Private Pay RateCalculator
Enter your contracted rate, denial rate, and billing hours. See what an insurance session really pays, and the private-pay fee that matches your take-home.
By Jesse, Registered Psychotherapist.
Your contracted rate: what your fee schedule or remittances actually show for your most common session code, not your listed fee. On several panels? Use a blended average.
The share of billed sessions you never collect: denials never won on resubmission, clawbacks, underpayments written off. An editable assumption. Check it against your own remittance data.
Time spent each week on claims, resubmissions, eligibility checks, and payer phone calls. If a biller does it for you, enter 0 here and count their cost as overhead instead.
Clinical sessions you actually hold in a typical week.
What you want to collect each month, before overhead and taxes.
Private-Pay Fee That Matches Your Take-Home
$95
A fully collected private-pay session at this fee equals one insurance session at your contracted rate, after denials. It also drops most of your 4 weekly billing hours.
Fee to Hit Your Target at This Caseload
$93
Collects $8,000/month at 20 sessions a week, before overhead and taxes
Sensitivity
Every 5-point change in your denial rate moves the effective rate by about $5 per session. Every $10 on the private-pay fee moves collections by about $10,400 a year at this caseload. Small rate moves compound; check your assumptions against your own remittance data before acting on either number.
Every number here comes from your inputs; the page carries no benchmark reimbursement or fee data. Taxes and overhead are excluded on both sides of the comparison. For the overhead math, use the caseload break-even calculator.
What the rate comparison actually shows
Your contracted rate is not your real rate
Denials, clawbacks, and write-offs come off the top before the money reaches you. The rate that matters for every planning decision is the collected rate, and most therapists have never calculated it from their own remittance data.
Billing time is part of the rate
Hours spent on claims are working hours that produce no session revenue. Dividing weekly collections by sessions plus billing hours gives the per-hour number that a fee-per-session comparison quietly hides.
Matching take-home usually takes a smaller fee than expected
A private-pay session collects in full and carries no resubmission work. That is why the matching fee equals your collected rate, not your contracted rate, and why the switch frees billing hours on top of matching the money.
The fee is only half the equation
A private-pay rate only pays when the caseload behind it fills. The math on this page tells you what to charge; whether the phone rings at that fee is a visibility question, not a pricing one.
Common Questions
What should I enter for insurance reimbursement per session?
Your contracted rate: the amount your fee schedule or remittance advices show for your most common session code. If you are on several panels at different rates, use a blended average weighted by how many sessions each panel actually represents. Do not use your listed fee; use what the contract pays.
What counts in the denial and write-off percentage?
The share of billed sessions you never actually collect: claims denied and never successfully resubmitted, clawbacks, and underpayments you wrote off. This slider is an editable assumption, not a benchmark. Pull two or three months of your own remittance data and count what was billed versus what landed in your account.
Why is the matching private-pay fee lower than I expected?
Because the calculator matches collected dollars, not billed dollars. A private-pay session at the matching fee collects in full, with no denial risk, so it equals the real value of an insurance session at a higher contracted rate. It also drops most of the weekly billing hours, which is time the fee comparison alone does not capture.
Does this include taxes or overhead?
No. The comparison is gross collected revenue and your time. Rent, software, insurance, and taxes sit outside the comparison on both sides. For the overhead math, use the caseload break-even calculator or the private practice break-even calculator.
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