Guilt-Based Money Mindset in Cash-Based Practices
Do you feel guilty for wanting a cash based practice?
I have heard this many times. Therapists don’t want to deal with insurance and start their practice only accepting clients who pay privately.
Then they think about all of the people who they believe aren’t able to access their services and start to question that decision. Often feelings of guilt accompany this. They feel bad that some people cannot afford to get therapy from them.
We got into therapy to help people, so this isn’t unusual for people in a helping profession.
Here are some considerations to help you process your decision to be in or out of network if you are having feelings of guilt.
Think about your own mindset about healthcare. Do you see it as a basic human right? Do you think all therapists should be accessible to all people? There is no right or wrong to this answer, but it is posed to help you think about what you want for yourself.
It’s important to take stock of your own money mindset. Do you believe that people won’t pay out-of-pocket for services because you wouldn’t? (Money mindset blog post coming soon–you may need to dive deeper with this topic!)
You don’t need to be all or nothing when it comes to insurance. You can choose to go in network with one insurance and test it out.
Think about why you wanted to be a cash based practice to begin with. Is it just because you hear bad things about insurance? Is it because you’re worried that your therapy may be limited and directed too much by insurance companies? Your beliefs about that may not be accurate.
Keep in mind that people will pay out-of-pocket without even thinking about it for a massage, or a dog groomer, or many other services that aren’t trained and experienced like therapists are.
It is not your responsibility to treat everybody. There are typically other providers clients can choose to go to that will take insurance. Even if you are in a rural area and there aren’t other providers, it is still not your responsibility to serve everyone.
Also keep in mind that if you’re just starting out, you have a lot to learn just as a business owner. Learning how to navigate insurance is another very challenging thing to learn. It also takes a long time just to get a network typically. You can always start the process and decide not to finish it, or not to sign the contract.
I started my practice as a cash-based therapist. I added Medicaid then some commercial insurances gradually. My reasons were not guilt-driven, though. Admittedly it was partly ego-related and partly related to my desire to expand my practice. What I mean by ego driving my decision: the main clinic in my area provided what I called “farm therapy” where the turnover of therapists was high and services so-so. Quality did not seem to be as important as quantity in that practice. I was proud of my skills and offerings and thought that others should be able to access that, not just those who paid privately. That was my primary reason for starting to take Medicaid.
At one point I decided that I didn’t enjoy clinic-based therapy all that much, but I had worked hard to build my practice and it didn’t make sense to stop it altogether. I decided to venture into commercial insurance because I wanted to reduce my effort with marketing. Marketing a cash-based practice is a lot of work, and even though I was expanding as word of mouth increased, much of that was focused on me as the therapist, not my practice in general. I anticipated hiring people who could provide therapy as I transitioned into a CEO position and/or did more in my school contracts, which I preferred.
Guilt is a pretty useless emotion in this situation. You also need to make a living and there will still be plenty of people for you to help who are willing to pay out-of-pocket for your services. There are definitely pros and cons to weigh when you decide to start a private practice and take insurance, but don’t let guilt be your guide.
I also encourage you to watch my “Pros and Cons of Being In-Network with Insurance” video if you are in the position of trying to decide whether to go in network with insurance. Just make sure you are doing it for reasons that make sense for your goals, not because you feel guilty.
I’m Alicia Kollmar and I am a pediatric occupational therapist in North Carolina. I started working for myself in 2010 and launched my business full time in 2015. I write these blogs to help new practice owners avoid some of the same mistakes I made when I started my practice. Looking for more support? I’d love to help! You can set up an appointment with me here.
