"I want to be completely divorced from HMOs. More than half of my clients are full pay. Should I just call up the HMO and sign off or should I first focus on building my full pay clientele and then let go?"
Jeanie C, MFT

First of all, Jeanie, congratulations on your percentage of cash pay clients!!

Okay, there is no perfect answer here. What I did was a combination. I put my self "on hold " with a couple of HMOs for 3 to 6 months and spent those 3 to 6 months building up my practice. If I needed to, I extended the hold for 3 more months. I didn't do it with all of them until I felt comfortable with my cash pay income. I put myself on hold with either the ones that frustrated me the most or the ones that sent me the most clients.

I did that to see what would happen if I was off the panel. Plus, the more you market your cash pay practice, the more people you will run into that have insurance and want to use their HMO. If you are "on-hold", my assumption is (although each contract is different) you can offer them your cash rate. (However, you can't do this if the client found you via the insurance company. Again, all contracts are different and you have to check what happens when you are on hold.) Sorry if that sounded confusing.

By being in this hybrid mode - you can spend time focusing on building the cash pay people! How cool is that! But please make sure you have a good "keep in touch" strategy with prospects and referral sources so that your name comes to mind when someone is looking for a good therapist!

Thanks for a great question!