companies without either a) being employed by a small group practice or agency, or b) billing through a supervisor who accepts OHP and allows their associate supervisees to bill through that supervisor directly. (I do not take OHP, as the panel hasn’t been open to new providers since last summer, and also, I do not want to bother with the paperwork requirements there.)

When I graduated in 2014, I immediately started a solo private practice, rented space through a lovely group here (Wise Counsel & Comfort) that does a ton of online marketing and offers very cheap rent-by-the-hour office space, and offered only private pay therapy at $20-40/hr. After six months, I had five clients/week and raised my new rate of $60 to only new clients. A year later, I was seeing one $10 client, two $20 clients, and three $60 clients per week. A year later, I raised my rate to $120/hr (for new clients), and in 2017 I was seeing ten $120/hr clients per week – while also doing the 20hr/week job I’d needed to get and sustain since 2014, because being in solo private practice wasn’t actually profitable at all for the first year (mostly because I had to rent office space and purchase a website and domain name and email account for that, to make my niche kind of therapy stand out in a sea of 2,500 other Portland counselors).

During COVID, Oregon allowed two big changes: they let new grads who weren’t yet licensed to take Medicaid for the first time, and they reimbursed (read: paid counselors) the same amount for telehealth that they’d used to pay for “in-person” only. Before COVID, there were I think less than 5,000 therapists in Oregon.

All of a sudden, therapists with family money started opening “small group practices” where they’d pay an associate counselor $30-60/hr to see clients on Medicaid (and Medicaid paid, I’ve heard, six times that amount). A general norm arose around group practices requiring associates to work 5-10 hour/week in office, and 5-10 hours/week from home, and that model persists today. Medicaid (also called OHP in Oregon) is widely understood to pay the best of any insurance company here (I have no clue if that’s true or not; I don’t take OHP), and it also has the most stringent rules around notes/paperwork; it requires counselors be available for in-person appointments; thus, the “hybrid” model.

If you’re interested in accruing direct client hours toward licensure, today you gave three distinct models: 1) work in-person at a big agency focused on supporting low-income folks with SPMI and Medicaid, with a caseload of 80+ clients you schedule with monthly, or maybe instead a caseload of 20-30 weekly clients if you’re lucky, with 1-3 meetings per week about notes/paperwork, 2) work “hybrid” at a small group practice, seeing 25 clients/week with 1-2 meetings per week about notes/paperwork, 3) starting your own solo practice, seeing only private pay clients, in a sea of 10,000 local therapists all making the same calculations, at the same time we’re likely looking at a national recession. There might be other ways of doing this; I am frequently wrong about how things work, but I do want you to be prepared around how hard things can be.

If it would be better for you to assert your boundaries at a group practice or an agency, I hope you do that. (And take the free supervision they’ll provide, if that makes sense for your wallet.) If it would be an excellent adventure to try a solo practice, and you already know how to network and hustle in this field, I hope you choose that. 

Good luck to you! Feel free to email me if you’d like 🙂