Accepting Insurance and Third-Party Payors In Your Private Practice | TPOT 204
The Practice of Therapy Podcast with Gordon Brewer
Release Date: 11/15/2021
The Practice of Therapy Podcast with Gordon Brewer
Have you ever wondered how much easier private practice could feel if you stopped fighting the way your brain works? In this episode, I’m talking with Martin Altman, LPC, about his experience as a therapist with ADHD and how understanding his own neurodivergence helped him find a niche that genuinely fit. We get into the strengths and challenges that can come with ADHD, how Martin stays present with clients, and why building the right systems can make private practice feel a whole lot more sustainable. Martin also shares a really helpful perspective on emotional hijacking and why distraction...
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Therapists are great at taking care of everyone else, but we are not always so good at noticing what the work is doing to us. In this episode, I’m talking with Lindsay Benson about the hidden toll private practice can take on our nervous systems. We get into therapist burnout, the stress that builds up from sitting with difficult stories all day, and the small practices that can help us reset between sessions. Lindsay also shares her experience moving from insurance to private pay, offering therapy intensives, and building a practice that feels more sustainable. This is a great conversation...
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What if the biggest thing holding your private practice back isn't your marketing strategy but your mindset? In this episode, I'm joined by Tyana Tavakol to talk about the beliefs that shape the way we build our practices. We explore scarcity versus abundance, the value of finding your niche, and why trying to appeal to everyone often keeps you from connecting with the clients who need you most. We also dive into building an online practice, creating meaningful professional relationships, and learning to trust your own expertise instead of comparing yourself to everyone else. If you've ever...
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Are you burning out in private practice without realizing it? In this episode of The Practice of Therapy Podcast, Gordon talks with Kristin Oja, DNP, founder of STAT Wellness, about optimizing stress resilience and preventing burnout. Kristin shares a functional medicine perspective on why burnout is not always caused by work alone. Often, it is the buildup of stressors outside of work, including sleep, caffeine, exercise, relationships, technology, self-talk, and lack of recovery. Kristin explains the idea of the “stress bucket” and how even good things, like exercise, intermittent...
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Is SEO dead, or is it just changing? In this episode, I’m joined again by Natalie Moore, a licensed marriage and family therapist and SEO coach for therapists in private practice. Natalie breaks down the difference between SEO and AIO, or artificial intelligence optimization, and explains why therapists don’t need to panic about AI search replacing traditional SEO. We talk about how private practice owners can make their websites easier to find on Google, ChatGPT, Perplexity, and other AI search tools. Natalie shares why specialty pages, Google Business Profiles, clear niche messaging, and...
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What happens when the therapist is the one who needs support? In this episode, I’m talking about the very real challenges therapists face when life disrupts their ability to work. Private practice can offer freedom and flexibility, but it can also leave clinicians vulnerable when illness, grief, natural disasters, burnout, or unexpected emergencies come up. We’ll look at why therapists need a safety net, how financial stress impacts clinicians, and what it means to prepare your practice for the unexpected. From emergency grants and burnout prevention to referral networks and professional...
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Can you really build a successful private practice right out of grad school? In this episode of The Practice of Therapy Podcast, I talk with Jarrod Hoffman about building a private practice right out of grad school and the lessons he has learned in those early years of practice ownership. Jarrod shares his experience of stepping into private practice, navigating pricing, working through imposter syndrome, and learning how to communicate the value of the work he does. We also talk about why niching matters, how our own stories often shape the clients we feel called to serve, and why private...
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When I started my private practice nearly 20 years ago, there were not nearly as many resources available for therapists as there are today. I learned a lot by trial and error, and looking back, there are definitely some things I would do differently. In this episode, I’m sharing what I wish I had known when I first started private practice. One of the biggest lessons I learned is that I made things more complicated than they needed to be. From keeping paper records to waiting too long to outsource, I can see now how simpler systems would have made a big difference early on. I talk about the...
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Are you charging enough in private practice, or does guilt keep getting in the way? In this episode, Gordon is joined by Bianca Hughes, LPC, therapist, speaker, mentor, and founder of Authentically BU and the Soulful Clinician Collective. Bianca shares how she moved from hospital work into private practice and the mindset shifts that helped her build a career that feels aligned, sustainable, and authentic. Gordon and Bianca talk about money mindset, imposter syndrome, marketing, confidence, and why therapists need to see themselves as both clinicians and business owners. Bianca also shares why...
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In this episode, I’m joined by Dr. Phebe Brako for a really thoughtful conversation about what it means to make therapy more culturally responsive. So many of the clinical theories we learn were developed through a Western lens, and while those theories can be helpful, they don’t always fit every client, every family system, or every cultural background. Dr. Phebe talks about why therapists need to examine their own worldview, stay curious about their clients’ lived experiences, and be willing to adapt the models they use in the therapy room. We talk about culture, family systems, CBT,...
info_outlineIn this episode, I talk about some of the myths and misperceptions people have about being on insurance panels. I delve into this topic and let you know what I've learned about it from my insurance-based practice. First, I speak about the stigma around accepting insurance in private practice. If you accept insurance, you are just as valid and can be just as successful as private practice owners who are cash-based. Tune in as talk about the pros and cons of insurance panels, why I chose to be insurance-based, and where to start when you decide to accept insurance.
The Stigma Around Accepting Insurance In Private Practice
Many people are curious about accepting insurance and if they should or not. There is no correct answer. If you start to delve into your mindset and think about it all, it might just be something that you should consider doing. When you look at all that is out there, there are so many great resources around building a private practice. It seems like most people are encouraging cash-pay. There seems to be a little bit of a stigma against having an insurance-based practice. Many people say that you don't want to be controlled by insurance companies. If therapists don't have a cash-based practice, they're second-class citizens for being an insurance-based practice. I don't agree with that at all! In fact, my success comes from being insurance-based.
The Pros and Cons of Being An Insurance-Based Practice
There are a lot of pros and cons to being on insurance panels. Certainly, one of the cons of being insurance-based is that you've got to have more systems and processes in place. You've got to do more work on the front end to get prepared for insurance. You need specific systems when you start accepting third-party payors and being reimbursed by insurance companies for your services. The biggest con is that there is some work on the front end of being insurance-based.
The pros for being insurance-based are that you've got a built-in referral source by being on insurance panels. I would say at least half the people that we find are from their insurance. In other words, they checked with their insurance provider first to see who would accept their insurance in the area. When making an appointment with us, people ask, how much does it cost? Plus, they ask if we accept insurance. That's why I wanted to be an insurance-based practice. People depend on their insurance, and I want to help those people.
Ready To Accept Insurance? What To Do First
Where do you start? Research your area to find out which are which insurance panels are the most prevalent. In my area, most people have Blue Cross Blue Shield health insurance. Another thing to research is looking at significant employers in the area. Then, check which insurance those companies use. Next, use that data to decide which insurance companies you want to be paneled with. Another thing to note is that when an insurance company offers you a contract, that's negotiable! Make sure to negotiate what rate you will accept.
Systems and Processes Around Filing Insurance Claims
Figure out your systems and your processes around filing insurance claims. If you're on insurance panels, you need a traditional way to send claims off. The best way I know to do that is through an electronic health record system. TherapyNotes helps my practice with this. It's a few clicks of a button to get your insurance claims sent to the insurance companies to be reimbursed. For the most part, insurance companies have a pretty quick turnaround for electronic health claim submissions. Within a week of sending off the claim, we are getting paid. There's a myth that you have to wait a long time to get paid from insurance companies – that's not true! So, make sure you have a way to submit claims and make it as automated as possible.
Cash-Based and Insurance-Based Private Practices
If you're not ready to be entirely reliant on insurance, there's a hybrid option! You can have a mix of cash-paying clients and clients that use insurance. Give people a choice on whether or not they want to pay for therapy through a third-party payor. Remember to set your full fee at a reasonable place; your fee needs to be your FULL fee. The insurance company will pay you what they pay you. Then, you write off the difference between the full fee and the contract rate. If they choose not to use insurance, you can offer a sliding scale based on family income. We don't go and check their income; instead, we go on the honor system. Ensure that the lowest rate on your sliding scale fee schedule is in the ballpark of your average reimbursement rate from insurance companies. If you want more tips about deciding to panel with 3rd-party payors, check out this FREE webinar coming up: https://practiceoftherapy.com/insurancepractice.
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Resources
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Meet Gordon Brewer, MEd, LMFT
Gordon is the person behind The Practice of Therapy Podcast & Blog. He is also President and Founder of Kingsport Counseling Associates, PLLC. He is a therapist, consultant, business mentor, trainer, and writer. PLEASE Subscribe to The Practice of Therapy Podcast wherever you listen to it. Follow us on Twitter @therapistlearn, and Pinterest, “Like” us on Facebook.