Plan B Business
Healthcare

Stop fighting insurance reimbursements.
Build a niche cash-pay practice that fills itself.

We work with licensed therapists and psychologists running solo or small group practices doing $150K-$2M in annual revenue. Our 12-month engagement gets you off the insurance treadmill, into a defined clinical niche, and to a waitlist of cash-pay clients paying $200-$400 per session.

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Industry Reality

8 patterns we see in >70% of therapists & psychologists

85%
frequency

Insurance reimbursement at $80-$120 per session (well below market)

Root cause: In-network panels (Aetna, BCBS, United, Cigna) reimburse below the cash-pay rate. Therapist works 30 sessions/week to gross $100K. Burnout is structural.

What we do: Strategic out-of-network transition. Build cash-pay client base in parallel. Once cash clients are 50%+ of caseload, drop lowest-paying insurance panels. Session rates lift to $200-$400.

80%
frequency

No clinical niche - 'I see anyone with anxiety or depression'

Root cause: Generalist positioning. Competes with every other therapist in the area on price and availability.

What we do: Pick a defensible niche: high-achieving women with anxiety, executives with ADHD, couples in 2nd marriage, postpartum mothers, trauma in first responders, gifted adults. Become the recognized expert in your region.

75%
frequency

PsychologyToday profile getting 2-3 calls per month

Root cause: Generic profile copy. No niche. Photo doesn't convey expertise. Reviews/testimonials absent.

What we do: Rewrite profile around niche specialization. Professional headshot. Specific outcomes language ('I help X overcome Y'). Add specialties, populations, and treatment modalities. Calls lift to 10-20/month.

70%
frequency

Solo practice ceiling (capped at ~25 billable hours/week)

Root cause: Therapist is the only revenue generator. Sick day = no revenue. Vacation = no revenue.

What we do: Hire associate therapist on W-2 or 1099 split (60/40 to associate, 40/60 to practice). Build group practice model. Founder caseload drops while practice revenue grows.

75%
frequency

Administrative time consuming 15-20 hours per week

Root cause: Manual scheduling, insurance verification, billing follow-ups, intake paperwork, notes. No automation.

What we do: Deploy SimplePractice or TherapyNotes EHR. Automate intake (digital paperwork), scheduling (online booking), insurance verification (eligibility checks), billing (auto-submit + ERA posting). Admin hours drop to 4-6/week.

65%
frequency

No sliding scale policy - or sliding scale is killing margins

Root cause: Therapist guilt-driven. 40% of caseload at reduced rate. Practice can't sustain that mix.

What we do: Defined sliding scale: max 10-15% of caseload, documented criteria, capped at $125/session, 6-month maximum at reduced rate. Refer overflow to community mental health centers or sliding-scale-only practices.

60%
frequency

Therapist burnout - thinking of leaving the field

Root cause: Caseload too high, reimbursements too low, admin overwhelming, no peer support. Classic helping-profession burnout cycle.

What we do: Restructure caseload to 18-22 billable hours (not 30+). Drop bottom-paying insurance panels. Build peer consultation group. Add self-pay clients at higher rates. Sustainable practice, not heroic practice.

70%
frequency

No referral relationships with primary care, psychiatry, or schools

Root cause: Practice relies entirely on PsychologyToday + insurance directories for new clients.

What we do: Build 8-12 strategic referral relationships: 2-3 PCPs, 1-2 psychiatrists, 1-2 school counselors, 1-2 OB/GYNs (if niche includes perinatal), 1-2 employment attorneys (if niche includes workplace trauma). Quarterly check-ins, case coordination, mutual referrals.

Benchmarks

The numbers we hit

KPIMarket avgPlan B targetAfter 12 mo
Average session rate (blended)$95-$140$200-$350$170-$300
% revenue from cash-pay / out-of-network10-25%60%+45-65%
Weekly clinical hours (sustainable)28-3520-2522-28
Caseload utilization (% of available slots filled)70-85%92%+ (with waitlist)85-95%
PsychologyToday calls per month2-415-2510-20
Admin hours per week15-224-66-10
Annual gross revenue (solo)$110K-$180K$280K-$450K$220K-$380K
Engagement Model

What working with us looks like

  1. 01

    Month 1: Caseload + financial audit

    We analyze your current caseload: rate per client, hours per client, insurance vs cash mix, no-show rate, average treatment length. We identify your highest-leverage niche and the bottom-25% of clients to phase out.

  2. 02

    Months 2-3: Niche positioning + profile rebuild

    Define your clinical niche in detail (population, presenting concerns, treatment modality, outcomes). Rewrite PsychologyToday profile. Build practice website (or rebuild existing). New professional headshots. Intake form rebuilt around niche.

  3. 03

    Months 4-6: EHR deployment + referral engine

    SimplePractice or TherapyNotes fully deployed. Online booking live. Automated intake and billing. First 4-6 strategic referral relationships established. First out-of-network clients onboarded at $200-$300 rates.

  4. 04

    Months 7-12: Cash-pay transition + associate hire (optional)

    Cash-pay mix reaches 50%+. Lowest-paying insurance panels dropped. If group practice path: first associate therapist hired and ramping. Founder caseload sustainable. We shift to quarterly cadence.

Common questions from therapists & psychologists owners

What size practice is this for?−
Sweet spot: solo therapists doing $150K-$400K and small group practices (2-8 clinicians) doing $400K-$2M. Below $150K, you typically need pre-launch advisory which we offer at a different tier. Above $2M, you need internal Practice Manager/COO.
I'm a fully insurance-based practice. Can I really go cash-pay?+
Yes, but it's a 12-18 month transition, not a switch. You build cash-pay clients in parallel while staying on panels. Once cash-pay is 40-50% of caseload, you drop lowest-paying panels (typically Medicaid, then HMO products). Most therapists end at 60-80% cash, keeping 1-2 PPO panels for accessibility.
What about parity laws and the No Surprises Act?+
We work within mental health parity rules (MHPAEA) and the No Surprises Act requirements (good faith estimates for self-pay clients). Going out-of-network is fully compliant. We help you build the disclosures and superbill workflow. Connect with a healthcare attorney for state-specific questions.
What licensure types do you work with?+
Licensed Psychologists (PhD, PsyD), LCSW, LPC/LMHC, LMFT, and prescribers (psychiatric NPs, psychiatrists) running outpatient mental health practices. We do not work with inpatient, residential treatment, or substance abuse treatment facilities (different economics and regulation).
What entity structure should I use?+
Most therapists operate as PLLCs (Professional LLCs) or PCs (Professional Corporations) depending on state licensure rules. Some states require specific entity structures for mental health practices. Your CPA + healthcare attorney handle entity formation - we focus on practice operations and growth.
I feel guilty about charging $300/session. Isn't that gatekeeping mental health?+
Real question, fair concern. Our answer: a sustainable practice with 10-15% sliding scale serves more people over a 20-year career than a burned-out practice that closes after 5 years. The therapist who charges $90/session and burns out helps no one. The therapist who charges $275 and sees 22 clients/week (including 3 sliding scale) helps 22 people sustainably.
Should I take Medicare or Medicaid?+
Medicare reimburses better than Medicaid (around $130-$160/session) and serves an underserved population. Medicaid reimburses poorly ($60-$90/session) but serves the highest-need population. We help you decide based on your niche, sustainability, and mission. Many of our clients keep Medicare and drop Medicaid (or vice versa).
Group practice or stay solo?+
Solo: maxes around $350K-$450K gross, full control, no management headaches. Group: scales to $1M-$3M+, requires management skill, brings legal/HR/compliance complexity. About 60% of our therapy clients stay solo (and we help them optimize). 40% go group (and we help them build infrastructure).
Who does the work?+
Ligal Frish and Eitan Eshtemaker - the two co-founders. Direct access. Fee structure: Diagnostic $1,500 one-time, Advisor $3,500/month, Partner $8,500+/month for group practices.

Stop fighting insurance. Build a practice that sustains you.

30-minute strategy call. We'll diagnose your top 2 levers and tell you if we're a fit. No pitch. No pressure.

Book My Free Strategy Call