Experience with Headway

[Dr. Pookie]

Hello all. I'm a PGY-4 graduating this month and preparing to start my solo practice. I plan to start out as an insurance practice and see where things go. Earlier in the year I learned about an organization called Headway, which says they will credential me with around 6 payors and gave me a fee schedule by CPT code for said payors. They help with marketing a little bit (SEO, online booking platform, etc.), and pay me as a 1099 twice monthly. They handle the billing and insurance stuff, which sounds appealing to me. However, I wanted to ask and see if anyone here had any experience utilizing Headway for billing. Any unforeseen pitfalls. Are the rates fair for commercial insurance?

As an aside, I compared the rates they quoted by CPT code and they seem to be ~20% lower than Medicare rates in my area (even though they tout that they negotiate rates that are supposedly higher than I would be able to get as a solo doc). I read that commercial insurers generally pay ~20% more than Medicare... Any insight would be helpful. Thank you.

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[Ironspy]

I started with Headway early this year after being cash only and am really happy with the experience. Hasn’t been long but rates are similar to my cash rate and platform has been hassle free for me and my patients. The better commercial insurances pays 20-30% more than Medicare where I am and I am not accepting patients from the lower payors which pay less than Medicare. Headway has better rates than Alma where I am.

Headway takes a cut but my hourly rate is much higher than private practice groups I've looked at and I get full control of my schedule and patient selection. I don't think I'm losing more than I would if I worked with a biller which I've been quoted at 5-8% of claims.

 

[splik]

Headway and Alma (the other company like this) take a huge cut. It really depends on what state/geographic location you are. For some, they pay more than you can get alone. For others, they pay way less. Commercial insurers vary in how much they pay (sometimes substantially less than medicare) but its not typical for commercial insurers to pay solo practitioners 20% more than medicare, though if you negotiate hard you can get 30% more than medicare. Some insurances in some locales pay even better. For big hospital systems, they often get 300% of medicare rates.

I would suggest seeing what the insurances local to you offer you when you negotiate. You may find you get a much better deal. If you are in Oregon, WA, CA etc then it won't be worth signing on with them. If youre in FL or TX it might be etc

 

[hallowmann]

Headway and Alma (the other company like this) take a huge cut. It really depends on what state/geographic location you are. For some, they pay more than you can get alone. For others, they pay way less. Commercial insurers vary in how much they pay (sometimes substantially less than medicare) but its not typical for commercial insurers to pay solo practitioners 20% more than medicare, though if you negotiate hard you can get 30% more than medicare. Some insurances in some locales pay even better. For big hospital systems, they often get 300% of medicare rates.

I would suggest seeing what the insurances local to you offer you when you negotiate. You may find you get a much better deal. If you are in Oregon, WA, CA etc then it won't be worth signing on with them. If youre in FL or TX it might be etc

What kind of cut are they taking? Do they provide EMR/Telemed platform or is it truly just billing and credentialing?

 

[liquidshadow22]

Headway actually owns the patients. You basically become an independent contractor for their large practice. I would avoid despite the good reimbursement rates.

They are essentially a middle man that negotiates the rates and scavenges off of the hardwork of private practices without allowing a private practice to actually grow its own patient base.

 

[TexasPhysician]

What kind of cut are they taking? Do they provide EMR/Telemed platform or is it truly just billing and credentialing?

It is just billing. You are credentialed under their company, not yours. You can’t up and switch billers if you wanted.

In some instances (despite being large), they can’t negotiate better than the individual rates anyone can get.

They take a cut of every code you bill, but I guess most billing companies do the same. Amount can vary.

Headway, Alma, Grow Therapy, Sondermind, etc are a growing trend of middle-men. They will credential you under them, set your rate, and your business is attached to theirs. I haven’t heard good things about any of their communication, but this is an easier way of accepting insurance. You get some ease of operations at a cost. It is up to you to decide if it is worth it. Expect to have patients sign your typical consents and also their consents.

 

[jbomba]

@splik how do I negotiate hard? Just hold firm when they tell me their price?

 

[Alemo]

“Headway”….. JFC. More like “Strip-away.”

Doesn’t it suck how every industry has this pack of parasites nipping at all the real value-generators’ heels, sapping wealth under the guise of “doing you a service” or “making things easier?”

 

[Atreides]

Headway and Alma (the other company like this) take a huge cut. It really depends on what state/geographic location you are. For some, they pay more than you can get alone. For others, they pay way less. Commercial insurers vary in how much they pay (sometimes substantially less than medicare) but its not typical for commercial insurers to pay solo practitioners 20% more than medicare, though if you negotiate hard you can get 30% more than medicare. Some insurances in some locales pay even better. For big hospital systems, they often get 300% of medicare rates.

I would suggest seeing what the insurances local to you offer you when you negotiate. You may find you get a much better deal. If you are in Oregon, WA, CA etc then it won't be worth signing on with them. If youre in FL or TX it might be etc

I'm in California (SF Bay Area) and Alma's rates are better than what I was offered by commercial insurance. Most commercial insurances told me they were full. The one that got back, Cigna, was offering me about 20% less than Alma.

I'm still in the free trial period, they gave six months, but am considering staying with them. If they are taking a huge cut, they're taking it before the rates they have listed in their contract. I've been paid out 100% of the listed rates in their contract with me. All their rates are less than Medicare though.

 

[splik]

I'm in California (SF Bay Area) and Alma's rates are better than what I was offered by commercial insurance. Most commercial insurances told me they were full. The one that got back, Cigna, was offering me about 20% less than Alma.

I'm still in the free trial period, they gave six months, but am considering staying with them. If they are taking a huge cut, they're taking it before the rates they have listed in their contract. I've been paid out 100% of the listed rates in their contract with me. All their rates are less than Medicare though.

You have to negotiate with insurance but you should be able to get more than Medicare rates for Anthem BC, Cigna and Aetna in the Bay Area. And yes the rates they offer are AFTER their deduction. How much they get is secret. I have access to rates for a major insurer so can look up how much most anyone gets with than insurance but I can't see the rates for Alma or Headway.

 

[jbomba]

I'm in California (SF Bay Area) and Alma's rates are better than what I was offered by commercial insurance. Most commercial insurances told me they were full. The one that got back, Cigna, was offering me about 20% less than Alma.

I'm still in the free trial period, they gave six months, but am considering staying with them. If they are taking a huge cut, they're taking it before the rates they have listed in their contract. I've been paid out 100% of the listed rates in their contract with me. All their rates are less than Medicare though.

Wait....so if I'm planning to open up PP in the bay area I HAVE to do cash because I won't be able to get on a panel...?

 

[Dr. Pookie]

Thanks for all the insight. It was helpful.

 

[the5thelement]

“Headway”….. JFC. More like “Strip-away.”

Doesn’t it suck how every industry has this pack of parasites nipping at all the real value-generators’ heels, sapping wealth under the guise of “doing you a service” or “making things easier?”

The psychiatrist takes ALL the risk and liability and does ALL the work and these middle men companies collect 50%+ of the reimbursements. Sounds fair.

 

[smalltownpsych]

“Headway”….. JFC. More like “Strip-away.”

Doesn’t it suck how every industry has this pack of parasites nipping at all the real value-generators’ heels, sapping wealth under the guise of “doing you a service” or “making things easier?”

Not every industry. In fact, I don’t think any industry other than healthcare really has this dynamic. As I say healthcare, a pet peeve of mine is how these parasites are referred to as healthcare. Blood pressure spikes every time I hear it.
edit: just to be clear, i am referring to the insurers as parasites moreso than these billing companies.

 

[splik]

Wait....so if I'm planning to open up PP in the bay area I HAVE to do cash because I won't be able to get on a panel...?

It's not uncommon for panels to claim they are "at capacity" (this is not specific to the bay area) or only allow people to join at certain times of year. That doesn't mean you won't be able to get on. you can hire a consultant to do the credentialing. someone with connections with the insurance companies and can get you on. You can complain to the state insurance commissioner. You can dispute with the insurance by showing them that they are not complying with state law in terms of availability, show how you fill a network gap (if you have a specialty or serve a population that they don't cover well), or show them that their network is full of people who are dead, retired, no longer in the state, or not accepting new patients. However, at a certain point you have to ask yourself whether it is worth joining an insurance panel that doesn't want you in the first place. Imagine what it will be like getting paid once you get on.

 

[Dr. Pookie]

I'm new to this, but I get the impression that insurance companies are fleecing everyone anyway (patients and docs). If a third party "biller" can make my life even a little easier, what do I care if they take some off the top? As long as the rate they give me isn't drastically different from what I would get from commercial payors anyway. The only way I'd be willing to do a primarily insurance-based practice is with some way to mitigate admin headaches.

 

[Atreides]

As long as the rate they give me isn't drastically different from what I would get from commercial payors anyway. The only way I'd be willing to do a primarily insurance-based practice is with some way to mitigate admin headaches.

This has been my logic. I know they're making money off of me but I haven't been able to get commercial payers to pay me any better. My average comes out to around $375/hour and I get paid reliably two weeks after submitting the claims. If commercial payers were offering me better rates, I'd drop Alma in a heartbeat but I haven't been able to get that yet.

 

[jbomba]

This has been my logic. I know they're making money off of me but I haven't been able to get commercial payers to pay me any better. My average comes out to around $375/hour and I get paid reliably two weeks after submitting the claims. If commercial payers were offering me better rates, I'd drop Alma in a heartbeat but I haven't been able to get that yet.

375/hr is fantastic. As someone who is thinking of opening up shop in the Bay, it sounds like Alma is a good option.

 

[smalltownpsych]

This has been my logic. I know they're making money off of me but I haven't been able to get commercial payers to pay me any better. My average comes out to around $375/hour and I get paid reliably two weeks after submitting the claims. If commercial payers were offering me better rates, I'd drop Alma in a heartbeat but I haven't been able to get that yet.

It sounds to me like maybe Alma isn't the parasite as much as they are helping you to deal with the real parasite more effectively.

 

[Ironspy]

375/hr is fantastic. As someone who is thinking of opening up shop in the Bay, it sounds like Alma is a good option.

It’s clearly regional but I’m getting similar rates in the NE. Lower for intakes and higher for follow ups. Private practices in the area are offering lower rates with more restrictive non competes

 

[jbomba]

It’s clearly regional but I’m getting similar rates in the NE. Lower for intakes and higher for follow ups. Private practices in the area are offering lower rates with more restrictive non competes

How many patients are you seen per hour for that rate?

 

[splik]

375/hr is fantastic. As someone who is thinking of opening up shop in the Bay, it sounds like Alma is a good option.

This is quite low (and it’s much lower for new pts). Even Medicare would get you to $460+ for follow ups.

 

[Ironspy]

How many patients are you seen per hour for that rate?

Two 30 min follow ups (99214+90833) is >$480

 

[jbomba]

This is quite low (and it’s much lower for new pts). Even Medicare would get you to $460+ for follow ups.

Wow. I've seen so many people on here talking about insurance reimbursing like 90 bucks for a 99214 I was assuming much lower. I have no idea what to expect to earn when I start PP in a year...quite difficult to forecast expenses.

 

[Atreides]

It sounds to me like maybe Alma isn't the parasite as much as they are helping you to deal with the real parasite more effectively.

Idk, I agree with @splik , this is lower than Medicare here by a good margin. I would very much prefer to not need to use Alma. Going to try and renegotiate again with insurance, see if I can get any better rates.

 

[calvnandhobbs68]

Wow. I've seen so many people on here talking about insurance reimbursing like 90 bucks for a 99214 I was assuming much lower. I have no idea what to expect to earn when I start PP in a year...quite difficult to forecast expenses.

Super regional. 2x 99214 + 90833 an hour would get me high 300s/hr.

 

[Atreides]

You have to negotiate with insurance but you should be able to get more than Medicare rates for Anthem BC, Cigna and Aetna in the Bay Area.

Lol, how much can I pay you to negotiate for me?

 

[splik]

Lol, how much can I pay you to negotiate for me?

I do provide a range of consultation services but honestly you are better off using a cheaper service as a solo practitioner for this (though I can help with things like reviewing documentation and helping with billing to maximise revenue and survive audits once paneled). Some examples of companies you can use include payrhealth Medical Billing Company - Healthcare Contracting Services or physician's ally Physicians' Ally or ngahealthcare Negotiating Healthcare Contracting Services | NGA Healthcare or zealie Reimbursement Negotiations and I'm sure there are many others. Best to use people who are familiar with the local players.

 

[deleted1153076]

It sounds to me like maybe Alma isn't the parasite as much as they are helping you to deal with the real parasite more effectively.

Yea you are paying for a service. people here saying they skim your profits... well yea because they find the patients, negotiate the contract and do your billing for you. I have rental properties, and I would use a property manager to run them except all the ones in the area do a terrible job. However a good property manager places good tenants, arranges repairs and deals with evictions for 10% of your rent. It can be worth it if the service is run well. I would hardly call that "parasitic". PRetty much all service industry businesses work on this model.