Hello there, and welcome back to the Mountain Practice Journeys podcast!

I’m your host, Cindy Norton.

Here in Episode 28 I share some considerations to help you decide whether to be private pay or take insurance in your private practice.

Let’s get started.

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See below for the episode show notes links and transcript…

Episode 28 Show Notes Links

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Episode 28 Transcript

Hello there, and welcome back to the Mountain Practice Journeys podcast! I’m your host, Cindy Norton. Here in Episode 28 I’m going to share some considerations to help you decide whether to be private pay or take insurance in your private practice.

Let’s get started.

Have you been wanting to start your private practice, but you can’t seem to take that first step? Maybe you’re afraid of failure or lack confidence, or maybe the idea of running your own practice is overwhelming. I’m Cindy Norton, owner of Mountain Practice Journeys and I help therapists and counselors to love the business side of private practice. I’ll share with you practical skills and advice along with a healthy dose of inspiration so that you can be on your way to the practice of your dreams. Put on your hiking boots, and let’s get going.

If you haven’t yet listened to Episode 27, I urge you to do that. In that episode I chat with Maegan Megginson about how to make it as an introvert & highly sensitive therapist in private practice.

Before I even get started on today’s episode, I want you to ultimately do this when making your decision on this topic: Ignore what everyone else says and listen to your own gut and intuition.

So, insurance or private pay? It can definitely become a heated discussion in the online therapist groups. When this question is asked everyone chimes in to tell you what they are doing, why it is better, why those who do it differently from them are greedy, why those who do it differently than them have money mindset issues, and why you should do the same thing they are without knowing anything about your practice or your personal situation.

No one is asking, “What do you want to do?” or “What is going to be best for your practice?”

As therapists we should know quite a bit about pushing our agenda upon others and why this is a bad practice. We should take this knowledge into our discussions with colleagues as well. I’ll share more of my thoughts about this in the acorn segment.

There are both pros and cons that come along with insurance based and private pay practices.

Let’s talk about insurance first. And I want to provide a disclaimer here that I hardly know anything about insurance. I’ve never taken insurance in private practice, but I have talked with a lot of colleagues who do, so I feel as though I’m informed enough to do a basic overview of these two options.

Insurance can be a great option for therapists who need to fill their practice more quickly. Back in Episode 1 I share some specific time frame estimates of how long it may take you to get full in both an insurance based practice and a private pay practice, so give it a listen if you’re interested.

Here’s a few pros of an insurance-based practice:
-you will typically get more referrals
-you will likely fill your practice faster
-sessions are often made more affordable to clients because of their insurance copay

And the cons of an insurance-based practice may include:
-the paneling and credentialing process can be complicated and time consuming
-it is time consuming to keep up with the administrative tasks such as filing claims and billing, and following up on claims that are denied or rejected (you can hire someone to complete the administrative work, but you are still paying out for that)
-insurance companies can have low reimbursement rates
-you are not always paid in a timely manner
-the insurance company determines the need for services, as well as your reimbursement rate
-you must assign a mental health diagnosis to clients

Moving on to private pay. Some of the pros of a private pay practice are:
-you get to set your own rate
-you don’t have to file any additional paperwork
-you are paid immediately
-you don’t have to assign a diagnosis to your clients
-you can offer unique and customized services and you and the client can work together more freely

Some of the cons of a private pay practice may include:
-it may take longer to fill your practice
-you may receive fewer referrals because clients are looking to use their insurance

And I believe that you can mitigate these cons of a private pay practice if you have a clearly-defined and sought-out niche and have done well with your marketing.

I can’t talk about this next issue without getting on my soapbox, so please bear with me for a moment.

If you’re someone who doesn’t take insurance and charges a sustainable fee, you’ve probably been on the receiving end of some veiled remarks from colleagues saying “I want to be accessible” or “I don’t want to have a caseload full of wealthy clients” – which is code for “I think you’re greedy and don’t care about people.”

Mental health therapists are NOT at fault here. We are not the reason that the mental health care system in this country sucks. We should not be martyrs for a broken system. This problem is much bigger than us. And charging a rate that leaves you burnt out, resentful, and unable to pay the bills is doing nothing to help anyone, and it sure isn’t going to change the system.

So guilting Sally for charging $200/session is doing nothing to incite the needed change on a governmental level. You’re only devaluing the field and alienating therapists who have devoted their careers to supporting others.

So for those therapists who are pissed at other therapists who have, what they consider, high rates – you’re pissed at the wrong people.

And the same goes for the therapists who make snide comments about others who charge, what they consider, a lower rate. They may imply that these therapists have money mindset issues to work through or don’t know their worth.

If you’re in either one of these camps – it’s not cool. Let’s trust other therapists to make their own decisions about what is best for their practice. Whether you charge what is considered a high or a low rate – awesome – and, its none of my business.

So let’s trust our colleagues to make the best decisions for themselves and do away with the shaming.

Another thing I want to mention while we’re on the topic of insurance has to do with mental health diagnoses. Receiving a mental health diagnosis is one of the main differences when clients opt to use their insurance.

In no way do I believe that we should use scare tactics to steer clients away from using their insurance, but I do believe they should be informed of what using their insurance benefits means for them.

They do need to understand that a mental health diagnosis is required in order for them to receive their insurance benefits. They should also be informed of the fact that their diagnosis will become part of their health record. And, lastly, that some mental health diagnoses may preclude them from certain jobs and careers in the future – and this will probably only be applicable to a small number of clients.

Whether you accept insurance or are private pay, it’s important that you educate your clients about their options so they can make an informed decision.

One more note about this topic. When I began my private pay practice several years ago I was naive and felt as though I needed to explain myself and my reasonings for being private pay. So I went to the trouble of writing a large section on my website about insurance and private pay, the pros and cons, and on and on.

You don’t have to do this. You don’t have to explain yourself. You shouldn’t be trying to convince your clients one way or the other. Just provide helpful information so they can make an informed decision and let your awesome work show for itself.

I hope this episode has provided some helpful information as you are deciding how you want to offer your services to clients. As always, do your own research and check in with yourself. And remember, you can always change your mind. If you need some extra support in making this decision, I highly recommend going back and listening to my conversation with Jane Carter about how to get unstuck in your decision making in Episode 25.

During each episode I’ll be giving you one small take away, action step, or mindset shift. I call these acorns. Listen to Episode 0 to get the scoop on what the acorns are all about.

The acorn from this episode is for you to practice responding to colleagues (whether in person or online) with kindness, compassion, and curiosity. If someone asks, should I do “X” or “Y”, don’t automatically say I do this and this is why you should too. Ask them about themselves and their business. Ask them what they have already considered. Ask them if they are leaning one way over the other and why? Ask them if they have considered the pros and cons of each, and help them with their list as a way of providing insight, instead of trying to influence.

Have a conversation with them and help them to figure out what they truly want. I have a hunch that they already know, and are just looking for validation outside of themselves – which I believe is dangerous and can take you wayyy off track.

When they ask a question and arguments break out in the comments section of their post, they are more confused as ever. Instead of imposing our beliefs about how others should run their practices, let’s get curious and help them to discover what is going to work best for them.

As I outlined in Episode 0, I’ll be alternating between a fun fact and ‘what I’m digging’ segment with each new episode.

The fun fact for this episode is that I’m an INFJ on the Myers-Briggs Type Indicator, and it seems as though a lot of therapists have this type.

I really love the personality test at 16personalities.com (that is the number 16 personalities dot com). This site has a lot of information about the types. The INFJ is called the advocate and common career paths listed for them include counselors, psychologists, teachers, social workers, yoga instructors, and spiritual leaders.

I want to take a minute to let you know about the fall cohort of my colleague Adi’s program. Adi is the co-owner of Marketing for the Modern Therapist and she has a 12 week business marketing mastery and mentorship program, designed specifically for therapists that are in transition, ready to grow and scale or are simply ready to reach the next level in their business. The deadline to enroll in the fall cohort is next Monday, August 31st. You can go to mmtcourse.com for more information.

And keep an eye out, Adi will be featured on the podcast next season. I can’t wait for you to hear our conversation about marketing!

Thank you so much for joining me today on your private practice journey.

For episode 29 I’m going to chat with Melissa Zawisza of Reilly Counseling in Texas. We’ll talk about all the reasons that self-care isn’t selfish, and the lessons she learned when switching roles from social worker to patient.

In the meantime, join me over on instagram @mountainpracticejourneys

There’s no way you can know how much it means to me that you choose to join me here as I share all things related to private practice. Please subscribe so you don’t miss a step. For more information about this episode, please visit the show notes page at mountainpracticejourneys.com/podcast I truly appreciate you Trailblazers. Your mountain is within reach. Journey on.

I Want You To Be Successful In Business & In Life!

Starting, growing, and maintaining a business is a big deal. It's super-exciting and super-scary all at the same time. I created Mountain Practice Journeys to support you through the difficult and muddy terrain, and to celebrate with you when you have reached each summit of the many mountains you will conquer on your journey.

Happy Climbing, Cindy

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