Your own contracts.
Your own clients. Your own schedule.
Ninety to a hundred-and-twenty days from kickoff to your first cash-pay session under your own LLC, with 5–7 direct payer contracts underway, EHR live, intake docs in place, Solo 401(k) opened, and a written operating manual on your shelf.
An operating practice,
not a punch list.
We don't hand you a Notion board. We hand you a working practice with direct payer contracts, an EHR full of intake docs, a website that's indexed, and a written operating manual you can hand to a hire in year three.
- 01
Direct payer contracts, 5–7
Sub-contracted credentialing via Medallion or CredentialMyDoc. State-tuned panel selection.
- 02
EHR + 14-form intake doc pack
SimplePractice or Sessions Health, configured. HIPAA-compliant intake forms, scheduling, and superbills.
- 03
Branded website + Psychology Today profile
One-page site under your domain, indexed and discoverable. PT profile written and live.
- 04
Solo 401(k) opened
Fidelity or Vanguard. Employee + employer contributions configured.
- 05
90-day post-launch marketing playbook
Three monthly in-person referral visits to named source types. Quarterly newsletter. ZocDoc listing.
- 06
Continuity-of-practice mini-checklist
Short-term + long-term disability, professional will, co-clinician coverage, business continuity, emergency-dissolution attorney on call.
- 07
Written operating manual
Vendor logins, recurring tasks, monthly close, quarterly review. The shelf reference that future-you can hand to a hire.
Will this work for you?
Three inputs. We email you a realistic 2026 marketplace silver-plan premium for your household and a revised solo break-even caseload. If the math doesn't pencil, we say so before you book a call.
This is a form in V1, not a live calculator. We respond inside a business day.
Week-by-week, the work
that actually happens.
Three phases. Twelve weeks for telehealth-only, up to seventeen for in-person panels. Phase ends are gated on deliverables, not calendar dates.
- PLLC / LLC formation, EIN, NPI Type 2
- CAQH attestation, individual NPI cleanup
- Direct credentialing applications submitted to 5–7 payers
- Business banking, bookkeeping, and quarterly tax estimates wired up
- EHR configured (SimplePractice or Sessions Health)
- HIPAA-compliant intake document pack — 14 forms
- Branded website published, Psychology Today profile live
- E&O / cyber liability bound, professional will signed
- Final payer effective dates land, first sessions billed
- Solo 401(k) opened, employer contribution scheduled
- 90-day marketing playbook handoff — referral routes, ZocDoc, monthly PT refresh
- Continuity-of-practice mini-checklist completed and filed
The retirement math
nobody mentions.
A solo therapist at $150K net contributes $23,500 as employee plus a 25% employer match (~$30,000) — $53,500 sheltered, pre-tax. A W-2 equivalent at a group practice gets $23,500 plus a 3–4% match, around $29,000. The delta is roughly $24,500 every year.
At 24% federal + 5% state, that's about $7,100 a year in deferred taxes — recurring, for as long as you keep contributing.
2026 marketplace premiums
are not 2024 premiums.
The ACA premium tax credit reduction lands in 2026. A family-tier silver plan in a high-cost state can run $2,000 to $3,300 a month — well above the pre-2025 baseline. If you don't have spouse-employer insurance to lean on, this is the single largest line item in your break-even math.
The qualification form above is built specifically to surface this number before you book a call.
Use the Will-This-Work form above to get the specific number for your household.
The income, by scenario.
Twenty-five sessions a week, billed at $150, across 48 working weeks: $180,000 gross. From there, two paths.
The platform fee
never goes away.
Twelve hundred annual sessions, at a 20–30% platform fee, is $30,000 to $45,000 every year, paid to a third party that doesn't own your client relationship. Over ten years, $300,000 to $450,000.
We don't argue this as opinion. We argue this as arithmetic.
It isn't hard.
It's two hundred hours.
Setting up an independent practice isn't conceptually difficult. It's two hundred hours of operational work across ninety to a hundred-and- twenty days — paneling applications, EHR configuration, intake-doc drafting, website, Psychology Today, insurance, Solo 401(k), bookkeeping setup, professional will.
Two hundred hours at $150 per session is $30,000 in forgone billing — more than the engagement price, and that's only if your alternative is not also burnout.
Three referrals a month,
by name.
The playbook isn't "do content." It's three named in-person referral visits a month, a quarterly newsletter to that list, a ZocDoc listing with same-week bookable slots, and a monthly Psychology Today refresh. Concrete, calendared, included.
- 01
Three in-person referral visits / month
OB-GYNs, school counselors, psychiatrists, pediatricians, NICU social workers — picked to match your niche.
- 02
Quarterly newsletter to that list
One page. Names. Case anchors. Sent on a recurring schedule.
- 03
ZocDoc listing, same-week slots
Configured to surface bookable openings inside the algorithm window that drives the most discovery.
- 04
Monthly Psychology Today refresh
Profile updates, new search terms, photo refresh. The cheapest reliable inbound channel for new licensees.
If you can't see clients
for six months.
Most solo therapists do not have a continuity plan. We build the ungalmorous one — disability insurance, professional will, co-clinician coverage, healthcare attorney on call. Included.
- 01
Short-term disability insurance — bound and active
- 02
Long-term own-occupation disability — bound and active
- 03
Professional will — signed and filed
- 04
Co-clinician coverage agreement — signed
- 05
Business continuity plan — written and stored with vendor logins
- 06
Healthcare attorney on call for emergency dissolution
Three states, three notes.
Said up front, not in a footnote at the bottom of an invoice.
PLLC formation adds $2,000 to $3,000 plus the New York advertising-compliance line item.
Kaiser direct credentialing carries a 6-month wait that is not negotiable. We disclose it before we accept the engagement.
Therapists running BCBS without Headway carry specific contract risk. We walk through it before paneling decisions.
I just had a baby and have realized how underpaid I am at my current group practice. I make $55K. I know I can't manage credentialing, billing, insurance, etc. while also learning how to be a mom. My best, most comfortable route would be having an outside entity handle all of those aspects.
— r/therapists, May 2026
Dan Wetzel
Capital One operations, AI consulting in healthcare-adjacent work, HIPAA for Business Associates training. PrivatePracticeOps operates as a DBA under Wetzel Solutions LLC (Illinois). The clinical work is yours. The business plumbing is ours.
Common questions,
honest answers.
01Why direct credentialing instead of staying on Headway or Alma?+
Headway, Alma, and SonderMind take 20% to 30% per session, indefinitely. On a 1,200-session annual caseload that's $30,000 to $45,000 a year — $300,000 to $450,000 over a ten-year career. Direct credentialing is a one-time operational lift in exchange for keeping that revenue.
02How many payers will I actually be on?+
Five to seven, selected per state market. Typical mix: BCBS, Aetna, Cigna, UHC/Optum, a regional Medicaid MCO, and one or two cash-pay-friendly EAPs. We sub-contract credentialing to Medallion or CredentialMyDoc and manage the application packet end-to-end.
03What if a payer takes longer than 90 days?+
Some do. Effective dates for a few payers land in the 100 to 150 day window. Your launch isn't gated on them — we open with the payers that are ready and add the rest as they clear. Telehealth-only practices can be fully revenue-positive on day one with the first contracted payer.
04What if my state has special rules?+
NY adds a $2K to $3K PLLC plus advertising compliance line item. CA carries a 6-month Kaiser credentialing wait we disclose up front. FL practices using BCBS without Headway carry specific contract risk we walk you through. State disclosures sit inline below.
05What if I already have an LLC or NPI?+
We use what you have. The fit call surfaces what's already in place so we don't double-bill you for entity formation. Pricing flexes down accordingly.
06What if I'm in active divorce or custody work?+
We won't take an engagement. Independent practice transitions are demanding and we won't build on shaky personal ground. We'll point you to a free transition checklist and revisit when the dust settles.
Twenty-minute fit call.
No pitch. No pressure.
We'll ask qualifying questions, share an honest read on whether this is the right time, and point you to the right offer — or to a free checklist.