Big work/life related decisions! Input and ideas needed!

[JustMe]

I am a behavioral therapist (LCSW) and have been working in a relatively new agency providing outpatient therapy. I am paid a percentage of what I bill I have health insurance through the company, but pay about $200 a month. Its not a good plan (deductible is $3000 and only things like office visits are waived..things like blood work are not waived. Co-pays for office visits are high--about $40-$60 and I only have a very limited list of in network providers with this plan. We (meaning my employer) had to shift from a plan that was somewhat better this Jan when costs went up. My kids are both covered through our state insurance. One child is adopted from foster care and will be covered until he is 18 no matter what. The other child qualifies due to my income..and in my state they are quite generous with that (You can make a decent salary and still qualify). Of course, there is no knowing when that will end. I am not trying to be political, just factual.

-Lately my paycheck has been higher. (It is very variable as its a percentage of what I bill and we bill multiple insurance which reimburse differently. I dont get paid when people cancel/dont show or when I dont work). I am almost starting to border on the point when dd would no longer qualify based on my income. That would be huge for me, as not only would I be paying some unknown premium for her (depending on what is or isnt happening with healthcare), but she has pre-existing as well as current health concerns. So, I have been trying to decide if I should find a way to ask my employer about reducing my hours. This would mean I would most likely not have my insurance (or would need to negotiate something about this) as anything below what I work would not quailify for the insurance provided by my employer. I should say that my boss is a very flexible person and tends to like to work things out (which is very new for me. My previous employer was government related and a rule was a rule).

-I currently work 32 hours/week but split that between 2 offices (they are right next door to each other in the same bldg); its a long story, but I was able to stop doing a different job (but within this agency) that I was hating and needed to bring all of my time back to this location. Ugh, trying to leave out unnecessary details, but I am basically in another office on Monday. The person who works in that office the rest of the time just very kindly shared with me that he is going full time and has discussed that with my boss. He is being nice and wants to discuss things around that office with me, but it really makes sense that he get if full time (he is also taking on a task that my employer really wants him to. I am uneligible to do that as I am an LCSW and he is a Phd but it is something my boss really needed covered..so she is going to be thrilled he is doing that).

-So, I feel like it is time for me to decide if I want to propose cutting my hours to my boss and not working Mondays so he can have the office. The downsides for me is that I am not sure about it as there is no way of knowing if my income will end up being too little--as it varies so much based on billing) or if I want to lobby with my boss that I need to have one office I can work in for 32 hours...I dont want to lobby with her for this only to later tell her I want to reduce my hours. Of course, I could be honest with her about this dilemma and, while I think she would try to be supportive, she has too much on her mind and does better when I present her with a proposal/ideas as opposed to involving her in the process.

-In another complicating factor, I consider doing private practice. There are other on-going issues at my employer it would be nice to break free from and I am working on bringing up my referral sources. Even the man whose office I have been using plans to go into private practice long term due to the work issues. Concerns about doing private practice include health insurance for myself and dd as well as making sure I have the referral base. I also have no one in my family whoever had their own business and it is not something I envisioned myself doing and I am aware this ends up taking a lot more time especially at the beginning.

Ugh, any thoughts or ideas?

[pinkmomagain]

Hard decisions.
I would see what resources you have for insurance if you were to go private practice. There may be some insurance plan through your social worker association.
If you need to bounce around private practice ideas, feel free to PM me. I am in private practice two years now and loving it.

[NCGrandma]

Be sure you find out all the hidden/non-obvious costs and planning issues involved in switching to private practice. Some of these will probably be pretty similar in most places, but others vary by state. Also, depending on how your current agency is set up, you may already be dealing with these.

A few things to explore (in case you don’t already know about all of these):
—what sorts of insurance would you need? Professional liability? Other kinds of business-related insurance? A friend was part of a group of psychologists and social workers whose business manager embezzled a large sum of money. Fortunately they had insurance (can’t remember what it’s called) that covered bad acts by employees but they still didn’t recover everything.
—are there any licensure issues that are different for private practitioners vs employees? Would you have to pay for supervision? If so, by whom, and what would it cost?
—how would you handle billing? Would you need to outsource this? To whom/how much $$? Would you accept insurance(s)? If so, would you accept multiple plans, or just the largest one in your area? Would you try to become "in network" for that plan? Or would you accept cash only, and maybe just issue a receipt that patients could use to submit their own insurance claims?
—how would you handle patient records? Assuming you would use some sort of computerized med record system, would you need any help in setting it up, ensuring all the usual security protections, backups, etc.? Do you know what your and your patients' rights are in case you are called to testify in a legal case involving your patients?
—would you see both kids and adults, or just adults? If you would see kids, do you know the relevant professional and state guidelines about treating children?
—do you have experience with the income tax issues for a private practice, or do you already know a good accountant or tax preparer?

I have no direct experience but have been an "interested observer" of friends' mental health practice for years, so these are some of the issues they have wrestled with. None of this is rocket science but the more info you have going in, the smoother the transition, if you decide to go this route, even on a part-time basis.


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[vonfirmath]

My husband has very GOOD insurance (as a state employee). I have insurance more like what you described -- $5K deductible, $50 co-pay. But a very low monthly pay. It turned out to make sense to keep the kids on my plan rather than put them on my husband's. We can pay a LOT of co-pays for the difference in cost. And hospitalization does not happen regularly.

[BDKmom]

I would start by finding out if it is even a possibility to stay on your employer's insurance if you cut your hours. Most of the time, there isn't really any discretion on whether that's allowed. It is something that has to be across the board for all employees. Now, you might be able to negotiate more pay if they aren't having to pay your insurance, so that you can find your own. But there are very strict rules as to how many hours an employee must work to be eligible for the company's group plan.

I really can't speak to your other questions, but I do wish you luck in navigating all of this.

[JustMe]

Thanks for the replies! Pinkmom again, I would love to talk about private practice and am pming you.

I know what I would need to do for most of the things NCGrandma mentions, except for billing and taxes. I don't know when it makes sense to have a billing person, what I would need to do to do it myself (I currently just code and check a box if I saw someone and do the necessary clinical documentation of course). I have no idea what I would need to do for taxes as a self-employed person. I do my own taxes on turbotax, but the standard deduction has done me very well while not in private practice.

Yes, it is a question as to whether I would be eligible for insurance, but I am thinking there would be a way to work with this at least temporarily (I know this was done for someone who took a teacher job pt and wanted to reduce her hours for that time). As a related update I ended up talking to my boss a little as I walked into our break room and there she was (which never really happens as she is in the building next door). I told her of my dilemma with dd's health insurance (which I have mentioned to her before..she cannot really track that which is understandable, but its not a new concept to her), how I just found out about the office situation, jhow I was thinking of asking to reduce hours but was not really sure. She wondered if I could not reduce my hours and she would figure out how much to pay me each month and move me off of the percentage payscale. She was under the impression the only issue is that I make too much some of the payperiods but annually it is okay. That is not actually true. So, the good thing is I know she is open to brainstorming solutions...I just don't think her idea covers my concerns (even longer story, but I wont bore you with the details).

So, I am thinking about what I actually want and how to present that to her. I am meeting with someone who may be a good referral source tomorrow, so that will bring me more info.

[bisous]

That is a conundrum. Can you approximate how close you are to the level that cuts off your DDs health insurance?

I think I’d be inclined to try to work less. If you can use those hours in a productive way to reduce your expenses (coupons? Housecleaning? Less childcare?) then your household income might be sufficient and you will not be penalized with significant health expenses. (I have a child with diabetes and our insurance plan is EVERYTHING) Only you know if it’s possible or worthwhile to do that. Maybe you’ll come out on top? Maybe you can even use that extra time to build up your education so that when DD is no longer covered by your plan you can jump into doing exactly what you want and increase your income?

[JustMe]

That is a conundrum. Can you approximate how close you are to the level that cuts off your DDs health insurance?

I think I’d be inclined to try to work less. If you can use those hours in a productive way to reduce your expenses (coupons? Housecleaning? Less childcare?) then your household income might be sufficient and you will not be penalized with significant health expenses. (I have a child with diabetes and our insurance plan is EVERYTHING) Only you know if it’s possible or worthwhile to do that. Maybe you’ll come out on top? Maybe you can even use that extra time to build up your education so that when DD is no longer covered by your plan you can jump into doing exactly what you want and increase your income?

Yes, I would really want to work less as well. Honestly, I would still have more than enough for our expenses...I live cheaply..and I think I could figure out how much I need to figure out the health plan for dd. Its hard to explain it...but I guess I can say that I am expected to schedule about 24 clients a week (they dont all end up showing) and I am thinking I would want to go to scheduling about 18-20/wk. The biggest issue is not knowing what I would need to pay for my own health insurance with all of the variables.

As far as getting extra education, that is not really needed and if I want to figure out how to increase my income or have her be covered that would mean either (1) working on building up a very successful private practice or (2) finding a job that allows for dependent health coverage. There are very few jobs that do that here and they are either govt jobs or at the university. They tend to involve working FT 8-5, which is not something I can do right now...but when the kids get older that is a possiblity.

[Pilotbaby]

You can PM me as well to chat Private Practice if you'd like

[JustMe]

Thanks, Pilotbaby! I will do that later today!