How to Know if You Should Add Insurance to Your Cash Pay Practice

Deciding whether to add insurance to a cash pay PMHNP practice is one of the most common questions I hear, and for good reason. It affects your revenue, systems, patient experience, and long-term sustainability. There is no one right answer. The best choice is the one that aligns with your values, your capacity, and the type of practice you want to build.

Here is a simple way to evaluate the decision with clarity and care.

Start with your “why”

Before you compare numbers or paperwork, pause and ask yourself why you are considering insurance in the first place.

A few possibilities:
• You want greater accessibility in your community
• You want a fuller caseload more quickly
• You are getting consistent inquiries from insured patients
• You are worried about slower months and want stability

Your why will guide the rest of the decision. If the motive is fear or scarcity, take time to get grounded before adjusting your model. If the motive is mission-driven or strategic, insurance may be worth exploring.

Understand the revenue impact

Insurance brings patients in quickly, but the reimbursement rates vary widely. That means the financial picture depends on your panel mix, visit lengths, and billing codes.

Cash pay gives you predictable revenue per visit but slower growth. Insurance offers faster growth but comes with greater administrative complexity.

Ask yourself:
• What is the reimbursement rate for the plans in my area
• How many patient visits would I need to meet my revenue goals
• How much time can I realistically dedicate to billing and follow-up

A balanced practice can come from either model, but you need clear expectations before signing contracts.

Consider the administrative load

Insurance adds work. That does not mean it is bad, but it is something to factor in without sugarcoating.

Admin demands include:
• Eligibility checks
• Prior authorizations
• Claims submission
• Rejections and resubmissions
• Contract negotiations
• Credentialing timelines

Many PMHNPs add insurance and immediately feel overwhelmed because they did not anticipate the time it requires. You can delegate billing later, but you still need systems. If your bandwidth is already stretched thin, cash pay may support your well-being more than insurance right now.

Reflect on patient access and community needs

Insurance increases accessibility for patients who cannot afford cash pay. It also gives you the opportunity to support underserved populations in a meaningful way.

Ask yourself:
• Who do I feel called to serve
• Does my community have access to prescribers
• Will accepting insurance align with the mission of my practice

Sometimes your practice values point clearly toward one direction.

Combine the data with your lived reality

Your decision is not permanent. You can start with cash pay and add insurance later. You can start with insurance and switch to a hybrid. You can try one plan at a time.

The goal is not perfection. The goal is sustainability.

Choose the model that supports your nervous system, your income goals, and your patients. And if you want support building a practice that fits your life and energy, this is exactly the work we do inside Strong Roots Mentorship. You deserve a practice model that feels clear, grounded, and truly yours!

If you’re feeling overwhelmed, stuck, or unsure where to start, join us inside Strong Roots Mentorship. We take you step by step from ground zero to seeing patients and beyond, without the overwhelm.