Making Sense of Insurance Billing and Client Referral Services for Therapists
Curt and Katie chat about a lot of the different services that therapists can sign up for to provide therapy. We talk about Alma, Headway, TalkSpace, BetterHelp, etc. We also look at what therapists should consider when deciding which service to sign up for (or whether they should).
Click here to scroll to the podcast transcript.Transcript
In this podcast episode we explore therapist insurance referral services like Alma and Headway
We’ve been asked to weigh in on insurance referral services like Alma and Headway. We explore the different things to consider when choosing a service to sign up for.
What client referral services should therapists sign up for?
“There are so many folks who want to use their insurance and these are in network therapists. So, this is something where people can’t get therapy [now] and [an insurance referral service] is an opportunity for folks to actually get therapy and for therapists to get paid reasonably, reasonable rates.” – Katie Vernoy, LMFT
- Betterhelp and TalkSpace models do not include insurance billing and pay therapists very little. We do not recommend therapists sign up as providers on BetterHelp and TalkSpace.
- Alma, Headway, and other similar models get therapists credentialed, bill insurance, etc.
- These services are very different and there are a lot of choices for therapists to make
What are questions therapists should consider when deciding which therapist referral service to sign up for?
“They [client referral and insurance billing services] seem similar, but there’s very specific differences that will make a difference based on what your practice needs. And you need to ask those questions: do I need more clients? Or do I just want to be able to offer insurance to a few people? Am I starting from scratch and I want to have a flood of folks come in and a lot of support? Or do I just want a couple more clients, and I don’t need to incur an expense for a whole system and a network that I already have in place.” – Katie Vernoy, LMFT
- Can I actually use these platforms?
- How quickly am I credentialed and how many different panels can I sign up for?
- Will this service get me clients?
- How many clients are they going to get you?
- Are the insurance benefits checks accurate?
- What does customer service look like?
- What are the rates they pay therapists?
- Is there a minimum number of clients you’re expected to see?
- What benefits are included for therapists (like CEs, group meetings, EHR, etc.)
- What do you want your practice to look like?
- What purpose will this platform serve for my practice? For example, are you wanting to get more clients or are you wanting to add insurance billing capacity (or both)?
Concerns about digital therapy platforms and insurance referral services
“If you are operating as a 1099, you’re not afforded a lot of the employee protections. And in some spaces, the laws are lined up to where you should be an employee based on what you’re doing with these [insurance billing and client referral] companies.” – Curt Widhalm, LMFT
- The tendency for things to change as startups grow
- Privacy concerns from app-based therapy apps (like BetterHelp and TalkSpace, etc.)
- Systemic impacts of tech companies negotiating with insurance companies instead of therapists
- Most are set up as 1099 businesses versus W2 employee models and seem to skirt some labor laws and put liability on the therapist
Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Alma VS Headway. Which company is better? An in depth comparison of the two. by Kym Tolson The Traveling Therapist
Top Mental Health and Prayer Apps Fail Spectacularly at Privacy, Security by Mozilla
Our Linktree: https://linktr.ee/therapyreimagined
Relevant Episodes of MTSG Podcast:
Why YOU Shouldn’t Sell Out to BetterHelp: An interview with Jeff Guenther
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
Consultation services with Curt Widhalm or Katie Vernoy:
Connect with the Modern Therapist Community:
Our Facebook Group – The Modern Therapists Group
Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
… 0:00
(Opening Advertisement)
Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:15
Welcome back modern therapists, this is the Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And this is a podcast for therapists about the things that go on in the therapy worlds, the ways that we can run our businesses better, the many different avenues out there to building a practice. And we have been asked by a number of people in the modern therapists community to dive in on what some of these third party sorts of business builder apps, other sorts of things, what it means to I don’t know there’s a collective just like, tech sort of…
Katie Vernoy 0:55
Insurance mumbo jumbo?
Curt Widhalm 0:57
Yes, all of, all of those companies, what’s the goods? What’s the bads? What’s our thoughts on them? So I haven’t used any of them. You are and I guess as a maybe addition on this, I haven’t done insurance stuff directly with my practice. Previous practice that I was on had me paneled for a moment, they handled all of that kind of stuff way back at the beginning of my licensure. So that was well before any of this stuff. So I’m coming into this episode with very little knowledge. I’m here to learn.
Katie Vernoy 1:42
Excellent, excellent. And just to kind of get some specifics here, Brandy Mansouri is one of our modern therapists who requested this episode and who provided some information and I definitely need to thank Patrick Davey Tully, who has been in a lot of these things, he and I are Facebook Messenger buddies talking about the state of the insurance world. And so a lot of this information comes from the two of them. I’ve done some of my own research and also our friend Kym Tolson who does Insurance Billing stuff she was on the podcast talking about the traveling therapist thing. She has an actually a really good video on Alma vs Headway those two specific ones. But so pulling a lot of information, I too have not signed up for BetterHelp, Talkspace, Alma, Headway, Path, Lyra, Cerebral, Grow or growth or I don’t, there’s a lot of them. So many of them. And so I think the the ones that I really want to start with are BetterHelp and Talkspace before we jump into the actual insurance ones, because I think too many therapists just jump to BetterHelp or Talkspace. And it’s a really bad idea.
Curt Widhalm 2:56
We’ve had some episodes in the past where we’ve talked about BetterHelp. And we will link to that in our show notes over at mtsgpodcast.com. I have to imagine that just the Betterhelp reach through all of their marketing efforts is at least a big piece that many therapists are thinking of them first.
Katie Vernoy 3:19
I think so. And I think Talkspace has a similar visibility. We’ll talk more about the evils of some of these later on. But I think for for if we’re looking at kind of how do I want to get my practice started? How do I want to grow my practice quickly, I need clients. I think a lot of folks go to BetterHelp, Talkspace, Alma, Headway, those are the kind of the main four I hear a lot about. Sometimes they’ll do their own insurance credentialing. But BetterHelp and Talkspace are, are probably the worst choices, I’m just gonna say it. They are the worst choices because they pay very, very little. And they have huge privacy issues. Like I said, we’ll go into some of that later. But it’s not a great model. There’s a lot of text based therapy, you have to be available. We’ve talked about this before. But just to start out with, if you’re thinking hey, I want to sign up for one of these services to get more clients. You don’t need to sign up for BetterHelp and Talkspace and take like $20 or $30 an hour. It is not, it is it is not required. There’s you get paid way more with a lot of these other ones. And there’s a lot of different things to consider. But but if you’re looking at one of those services, and they’re like, Hey, you can make $150,000 a year but the fine print is if you’re seeing 50 clients a week. I think you really want to take a look at those. Am I overstating it, Curt? Because you’re looking at me a little bit funny. Am I overstating that BetterHelp and Talkspace and the like, which they’re not billing insurance. They’re paying therapists very little and charging clients a bit more than that. It just seems like a bad model and we should get out of there.
Curt Widhalm 5:00
I’m wondering if our attorneys are better than BetterHelp’s attorneys, making statements like this. So…
Katie Vernoy 5:10
We may edit this down.
Curt Widhalm 5:11
What I will say is I disagree with their business model. And I think that it cheapens what we do as a profession, given the limits that we have discussed previously on the podcast and makes it to where they’re not not helping the profession, not actually helping clients and makes it to where if you come to the same conclusions as us, then you go right ahead and make those same conclusions as us.
Katie Vernoy 5:45
All right. All right. So choosing BetterHelp and Talkspace is choosing a fairly low fee, but a lot of clients, so you’re going to fill up your practice, you’re going to be very busy. And they don’t take insurance as far as I can tell. But when we look at some of the insurance based ones, we this is the Almas and the Headways of the world, I think Lyra and Path also do this. They are usually, not always, but usually bringing you in as a 1099 contractor and you maintain control over your practice, this is really more about the insurance portion of it. And they some of them do marketing for you, some of them will get you well, they’ll all get your credentialed, then they’ll get your credentialed pretty quickly. And they will do all the billing, oftentimes, they actually are better able to negotiate rates, so they get higher rates, because are these they’re kind of put together as kind of these gigantic group practices. And one of the benefits that people have is if you sign up for one of these services, they’re putting you on an they’re credentialing you on their NPI. So in your private practice, you are still private pay unless you credential yourself. So it’s a completely different credentialer. And so you can actually control your practice while having one of these services be an adjunct to your practice.
Curt Widhalm 7:14
So this is interesting to me. And I’m just going to then kind of respond from my business end of things. A lot of I don’t take insurance in my practice, I’ve been able to build out a cash paying practice without having to take insurance. As I’m expanding out my team, you’re saying that I could have the other licensed people on my team be credential, but it wouldn’t affect those clients who are already within my practice, who might have the very same insurance that other people, you know, if it’s one of the blues, let’s, let’s say it’s…
Katie Vernoy 7:56
Anthem Blue Cross or Blue Shield?
Curt Widhalm 7:58
And yeah, let’s, for purposes of this, let’s make up an insurance company called blue sword.
Katie Vernoy 8:04
Alright, blue sword.
Curt Widhalm 8:07
If I have clients already in my practice with blue sword, if I go through one of these companies, like you’re describing, and they’re like, hey, under our NPI, we’re gonna send you blue sword clients. It doesn’t put me in network with the people who are already coming to see me.
Katie Vernoy 8:24
No, no, they it’s a completely different NPI. And that was one of the issues that Kym commented on is that if you really are an insurance based practice, you may still want to credential yourself because if you are dropped by Alma or Headway or if they go out of business, or that kind of stuff, you want to make sure you can still see your clients. And that would only be if you were actually credentialed on your own. So to me, it’s it’s kind of a benefit, because I used to have a hybrid practice, I am now out of network with insurance. And so if if things were to shift in my life, or in the economy, stuff like that, I might join one of these with the express purpose of being able to have insurance based clients. And a lot of them say that you can get between 50 and $150 a session. So they actually are able to, especially in California, they’re able to get much higher rates because of the negotiation. And so they might take a little bit off the top as part of their fee, but you’re still getting higher insurance rates. And actually, my therapist is using one of them and she also got a higher insurance rate, and I’m paying the same amount. Yes, I’m seeing my therapist through insurance. And so it can be a benefit there because I don’t have to take insurance myself. I don’t have to have to do the billing. I get credentialed very quickly so I don’t have to do the process myself. They get you credentialed on a whole bunch of panels. For me when I did it, it was a lot of time, a lot of different forms and they just get the information and do it for you. And I’m getting paid more than if I were to take insurance in my own practice by myself, so I can see the appeal here.
Curt Widhalm 8:49
My next question, then, as what we had talked about with like the BetterHelps in the Talkspaces… Do you now have to operate on their system as well? Like or if you have your practice or do you still like doing everything still on your own EHR, and you’re just like, Hey, I saw clients on these ones, and go ahead and bill for them and then pay me.
Katie Vernoy 10:30
It varies. And I think one of the things I want to get to in this episode is really the questions to ask, because some of them have a benefit of pretty much being an EHR as well. And so you can have your whole practice in there. And you can see your private pay clients through it and all of that kind of stuff. Some of them, they give you the options. And so you do have to bill through them and probably do payment processing and all of that through them for your clients with them. But you may have a separate system for your progress notes, you may do a telehealth session through them, or you may do it through your own platform. It really varies platform by platform. And to me, there’s benefits to both. If I was going to go all in with a platform where I can do my private pay, they’re not taking money from my private pay, and they’re doing all the billing, they got me credentialed, and blah, blah, blah. It’s kind of like some of the other states group practices, right. I’m a 1099. They have all the infrastructure, they’re getting me clients, insurance clients, I’m getting my own private pay ones. And everything’s done through their systems. Others ones, it’s just, you have to put the billing through them. So it really it’s the short answer is, it depends.
… 11:46
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Curt Widhalm 11:49
From just kind of an ease of use sort of thing, the more that I’m operating on my own platform and own systems on these kinds of things, these sound like insurance billers that also do some marketing for you.
Katie Vernoy 12:08
That is the case for some of them. So my understanding of of Headway in particular is that they credential you, they may or may not get you clients, and they bill and they potentially, you know, some of the some of the platforms cover clawback. So you’re not losing money, some of them pay you and they’re waiting on the reimbursement, you know, so you’re getting paid consistently, even if the reimbursements are slow, like they’re handling all of the insurance side. And so that’s really they are insurance billers. Alma, my understanding has a lot more benefits, it has more of the EHR, it has the ease available, it has a community, there’s and they do a lot of marketing, but you’re actually paying a fee to ALMA to be able to get all these extra benefits. And so if you don’t need more clients, for example, and you just want to be able to use your insurance for some of the clients that you already have, something like Headway could work or or one of these, you know, insurance biller kind of things could work to be able to provide that without going in network for all of your clients. Right, you could pull, you know, you could say, Hey, I’m gonna put you through Headway or I’m gonna put you through one of these insurance biller platforms. With Alma, they actually you choose which insurance panels you want to be on. And you tell them what their your availability is, or you even put it on a calendar and there’s a scheduler and you just get, you’re getting clients.
Curt Widhalm 13:34
So that would make it to where I’m assuming that these places are credentials or credentialing people with all sorts of the insurance clients that are all different kinds of insurance panels, so not only, you know, the the blue sword, but also the blue mace and the blue armor and whoever else it is that, you know, I hear from some of my colleagues that the insurance reimbursement rates around here can vary as much, you know, by $70 $80 a session so you can just kind of selectively be like, I’m only signing up for the diamond plated blue swords.
Katie Vernoy 14:14
Yeah, my understanding is that any of these any of these places should let you know what the reimbursement rates are. I think with Path that was one of the ones that I had seen, and there was other ones, so I don’t I don’t want to be specific, but some of them will say, We’re gonna get you credentialed. And your rate for sessions is $80 a session, for example. And so that’s across the board. And so if Blue Shield blue, sorry, blue sword, pays them at $82. And Aetna pays them $120 You’re still getting $80 across the board. They’re, they’re doing the averaging out and they’re and they’re you have a rate with them. Whereas my understanding with like the Almas and Headways, they actually give you a percentage and it’s a very high percentage. And it varies based on the rates. And they tell you, you’ll get this rate for blue sword clients, this rate for blue mace clients, you know, and you can choose which ones to be in network with. So there’s a lot of complexity, I think, in deciding which of these to do because there’s so many different variables, and they’ve all set it up differently. They all have the solution to mental health care in the in the United States. And so it’s important to know which questions to ask because I think there’s, there’s so many different elements that may make a big difference to you.
Curt Widhalm 15:39
So what are those questions to ask, Katie?
Katie Vernoy 15:42
All right. All right. So and this again, I’ll link to Kym’s video in the show notes because she went through specifically for Alma and Headway, the answers to these questions. But I think the first, the first question is, can I actually use these platforms? And for pre licensed folks, provisionally licensed folks? Nope. You cannot.
Curt Widhalm 16:06
Okay.
Katie Vernoy 16:07
You need to be licensed. Now, there may be some that that’s different. But most of the ones I’ve looked at, you have to be fully licensed to be able to be credentialed by these insurances. The next question is, how quickly do they credential me? And how many panels do they credential me with and all of that? And most of them are pretty fast, it’s obviously in their best interest to get you as credit credential as quickly as possible. And so for me, that’s a big benefit for folks that are like I am done with my agency job, I need to get start making money immediately. Signing up with one of these folks and getting credentialed within days or weeks is pretty phenomenal. I think Kym said one of them, she got literally got credentialed in three days. Now she had been credentialed in a lot of these panels otherwise, so it could be that it was just real quick for her. But she said another one, it took like six months. So for me, my experience was all of the panels that I personally applied for took three to six to nine months to get credentialed and and I got refused from some of them. Whereas I don’t hear people getting refused from any of these panels. Like it’s like you go in, you pick which ones you want. And it’s just how long it takes you to actually get credentialed.
Curt Widhalm 17:25
Inherent inherently, that sounds like it’s starting to bring up the problem with what I’ve seen in like the Uber and Lyft driver communities. That if everybody is all of a sudden driving, then it doesn’t end up becoming where you’re getting enough referrals are profitable for anybody.
Katie Vernoy 17:41
I don’t know that that’s the case. To me, that’s not happening now. It’s something where most people have to turn off the spigot, they get way too many clients. They’re seeing like 30/40 clients a week. I have a colleague, my friend Luis, who I keep telling him stop, turn off the spigot, it’s too many clients. It’s like, No, I can see 40 clients a week. I’m like, No, you can’t. And so I’m not seeing that, because there are so many folks who want to use their insurance. And these are in network therapists. So this is something where people can’t get therapy. And so this is an opportunity for folks to actually get therapy and for therapists to get paid reasonably, reasonably reasonable rates. I think that was too many reasonablys. But anyway, so I’m not seeing that. However, with Headway I’ve heard, there’s less referrals, because they’re not really doing the marketing piece. But it’s also free. So with Alma they’re doing like tons of marketing, they’re getting a ton of clients, but you pay I think, right now it’s like $125 a month or a little over $1,000 a year. And so it’s it’s one’s a service, one, you know, I guess they’re both services, but one to one is a more full service opportunity. Whereas others are just the billing. They’ll say, hey, we’ll get you credentialed. We’ll, we’ll give you clients when we have them. But we’re not going to fill your practice. They say they are and they’re not going to. So yeah, I would I would find out and potentially investigate from folks. How, how many clients they’re getting, how quickly they’re getting those clients. But before you even can really take these clients, you have to look at the eligibility checks, like how quick do they actually make sure that they are covered that somebody is able to be seen. And you were mentioning ahead of time that that you saw a Reddit thread on them being inaccurate.
Curt Widhalm 19:35
Right. So more than one thread. So over in the r/therapists subreddit, I just typed in Alma. And there was several different threads where people were talking about, Hey, Alma didn’t actually accurately verify my clients information and they went, you know, a few months into treatment, then the clients would get a bill for like $1,000 because they Alma had not verified the information correctly. Now, it seems like, you know, if this is a step that’s being taken out of the therapists hands in this kind of situation that I’m sure big tech companies run by venture capitalists would gladly step in and take all of the responsibility but…
Katie Vernoy 20:27
Some of them claim actually to do that, that they will protect an audit, they will protect from clawbacks, they’re gonna pay you regardless of when the claim comes in. And that’s probably why the client got the bill, right, is that they’ve already paid the therapist and and probably in their contracts, they don’t do they don’t forward along clawbacks. But I don’t know, I think company by company that’s going to be different. And so that would be a question you would want to check on.
Curt Widhalm 20:53
And, you know, this was not specifically just limited to Alma in these threads. This was also something that a couple of other users had been pointed to. All right, hey, this happened with Headway or this happened with somebody else as well. But…
Katie Vernoy 21:08
Yeah.
Curt Widhalm 21:08
…it was something where this is not a perfect system is what I’m looking at.
Katie Vernoy 21:16
No, it’s not a perfect system. But I know I’ve had the same thing happen in my private practice when I was in taking insurance, my insurance biller checked it, it seemed fine. And then, months later, the insurance company was like, No, it really wasn’t that. So part of this is an insurance company issue versus like an Alma or Headway issue I’m assuming. Just because insurance companies say, Yeah, we’re saying that they’re eligible. But you know, what, we can’t really promise that what we’re telling you is accurate. And so we may take that money back from you. And it just seems shocking to me that this is a business model that is allowed. But yeah, a lot of them I think, say that they will, you know, pay you as the claims come through or every two weeks or that kind of stuff. And I think it’s just something where that’s, that’s a question you’re gonna want to ask. If, if they’re taking responsibility for eligibility checks, they’re running the all the billing, they’re doing all this stuff, are they guaranteeing that if you see a client, you’re gonna get paid, regardless of what happens on the back end. I think that seems that seems fair. But I’m assuming that some people will only pay some of these platforms will only pay for claims that have been processed and paid to the platform. And so you just want to figure out how they set that up, what their practices are.
Curt Widhalm 22:35
Get paid people.
Katie Vernoy 22:36
Get paid get paid. Another thing is that apparently, customer service is variable. Some customer service is great, some is not so good. And oftentimes, when either you’re getting set up, or going through one of these claims issues, or just trying to make sure your client gets what they need, you may need to get to customer service more readily. My understanding, and this, I think is your biggest issue is when they’re first starting out, customer service is amazing. They’re talking to all the therapists, and then they usually try to expand exponentially, you know, like state to state to state to state and, and then all of a sudden there’s this they outstrip their systems. And so even if you start with a one of these companies, and you know, they’re expanding customer service may shift. And so self sufficiency is good, but if they have a good policy in place, and they have good, you know, kind of accessibility, I think that can be helpful, too.
Curt Widhalm 23:34
And I think that this is the concern of looking at other tech type companies like this, and both from the user experience as a customer, and also as the providers and looking at what some of the providers have talked about in some online forums, whether it’s, you know, Lyft, Uber, DoorDash, any of these kinds of things that the initial bonus is to get people signed up on both ends as a provider and as a customer are great. And it’s after a couple of years, when the initial investors are wanting a return on their money, that we start to see some of the perks and things that were there initially, tend to go away, the user experience is worse, the prices go up. The pay goes down.
Katie Vernoy 24:24
Yeah, yeah. And I think those are things that it could be, you know, well aligned. You’re building your practice use this for a while as they start getting worse, you’re able to decrease the number of clients you see with them and off you go, right, like it could be it’s fine. But you do want to know what the reimbursement rates are. You do want to know, if they have a minimum number of clients you need to see to get credentialed and set up with them. And to be clear, you know, as we said, before, you get credentialed with them that you don’t take that with you. So, so it’s not like hey, go get credentialed with them and off you go in your own practice. You would still have to credential yourself. But I think the the determination of what’s required of you I think is really helpful, even though you’re a 1099. Many of them say, yeah, it’s your practice, you get to decide how many clients you want blah, blah, blah, blah, blah. But some, you know, some of the smaller ones especially may say, you have to see at least five clients, or you have to have at least this number of appointments open a week, or whatever. And so I think it’s, it’s important that you’re looking at all of that those things. And another thing is like benefits, you know, the CEs, the training, the group meetings, consultation, the client scheduling, appointment reminders, telehealth, EHR, you know, all that stuff, it’s important to know what’s available.
… 25:48
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Katie Vernoy 25:48
It really comes down to what type of a practice you want to have, and like what you’re actually going to need. And so for a lot of folks, if it’s, I want to start a practice and get up and running really quickly and have a lot of clients, you want one that’s going to market and give you clients. If it’s someone that’s more longer term, and obviously, there’s so many variables, but for example, if someone’s longer term, and they’re like, hey, I want to add insurance to my already robust therapy practice, because you know, I want to weather the dips better, the economy is strained or more of my clients want to use insurance, you might want to go on that doesn’t actually give you a ton of clients, but just has, you know, cost less and does the billing for you. You know, they credential you, they bill, you and you, you can get those clients or they can give you a couple, but you don’t want to flood because you already have a reasonable sized practice. And so being able to determine what is it you actually need is also important, because I think people can say like, oh, well Alma sounds super cool, or Oh, Alma sounds horrible. Because it’s like you have to pay money to work for them. You know, like, those, those global statements aren’t really helpful when you’re looking at what do you actually want for your practice?
Curt Widhalm 27:06
Is it a good return on investment that…?
Katie Vernoy 27:10
Just that you have.
Curt Widhalm 27:11
Right. And so, you know, if I’m looking at expanding my practice for myself and taking on more clients, because I need to collect them all, then…
Katie Vernoy 27:23
You need to clone yourself to see all the clients that you currently have.
Curt Widhalm 27:28
So it would look very different for me. I’ve had, you know, a lot of the marketing and stuff to develop the practice that I’ve had over the years that it’s a lot different for me than if I was, you know, all right, I’m launching out on my own for the first time. This seems like something that you can adjust over time as well, that if you have a bunch of things open up, then I’m assuming you can open up more slots in your schedule. Is that a thing?
Katie Vernoy 27:58
Yeah, yeah, it is a thing. I think if you’re thinking that you’re going to want to generate clients, you want to make sure that they actually are referring clients. And they’re not just billing for clients that you find, right. And so I think that’s the biggest difference. So, for example, with one that markets for you that you’re that they bring in clients for you, and they have other benefits and they cost money, you can say I have 10 spots, and you can say I have one spot or I’m not taking clients right now. So you can you can adjust that. And sometimes you have to adjust it really fast, because you’ll get filled up with stuff. But with ones that aren’t really giving you referrals, you can’t say Oh, I’m you know, I’m taking one client, you get nothing, okay, now I’m taking 10 clients, and you still get nothing like they’re still, you know, like, you can say you have more space, but that’s not going to necessarily get you more clients, if they’re not really they don’t have a robust robust marketing and SEO setup. And I think both Alma and Headway have decent SEO and they they’re big, big, big companies. But for the littler ones, you know, there may be ones that are more local to your to your state. And, and there there might be ones that are set up a little bit differently where you have to opt in for marketing, or you have to, to know, you know, how, how much have they actually entered into your state? What relationships do they actually have? Because early on, they may have fewer relationships, but they’re trying to get therapists because because right when they enter a state, it’s like, okay, we need to have therapists…
Curt Widhalm 29:30
Right.
Katie Vernoy 29:30
…for the insurance companies, but the insurance companies won’t, you know, but but if we don’t have insurance companies, we can’t get these therapists up and running. So it’s kind of determining where they are in the developmental process and, and how well they’re they’re actually doing within your state. So sometimes jumping in at the beginning, they give you higher rates and that kind of stuff. And I think Patrick had told me that some of them will offer exclusivity. So if you’re only with a particular platform, they’ll pay you a little bit more so there’s, you know, I guess a loyalty clause. But there’s, there’s a lot of this stuff where they’re just, they they seem similar, but there’s very specific differences that will make a difference based on what your practice needs. And you need to ask those questions with that in mind. Do I need more clients? Or do I just want to be able to offer insurance to a few people? Am I starting from scratch and I want to have a flood of folks come in and a lot of support? Or do I just want a couple more clients, and I don’t need to incur an expense for a whole system and an assist and a network that I already have in place. And so it’s really based client, you know, kind of person by person, what you’re going to want to do for your practice. So so I think that’s the advice part, like if you’re considering these things, that’s what those are the small things to think about for your practice in the moment is, does this work for my practice? What actually does it look like? And do I want to be involved in it? You know, there’s, and this is, if you want to actually bill any, you know, have insurance for any part of your practice. You know, we we’ve partnered with Thrizer. There’s other out of network billers that can help with some of that accessibility. You can get credentialed and bill on your own. You can do low fee clients through like Open Path and build your practice that way if you’re willing to take like $30 or whatever. But if you don’t want to really have to do all the work of private practice, I would get into one of the more full service ones, where you get your quote unquote, private practice, but they’re giving you clients, they’re billing, they’re doing all the marketing, they have the infrastructure, and so you get the benefits of private practice without having to do it. Okay, so all of that being said, I still have big concerns about these platforms. I know we’ve talked about BetterHelp and Talkspace. They have, well BetterHelp had an FTC complaint. BetterHelp, Talkspace and Cerebral, you sent me this article about huge privacy concerns. And let’s start with that. So the privacy concerns, my understanding is like the Alma and Headways, they’re health care companies, their billing insurance they’re keeping, they’re keeping things there and I looked them up, they were not part of this privacy thing. I think they are regulated by HIPAA. But when we start looking at these apps that are I think a little bit more like Uber and Lyft, the BetterHelps in the Talk Spaces, there’s big big problems there. And so briefly, because we’ve talked about this before, you want to talk about that problem.
Curt Widhalm 32:28
So this was a May 2022 article that was run by the Mozilla Foundation. And this is titled ‘Top Mental Health and Prayer Apps Fail Spectacularly at Privacy and Security.’ And they say that 28 out of 32 apps receive Mozilla’s privacy not included warning label. So and this includes things like Talkspace, BetterHelp, Calm and Glorify and…
Katie Vernoy 32:59
Cerebral was also in there. That’s one of the ones I’ve seen advertised. I haven’t heard about therapists getting on it. But Cerebral was in there also really bad privacy as well.
Curt Widhalm 33:07
And 25 apps failed to meet Mozilla’s minimum security standards like requiring strong passwords and managing security updates and vulnerabilities. Mozilla researchers spent over 250 hours over eight hours per product when writing this guide. And the lead on this, her name is Jen Caltrider, to “the vast majority of mental health and prayer apps are exceptionally creepy, they track share and capitalize on user’s most intimate personal thoughts and feelings.” And the six worst offenders were BetterHelp, Youper, Woebot, Better Stop Suicide, Pray.com and Talkspace. So…
Katie Vernoy 33:51
And they did update this. I went in and they did up that data guide for 2023 and BetterHelp and talkspace, I think we’re the same or worse than in 2022, even after the FTC complaint. BetterHelp is, I think just basically saying more, we’re going to use your data. So so really, really bad for you because of your responsibilities around HIPAA compliance, and really bad for clients. So…
Curt Widhalm 34:21
Yeah, they said that there’s only two trustworthy products. One is PTSD Coach. It’s an app that’s made by the US Department of Veterans Affairs, and also an AI chatbot called Wysa w-y-s-a, but some of the security is laughable allowing passwords as short as one letter or one character long to also being able to just repeatedly use the same character, you know, 11111 for passwords as well.
Katie Vernoy 34:52
Oh, my gosh.
Curt Widhalm 34:53
And Mozilla’s concerns are that teens are especially vulnerable when using these and especially with a lot of teen mental health being targeted by this kind of stuff. So all of our concerns seem to be coming true.
Katie Vernoy 35:11
Yeah. So on top of being paid very poorly, and not being able to really design treatment the way that you want to: see our other episodes on BetterHelp. But I just think that those are not great choices. I think the piece that I think Dr. Ajita talked about on our, one of our episodes that we’ll link in the show notes was that she’s saying that, like the Almas, Headways, that kind of stuff, are the fact that they’re communicating with the insurance and and kind of being the middleman between us and the insurance, it kind of removes us from the table and keeps us out of parity conversations. It keeps us out of a lot of those things. And so I think there’s there’s a distance there that for our profession, I think becomes troubling as we start looking at kind of the big tech really entering this space. And so something to be aware of. That being said, I think that there are some big benefits to not being a network and having higher rates, and it’s, I just have mixed feelings, what are your feelings about it?
Curt Widhalm 36:18
Out of the ones that seem to be working, they seem to be doing good for now. And maybe this is just jadedness over watching our profession for as long as we have and looking at the trends of things that those places that are doing good, I don’t hold my breath on them continuing to have a good upward trajectory forever. And I think that this is something where we have a lot of strong opinions about a lot of things. And most of the time on this podcast, we keep them relevant to therapists and mental health sorts of things. Overall, I’m kind of in a place with this of like, alright, this is just what’s happening right now, I don’t see this being the, you know, fix of everything for everybody that, you know, as individuals, do all of the questions that Katie is and then be ready to be like, I’ve got the things in place that I have that are going to allow for me to actually better the profession. Do I wish people would stop signing up to be therapists for some of these big platforms that, you know, the BetterHelps? Yeah, I absolutely wish people would stop doing it. Don’t, you know, go and be a, you know, huge spokesperson for BetterHelp. And, you know, advocate for like people getting paid what they’re worth at the same time that you’re, you know, making sure that everybody gets paid like 20 bucks a session. So I’m maybe in a space of like, these things aren’t all of the answers they never will be. And they give all of the signs that they’re going to follow pretty much the same lifecycle as a lot of other venture capitalists backed sort of stuff. You know, Alma and Headway maybe seemingly have a few better things in place. And I’m always just give that as a for now.
Katie Vernoy 38:24
Yeah, yeah. Well, I think that to kind of clarify what your meaning is that they will have services in place, they’ll have this stuff. And then over time, as they get more investors, or as they shift gears, they move from growing to selling and therapists become more of the cogs in the machine, and they just need to be marketable, not happy. And so I get worried about that, too. I think that some of these places may do better than others, I don’t know. But that’s what I always worry about when there’s a business model that doesn’t seem to quite make sense. It’s like, okay, you’re just trying to get a whole bunch of therapists in there, so you can sell the company and then new people come in and change everything. So the final concern and I know we’re getting a little long on time here, but the final concern is, most of these are 1099 situations. So I’m just going to leave that there so that you can do your 1099 versus W-2 rant.
Curt Widhalm 39:28
I’ll keep it brief. I I know that you would I have differing opinions on this. But when it when it comes to, you know, skirting labor laws, sorts of things like this, that if you are operating as a 1099, you’re not afforded a lot of the employee protections. And in some spaces, the laws are lined up to where you should be an employee based on what you’re doing with these companies. And you may not think it’s a big deal. But at the end of the day when the liability is passed on to you as the therapist because of something going on because of something you didn’t know, it’s it’s a very, very mixed bag. I personally am like people should get employed people, it allows for you to unionize. It allows for you to actually have this be the best for everybody involved. But who am I other than somebody who’s been studying and advocating on this for years.
Katie Vernoy 40:35
So I got some some different resources in researching for this. And you know, we’ll include all those articles and resources including Kym’s video on Alma versus Headway where she actually signed up for both of them and had some feedback based on last November. So it’s a little out of date, but still probably pretty relevant. We’ll put all those in the show notes over at mtsgpodcast.com.
Curt Widhalm 41:00
And follow us on our social media. Join us in our Facebook group, the Modern Therapist Group to further the conversation on these episodes. And until next time, I’m Curt Widhalm Katie Vernoy.
… 41:11
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