This question has been perplexing private practice clinicians for the last couple of years:

“Why does it feel like we’re doing more work — but getting paid less from commercial insurance?”

When I talk to clinicians trying to unpack this, I usually go through my punch list:

  • Has your overall client volume changed from the previous year?

  • Are you doing more group therapy or individual sessions than before?

  • Has your payer mix shifted — maybe you’ve seen more public sector or Medicaid clients recently?

But then comes the question that stops many in their tracks:

“Did your commercial clients’ benefit plan designs change?”

The usual response is, “What do you mean?”

Understanding the Shift in Commercial Insurance Plans

Over the last several years, commercial insurance plans have shifted much of the cost burden to employees. Those of us who’ve been around remember the days of:

  • $10 co-pays

  • $100 individual / $200 family deductibles

  • A modest 20% coinsurance after deductible, with a low out-of-pocket max

Fast forward to today:

  • Deductibles are often thousands of dollars

  • Co-insurance costs are higher

  • Out-of-pocket maxes can be $5,000+ per person

That means your clients, not their insurance plans, are now responsible for more of your revenue. Often, your services are applied to a deductible that the client may not even meet for the entire year.

What Can You Do to Protect Your Practice?

To avoid revenue disruption and improve collections, consider the following action steps:

1. Set Clear Financial Expectations

Ensure every client understands their financial responsibility upfront — ideally before their first session.

2. Verify Eligibility and Benefits

Have staff confirm commercial insurance details and educate the client about how their benefits apply to mental health services.

3. Discuss Costs with Clients Early

Proactively talk about deductibles and coinsurance — this builds trust and transparency.

4. Offer Payment Plans

If clients have high deductibles, make it easier for them to stay current with a structured payment plan.

5. Monitor and Follow Up

Create a system to track clients falling behind and reach out before balances become unmanageable.

Don’t Wait — Get Ahead of the Problem

Not every financial hardship can be avoided — life happens. But many times, the warning signs are there if we’re willing to look.

At G&M Consulting, we help behavioral health practices stay financially healthy and adapt to the ever-changing world of commercial insurance. With over 43 years of experience in managed care and revenue cycle operations, we’re ready to help you navigate these changes.

👉 Contact us today to talk through your practice’s challenges and how we can help.