Paneling with a few major payors - how long until filled?

[BiscoDisco]

I'm taking cash pay and have a few patients lined up so far. I am going to continue to grow this and also take a select few insurers. Can anyone give a ball park in terms of how soon one might expect to fill when they get credentialed with a few big payors - largest in my area are BCBS, Aetna, Cigna. I'm in a major city in CA. I am planning to take patients from outside my immediate metro area though too, if that makes a difference.

Hoping to build a panel of ~150 patients. I think I can do about 15 intakes a week, so that would be something like 10 weeks if I had that flow of patients. Just curious for those who take insurance, how long does it take to build to this level?

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[whopper]

Can't answer cause there's a lot of factors at play. When I started my own practice took me about 3 months to completely fill up.

 

[BiscoDisco]

Can't answer cause there's a lot of factors at play. When I started my own practice took me about 3 months to completely fill up.

Wow, that is fast. How many intakes a week were you doing? What is "full" for you?

 

[trophyhusband]

Are you doing therapy or just med management? Wife was doing just MM and it seemed to work out that every 10 active patients on the panel worked out to about 1 hr per week of clinical work.

If you're doing therapy as well I'd guess it works out to be double that or more depending on frequency of appts.

 

[whopper]

Full for me is 8:30 AM to 5 PM. 1 hour intakes, 30 minute follow ups. 5 days a week.

Seriously, I wouldn't be worried about filling up. I'd be more concerned with learning the ins and outs of private practice. You will fill up and relatively quickly compared to other fields. The problems of figuring out how to do your payroll, accounting, the legal issues you will face should be higher concerns.

 

[yanks26dmb]

Full for me is 8:30 AM to 5 PM. 1 hour intakes, 30 minute follow ups. 5 days a week.

Seriously, I wouldn't be worried about filling up. I'd be more concerned with learning the ins and outs of private practice. You will fill up and relatively quickly compared to other fields. The problems of figuring out how to do your payroll, accounting, the legal issues you will face should be higher concerns.

What were these legal issues you speak of?

 

[yanks26dmb]

Also do you find you need to screen out a lot of patients when you first get paneled and the flood gates open?

 

[whopper]

Most physicians I know don't know anything of the employment laws, how to do payroll, getting an account etc. The legal stuff? You will get at least 1 a-hole patient who starts making threats. Recommend you lawyer up at least a few months into practice if not earlier. No that doesn't mean spending an arm and a leg already but already having a defensive structure such as an LLC, a lawyer you can count on if need be, an accountant, and a financial advisor who can set up your money so if worse comes to worse your LLC can declare bankruptcy and they can't touch you outside the LLC.

 

[Bartelby]

I may be wrong but an LLC does nothing to protect you against malpractice claims right? It only protects personal assets against claims like slip and falls, employee wrongful termination, etc. And that's only if you appropriately maintain the corporate veil.

 

[calvnandhobbs68]

I may be wrong but an LLC does nothing to protect you against malpractice claims right? It only protects personal assets against claims like slip and falls, employee wrongful termination, etc. And that's only if you appropriately maintain the corporate veil.

This is correct, in most states a solo LLC is essentially treated the same as a sole proprietor legally and for tax purposes. Does nothing for you with malpractice, which is by far the most common reason why doctors get sued.

 

[surfguy84]

Do you need to be board certified for payors to accept you on their panels?

 

[calvnandhobbs68]

Do you need to be board certified for payors to accept you on their panels?

No they'll panel you if you're board eligible, I had to provide verification from the programs that I completed residency/felllowship. Don't know what happens if you get past the 7 year board eligibility mark without being certified though.

 

[whopper]

I may be wrong but an LLC does nothing to protect you against malpractice claims right? It only protects personal assets against claims like slip and falls, employee wrongful termination, etc. And that's only if you appropriately maintain the corporate veil.

Yes. So say you're sued for millions of dollars and lose. Your LLC, if you did business under it, gets sued and your LLC has to pay the damages, but they can't touch your personal assets. Of course your license, malpractice etc could still be adversely affected. Bear in mind I'm not a lawyer and a lawyer could give better information.

This is more of a peace of mind thing. Unfortunately there's bad people out there that could create complicated legal situations. While the overwhelming majority of patients are not like this, you just need 1 your entire career to create this problem. If worse comes to worse and your LLC becomes a sinking ship, you can jettison that sinking ship if you set your practice as an LLC and your personal bank account can't be touched.

 

[calvnandhobbs68]

Yes. So say you're sued for millions of dollars and lose. Your LLC, if you did business under it, gets sued and your LLC has to pay the damages, but they can't touch your personal assets. Of course your license, malpractice etc could still be adversely affected. Bear in mind I'm not a lawyer and a lawyer could give better information.

This is more of a peace of mind thing. Unfortunately there's bad people out there that could create complicated legal situations. While the overwhelming majority of patients are not like this, you just need 1 your entire career to create this problem. If worse comes to worse and your LLC becomes a sinking ship, you can jettison that sinking ship if you set your practice as an LLC and your personal bank account can't be touched.

This should be clarified as “say your BUSINESS is sued for millions of dollars and lose”. So yes having a separate business structure is helpful if, for instance, you have an employee who sexually harasses someone and this person sues your business or if someone slips and falls in a building your business owns and sues the business for not maintaining the building properly. If your business is a separate entity than you personally and your have a judgement against you for higher than your general liability or property insurance or whatever then yes your personal property/assets (house, cars, future personal wages) are generally safer.

This isn’t the case for malpractice as far as I’ve ever seen. Similar to how lawyers themselves can’t just set up a business and not be sued personally for malpractice. Considering malpractice is by far the most common reason you’d get sued as a solo physician, it’s not clear that trying to set up any separate business entity would actually protect personal assets if a malpractice judgement is above your limits. However, a malpractice judgement that stays above your limits (many of them end up getting settled down to the insurance limits even after some sensational judgement) is very rare.

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[whopper]

This should be clarified as “say your BUSINESS is sued for millions of dollars and lose”. So yes having a separate business structure is helpful if, for instance, you have an employee who sexually harasses someone and this person sues your business or if someone slips and falls in a building your business owns and sues the business for not maintaining the building properly. If your business is a separate entity than you personally and your have a judgement against you for higher than your general liability or property insurance or whatever then yes your personal property/assets (house, cars, future personal wages) are generally safer.

Correct. Someone slipping on your front step isn't malpractice, but the person could try to sue you.

 

[surfguy84]

Correct. Someone slipping on your front step isn't malpractice, but the person could try to sue you.

This is what general business liability insurance is for. And would recommend an umbrella on top.

 

[psychma]

This depends on what you consider filled up and which insurance companies you’re paneling with. When I took insurance, there were carriers that sent referrals every other day. I couldn’t do gate keeping. I accepted pretty much everything. The problem I had with insurance companies was getting paid and the hassle around that. If you have someone working for you that can focus on taking care of that, you’re good. I moved away from insurance and I’m full.

 

[BiscoDisco]

For me, "full" would mean 12 hours a week. I have other jobs I do, I just want to supplement.

If I didn't take insurance, what's the best way to start getting filled with cash patients? Psychology today, network with therapists...anything else? I live in a very high income area in a VHCOL west coast city and almost no psychiatrists take insurance here. So I'm certain the demographic could support cash...just don't know how to get people in the door.