TallwoodPractice Coaching

For licensed therapists in the US

The Private-Pay Readiness Scorecard

Score your private-pay readiness before you drop a single panel.

Fifteen questions for LCSWs, LPCs, LMFTs and psychologists who are thinking about leaving insurance. You get a score out of 100 across five areas, your three biggest gaps, and one concrete action for each.

Score my practice

15 questions, about 4 minutes. Free, and your results show on screen.

Written by Meredith Alcott, LCSW, who took her 14-clinician group practice off five of its six panels. 2,340 therapists have taken it so far. The median score is 53.

PPR-15

Private-Pay Readiness Scorecard
Result summary, page 1 of 3

Sample result: LPC in Columbus, Ohio. Licensed 9 years, on 4 panels, 22 sessions a week.

59/100

Ready in stages

Lowest area: referral sources outside insurance, 10 of 20.

Interpretation
ScoreReadingSuggested next step
70 to 100Ready to plan the moveFree planning call
45 to 69Ready in stagesRate Reset Workbook
0 to 44Foundation first3-part email series

Built for therapists who are tired of panel rates and wary of leaving too soon.

Most therapists who regret going private-pay didn't pick the wrong goal. They dropped a panel before their referrals, savings or fee could carry the gap. The scorecard checks those first.

Take it if

  • You're fully licensed and have been in practice for two years or more.
  • You're on at least one panel, and reimbursement hasn't kept up with your costs.
  • You'd rather see 20 clients a week at your full fee than 32 at panel rates.
  • You can't tell yet whether your caseload would survive the switch.

Skip it if

  • You're pre-licensure or still under supervision.
  • You're trying to join more panels. This won't help with that.
  • You work in community mental health and your clients rely on Medicaid. That work matters, and this scorecard isn't built for it.

Five areas, twenty points each.

Each area has three questions. Answers are weighted, so the habits that matter most for a stable exit carry the most points. Your total is out of 100, and nothing is scored on a curve.

The median shape from 2,340 completed scorecards. Referral sources outside insurance is the lowest area for most therapists, at 9 of 20.

  • Fees and rate confidence

    Whether your fee matches your local market, and whether you can say it without discounting.

    Asks things like: a new client asks what you charge. What usually happens next?

  • Niche clarity

    Whether other people can say who you help in one sentence, and whether your intake matches it.

    Asks things like: of your last ten intakes, how many were the client you most want to see?

  • Referral sources outside insurance

    How many new clients reach you without a provider directory, and from how many different people.

    Asks things like: where did your last five new clients find you?

  • Cash runway to drop panels

    How long your savings and current private-pay income could carry a slow quarter.

    Asks things like: how much of your income comes from your lowest-paying panel?

  • Intake and admin systems

    How fast inquiries hear back, how fees get collected, and whether clients understand out-of-network benefits.

    Asks things like: someone fills out your contact form on a Tuesday morning. When do they hear from you?

What you see when you finish

  • A score out of 100, split across the five areasEach area shown against the median of everyone who has taken it.
  • Your three biggest gaps, in plain languageRanked by points missed, each with one action you can take this week.
  • A next step matched to your score, stated up front70 and above: a free 30-minute planning call. 45 to 69: the $47 Rate Reset Workbook, or the call. Under 45: a free 3-part email series.
  • A copy in your inboxSo the actions are there when you plan next week's schedule.
Score my practice
PPR-15Sample result, page 2 of 3

Your three biggest gaps

1

Only a handful of people send you clients.

Referral sources. 5 of 7 points missed.

Ask every new client this month how they heard about you, and write down the exact name.

2

Almost all of your income depends on panels.

Cash runway. 4 of 7 points missed.

From today, take new clients only at your full fee or out-of-network.

3

Your fee wobbles when you say it out loud.

Fees. 3 of 7 points missed.

Write your fee sentence and say it to a colleague five times this week.

I took a 14-clinician practice off five of its six panels. Most of what I learned was about order.

From 2012 to 2023 I owned Birchline Counseling Group in Portland. By 2019 our reimbursements were flat, denials were climbing, and our billing coordinator spent more hours on one insurer than on anything else. Over two years we dropped five panels, raised our full fee from $120 to $185, and nobody lost their job.

What I got wrong first: I dropped our biggest panel before we had referrers lined up, and intake fell by a third for four months. The scorecard asks about the things I wish I'd checked before that notice letter went out.

Meredith Alcott, LCSWFounder, Tallwood Practice Coaching. Portland, Oregon.

11 yrs
running a group practice
186
therapists coached one to one since 2024
2,340
scorecards completed

"I scored 51 and was annoyed for about a day. Then I worked on the two lowest areas first. Fourteen months later I'm off three of my four panels and my full fee went from $118 to $175."

Priya Natarajan, LMFT, San Jose, California Scored 51

"The runway question is the one nobody had asked me. I had eight weeks of savings and was about to drop my biggest panel. The plan had me wait five months. I'm glad I did."

Tom Okafor, LCSW, Raleigh, North Carolina Scored 64

"I expected a sales pitch on the call. I got my panels ranked by real hourly rate and a date to stop taking new clients from the worst one."

Hannah Reyes, PsyD, Denver, Colorado Scored 78

Before you start

Is this a quiz that ends in a sales pitch?

You see your full results on screen before anything else. If you score 70 or above, you'll be offered a free 30-minute call. If you score lower, you'll be pointed to cheaper, slower steps first, because a call won't help much yet.

What happens on the free call?

We look at your panels, fees and caseload together, and you leave with a written plan: which panel to stop taking new clients from first, the fee to quote, and a date. If the 6-month Panel Exit program would help, Meredith will tell you the price ($3,600, or six payments of $620). Most people who book don't join, and that's fine.

Do I have to drop every panel?

No. Many therapists keep one panel that pays well or serves clients they care about. The goal is a caseload you chose on purpose.

What do you do with my answers?

They calculate your score and personalize your results email. You'll get two short follow-ups about your score and can unsubscribe in one click. We never sell or share your details.

I'm in a group practice. Does it still apply?

Yes. Answer for your own caseload. Group owners often have each clinician take it, then compare the shapes.

Is this clinical, legal or financial advice?

No. It's a self-assessment for the business side of your practice. Check each panel contract's notice period, and talk to your accountant before a big income change.

Find out where you stand before you send a panel notice.

Score my practice

15 questions, about 4 minutes. Results on screen, plus a copy by email.