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Should Private Practice Therapists Take Insurance?

Curt and Katie chat about the latest data from SimplePractice on private practice clinicians billing insurance. We explore the most common set up for clinicians (a hybrid insurance/private pay practice) as well as how therapists bill insurance, the disparity between private pay fees and insurance rates (and how different these disparities are across the United States), how strategies for growing private practices are affected by who is paying, and how to set yourself up for a successful hybrid insurance practice.

It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.


Click here to scroll to the podcast transcript.

In this episode we talk about:

  • Demystifying the most Common CPT Codes E-Book from SimplePractice
  • Looking at the most common make up of therapists’ private practices (hybrid: insurance and private pay)
  • The theories about whether to take insurance of not
  • The process of starting a practice (credentialing timeline, marketing, etc.)
  • The benefits of being on an insurance panel (e.g., nearly 100% close rate)
  • The income differences for clinicians at different stages of practice development
  • The average number of appointments per week by type of practice (insurance, hybrid, or private pay) and what that means for your income
  • How well insurance reimburses in different states (and comparing these rates to typical private pay fees)
  • Financial considerations when looking at the insurance rates you will get in your area
  • How to set up your practice if you choose to take insurance
  • The most frequently billed CPT code (as well as others to consider)
  • The controversy around 90837 and how to make sure you get paid
  • Different strategies to build a sustainable business with an insurance or hybrid private practice

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Logo Image of Simplified SEO Consulting, our very generous sponsor for this week's podcast episode of the Modern Therapist's Survival Guide. Simplified SEO provides search engine optimization services and training to improve your organic search rankings on Google.

Simplified SEO Consulting

Simplified SEO Consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO Specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings.

These days, word of mouth referrals just aren’t enough to fill your caseload. Instead, most people go to Google when they’re looking for a therapist and when they start searching, you want to make sure they find you!  That’s where Simplified SEO Consulting comes in.

Founded and run by a private practice owner, they understand the needs of a private practice.

They can help you learn to optimize your own website OR can do the optimizing for you.

Visit SIMPLIFIEDSEOCONSULTING.COM/MODERNTHERAPIST to learn more and if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO Courses using the code “MODERNTHERAPIST”

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!

Demystifying the Most Commonly Used CPT Codes for Mental Health

Relevant Episodes:

Busting Insurance Myths

Make Your Paperwork Meaningful

Noteworthy Documentation

Negotiating Sliding Scale

Special Interview: Open Path Psychotherapy Collective

Connect with us!

Our Facebook Group – The Modern Therapists Group

Our consultation services:

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Who we are:

Picture of Curt Widhalm, LMFT, co-host of the Modern Therapist's Survival Guide podcast; a nice young man with a glorious beard.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

Picture of Katie Vernoy, LMFT, co-host of the Modern Therapist's Survival Guide podcastKatie 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:



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Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano http://www.crystalmangano.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated)

Curt Widhalm  00:00

This episode is brought to you by simplified SEO consulting.

Katie Vernoy  00:03

Simplified SEO consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings.

Curt Widhalm  00:21

Stay tuned at the end of the episode for a special discount.

Announcer  00:24

You’re listening to the modern therapist Survival Guide, where therapists live, breed 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  00:40

Welcome back Modern therapists. This is the modern therapist Survival Guide. I’m Curt Widhalm with Katie Vernoy. And this is the podcast where we talk about oh things, therapy, running our practices, that all things therapy, we don’t really talk a lot about what we do with clients, but talking

Katie Vernoy  00:58

sometimes we do

Curt Widhalm  00:59

sometimes. But today, we are talking about an ebook that was sent over to us by our friends over at simplepractice. And this is called demystifying the most commonly used CPT codes. And Katie and I come from very different places, when it comes to insurance, and Katie’s got a hybrid practice, I have a cash pay practice where we do super bills, and I understand some of this stuff. And Katie understands a lot of this stuff a lot more. And we wanted to be able to give our take on things and help you make some decisions on whether or not insurance is right for your practice.

Katie Vernoy  01:47

Yeah, I think it’s something where I am actually in the majority Curt and I don’t know that that’s well seen the hybrid practices 51% At least have simple practice users and 61% of simple practice users billed insurance this year, and have an insurance portion of their practice, but only 10% are just insurance. So to me, I think when someone comes on to a Facebook group or in a networking situation and says, Hey, should I accept insurance? I feel like a lot of people are like, no, don’t take insurance private pays the best. But I think a lot of us in the background are quietly accepting insurance, at least for a portion of our practice. So there’s a lot of detail in this report that talks about kind of regular rates, you know, how many sessions are being billed and that kind of stuff. And so I would recommend looking at it, we’ll link to it in the show notes, as well as a link to an interview that we had with one of the authors, Barbara Griswold, that when we talked about kind of insurance myths, I think, I think we’re coming back around to insurance myths that that episode is quite some time ago. So I think we’re going to have some new things to talk about here. But to me, I think the hope in this conversation is that there are folks who will, maybe are considering insurance and shouldn’t be. And there are folks who are feeling like they shouldn’t accept insurance, but that might actually be better alignment for them. Because I think there’s a lot of things that are stated as facts by people who are either like you solely in self pay or private pay practice, or folks who are in very different states. And there’s there’s a lot of misinformation that I think it’s shared or inaccurate information for someone’s individual situation. So what are your thoughts? What do you know, as a private pay practice, about taking insurance? And why would you tell people not to take insurance? Maybe let’s start there.

Curt Widhalm  03:55

The more of these conversations we have the less that I’m finding myself telling people what they should do. And I will speak broadly to the

Katie Vernoy  04:05

Fair enough.

Curt Widhalm  04:07

Why I see people making some of the decisions that they do. And I know and this is stated in the eBook. Our friend Dr. Ben Caldwell is quoted as saying many clinicians want the stability of income and to not have to market themselves and paneling with insurance allows them to focus on clinical care rather than spending time on marketing. And I think that this is true. There are a number of people who are in our profession who just want to see clients and do work and not have to deal with the stressors of where my next clients coming from. They don’t want to deal with a lot of marketing aspects going out to networking sort of things. And for those of you who that’s your jam have that be your jam. I am not one of those people, myself, I am. I love the networking and the marketing aspects. It takes a while to be able to build up a reputation in the community with referral sources. Not everybody can afford to take the time to build the practice that way you need the income sooner. And I think one of the themes that you’ll probably hear from me a lot throughout today’s discussion is just kind of you have to do what’s right for you. And there’s no one size fits all approach on this. But I also in kind of setting up my practice when I was initially considering applying to be on some of the insurance panels, and was talking with some people in my community, who were panels and hearing how long it takes to actually get panels. Hmm, I found that I was getting clients who were cash pay clients in the meantime, of what that paperwork length of time was going to be anyway. So my practice started to develop cash pay, even while I would have been waiting to get paneled in the first place. So maybe it was just that I was kind of eagerly out there going out and seeking clients and marketing anyway, that at the time was just kind of where, oh, if I’m getting them anyway, why do I need to accept a lower rates of insurance, to see the same people that I’m already getting into my practice?

Katie Vernoy  06:35

That’s a really good point for myself, I actually started my private practice while I was working in community mental health, so I didn’t have time to market or network or do any of those things. And I, you know, I put my shingle out in an area that didn’t have many clinicians. And so I did get some private pay clients while I was credentialing, but I was credentialing without having any clients at all. And without even trying to get clients it was like that was my escape plan, I was going to credential on the side, you know, kind of send those things in. And as I started getting insurance panels, then I was kind of adding clients to my practice. So I think there are different ways that people go about starting a practice. And I think you know, whether you credential or you have someone help you credential, that that is a time gap. I think for some people, it’s been up to six months, I don’t know what the current timeline is right now. But it can take a long time to get panels, which can be ideal for someone that needs to stay in a community mental health job or a group practice job before they can really go out on their own. I think at this point, once you are paneled, for some panels, you can almost fill up your caseload in a couple of weeks. And so it becomes a an a way to have some solid income. And that stability, because I honestly can say with my insurance based portion of my practice, which is very tight, tiny at this point that I’m going to be private pay very soon. But what I was in the height of my hybrid practice, someone would call, I had a similar specialty or was close enough, and I took their insurance. And it was almost 100%. Close, right. Whereas with the private pay, you know if your marketing well, and your networking well, and all of those things, they may come in already knowing your fee, they may come in already knowing your specialty, and it could be a pretty high close rate. But I’ve heard more like 10 to 30% close rate sometimes for private pay clients, especially at the beginning.

Curt Widhalm  08:36

Oh, and speaking of the beginning, I also hear in our larger therapist discussions within the therapist community that some panels require people to be licensed for two years, before they can even get on the panel in the first place. And for those, you know, very energetic, freshly licensed people, if that’s another limitation, as it was, you know, when I first started my private practice, it was shortly after I got licensed that if it’s not even an option to you, and you’re looking at developing some of these other marketing and referral network streams. I can say from my vantage point that if my fee is twice as much, and I’m closing only a third of the clients, if that still balances out as far as the number of sessions that I’m seeing, I’m actually potentially even working less than I am if I am panels and seeing fewer clients.

Katie Vernoy  09:36

Well, that’s assuming that you’re getting the same number of calls, which you don’t.

Curt Widhalm  09:41

That is very true, I’ll grant you that

Katie Vernoy  09:43

So 100% of 10 versus a third of three is is actually 10% of the clients so so just a little a little math, I think it it does take a while to build a private pay practice it is much more cost efficient as far as your time, and that actually is not necessarily totally true, we should talk about fees in a second. But I think it’s something where overall income is very different in the beginning. And then again, very different, when you get to your kind of stable number I think for at the beginning and insurance practice, you can immediately get up to that 50 or 60,000 a year, probably, with a private pay practice, that’s going to take a little while, but then you’re going to get up to a much higher number, you know, and these are just made up numbers. But like that 100,000 A year or 75,000, a year or 120,000, a year, I think is more likely in a private pay practice than it is in a an insurance practice, or a hybrid.

Curt Widhalm  10:47

And looking at the data from simple practice here, kind of reflecting what Katie is talking about, they have a nice little graph that shows the average number of appointments per billing type in the last 30 days. And those who are doing self pay only, the average number of appointments for the median, I guess, is 28. self pay only over 30 days, that’s

Katie Vernoy  11:17

pretty low

Curt Widhalm  11:18

the upper 75th percentiles 55 sessions over a 30 day period. But you compare that to the insurance only. And it’s 20 and 46, which are below what those self pay therapists are in

Katie Vernoy  11:36

that. Yeah. And the insurance when the way that that’s talked about is those insurance only practice, folks are typically like new group practice, associates kind of that are billing, just insurance, the practices only they’re using associates or other folks in the practice for insurance only. So I think the the thing to look at is the hybrid, and the hybrid actually has a lot of appointments. You’re looking at it. So what are the numbers for the hybrid practice

Curt Widhalm  12:06

So medians at 55 sessions? That’s compared to 28 for the self pay, and the upper 75th percentile is 80 versus 55.

Katie Vernoy  12:17

Yeah, so it’s, it’s, it’s a, it’s a fuller practice. Now, whether or not you want a fuller practice, they don’t actually say overall income for folks, which I think is interesting, and might be interesting data for them to look at. But I think it’s so variable, I think it’s hard to say. But I think determining whether you take insurance at the beginning, obviously, if you’re not licensed long enough, that’s going to be a factor. But I started paneling. I was five years licensed, I was ready to be out of community mental health, or I wanted at least an escape route from Community Mental Health. I got paneled pretty easily. It took a while, but I was still working. And then I was able to start adding clients afterwards. I think if you are able to kind of do the pace of building a private pay practice, that may be the right move for you, depending on where you live. And I think that so the the initial one is, can you have your income ramp up, you know, slowly? Or do you need to have it ramp up quickly? Once you get, you know, panels, I think that’s that’s the first thing to think about. They didn’t say kind of how long insurance clients stay versus private pay. I’ve got a mix. In my practice, I found that I think more private pay clients are going to finish sooner than insurance clients. But But what is your experience of that? Because you’ve had private pay for a long time? I mean, do you have a churn rate that’s pretty high, where you’re having to constantly get new clients? Or do you have clients that stay for long term I mean, I’m a long term therapist, I’ve got clients for years. So it’s, it’s a different model.

Curt Widhalm  13:54

I have mostly clients who have stuck with me for quite a while. And while I do have some churn in my practice, I would say as far as my particular caseload goes, that’s probably somewhere around 10% of my my caseload. Now, it doesn’t mean that I have the same, you know, 90% of the clients forever, but I do tend to have my repeat people coming back after a couple of years off. And so I see relatively few new clients in my practice. So most of my people are lifers. And yeah, you know, I imagined that, you know, if I preview that I’m going to retire in like 30 years that that might create some panic for some of my clients now just knowing that things are going to end so I may not

Katie Vernoy  14:49

We are both long term therapists.

Curt Widhalm  14:51


Katie Vernoy  14:52

You may not be the best to say that. And maybe that’s another thing potentially if you are a clinician that already has has more of a short term model, if you’re already going to have churn with your clients might as well get the best bang for the buck and do private pay or have a huge referral source and get insurance. And so I think it’s, it’s something where there’s a lot of factors in what is going to be the right mechanism for you. The other thing is, is there are very different rates that people charge across the country. And simple practice has that in there, as you know, kind of their private pay full fee. There’s also very different insurance rates. And so I don’t know if you looked at this chart, but it’s, it’s crazy, because as California being one of the most expensive places to live, we actually are our middle the middle of the pack or lower part of the pack on what the median insurance reimbursement rate is.

Curt Widhalm  15:51

And looking at this, I have to imagine that a big piece of this is supply and demand, because some of the states with the highest reimbursement rates are South Dakota, North Dakota, Minnesota. And while there is the Twin Cities in Minnesota, there’s a lot of rural area out there. And so I have to imagine that some of the higher rates are being either commanded by therapists were like, look, there’s nobody else in town to take your insurance, and they’re doing a good job of advocating for themselves for higher reimbursements. Or the insurance companies are trying to draw more practitioners to work in these areas. And, you know, in California, like the building that my office is in, I think that there is and don’t quote me on this, I think that there is roughly 8 million therapists that work in my building. And so a, and obviously, not all of us are handled with insurance companies. But I have to imagine that the insurance companies could panel every single therapist and be like we have so many people that we only need to pay you $8 per session.

Katie Vernoy  17:09

Well, I think the problem is that’s there’s I mean, we could have whole conversations about ghost panels and people being fall and stuff like that, because I certainly still get calls from folks. And they they basically are searching for weeks trying to find someone who accepts their insurance. So I also think that there is a an issue in California with insurance because the the average fee, or the median fee for California I think, is $100. For insurance reimbursement, and 150 is the private pay fee, although the the one in 2018, apparently was 130. So there’s, there’s a big difference. And you and I are both double insurance rates or more. So it’s, it’s a huge difference. And if you’ve designed your fee, and they have some information in this about how you can set your full fee, but if you design your fee based on what you need to make, and the insurance reimbursement rate is half of that, that’s a huge difference and needs to be a consideration you I would have to see double the insurance clients to make the same amount of money that I make with my private pay clients there, when we look at places like Oregon, their regular full fee is 165. They’re one of the five most expensive places to live, but insurance reimburses them at 130. So that’s only a $35 difference, you know, and it’s still per session, blah, blah, blah. But it is much closer, it’s not half of what the fee is, or, you know, two thirds what the fee is. And, and it’s a lot more approachable. Texas is another one that they reported on the average private pay fee, or the medium private pay fee is 125. Insurance is only 88. But it’s still only a $37 difference. And so and it’s also costs a lot less to live in Texas and live than it does to live in California. And some of these fees. You know, Oregon was the highest one they reported at 130. But if you’ve got a private pay fee, that’s typically around 130 to 150. And insurance is paying you 130 It’s not functionally different. And if you’ve got an almost 100% close rate, and can be choosy. And insurance practice may be awesome. Because you don’t have to do the marketing. There’s consistency insurance is going to consistently refer to you most when I was taking mostly insurance I had to put outgoing messages saying I’m not currently taking new clients. So people would stop begging me to call them back. And so it’s it’s this thing of there are places in the country in the United States where taking insurance makes a lot of sense.

Curt Widhalm  19:57

And especially when it does save you some of that time to go out and markets and to pay for SEO and fancy websites and all of that kind of stuff. And this is really where you’re looking at your cost basis. And, you know, that’s having to look at your finances. And that also includes how you value your time in putting that stuff together. So if it is functionally the same, and it does save you a bunch of other time, makes sense.

Katie Vernoy  20:30

I think the big caveat is the number of clients you’re seeing, or need to see to make the money, the total money that you want to make. And then also the amount of time that you’ll spend on insurance billing, there are some panels that are great, not a lot of, you know, denied claims, not a lot of work on that part that you know, you get paid easily, you know, I have one panel that I’m still on and I’m getting ready to go off of, but I, if they could just pay me a little bit more, I’d stay on it because I get a direct deposit, almost, you know, a few days after the session. And I’ve got clients paying 10 or $20, to see me like it’s, it’s amazing, it’s really cool. However, there’s other ones where I will charge something, they’ll pay me once, they won’t pay me another time. And then I have to chase it down. And so when you get into more of that, there is a bigger amount of time that’s spent on kind of managing the billing and tracking the billing and doing all those things. A lot of that became really easy when I did it through simple practice. So I will, I will acknowledge them for that, that I at this point, I push a button, it goes through, it tells me if it’s been denied, and then I can chase it down. But most of the time, I don’t even need to worry about it because I don’t have to chase it down.

Curt Widhalm  21:51

Now, one of the other things that I hear from you and some of my other friends who are panels is also that you take the copay, but then you might be waiting several months for the rest of the payments to even find out if it’s been approved or not. And one of the considerations of having that cash pay practice is my clients give me the money, and then all of the money is mine. Yeah, right up front. And so yeah, there’s, you know, anywhere that gets into, alright, you’re getting paid, but when and how and are you able to tie those things back to the specific sessions that, you know, might move you into a, this is gonna be a big part of our discussion here, move you into a different CPT code.

Katie Vernoy  22:43

I think there are definitely situations where people don’t get paid right away. And I think sometimes it is due to shifting from an individual contract to a group contract. Or if there’s like, I had a situation where I wasn’t paid because I had left the panel. And I billed for three sessions for a couple of clients right before I was off the panel. And they said I was off the panel, even though I submitted the claims before the final date, you know, like and so I had to go in and fight them for that. But otherwise, most of the time I get paid right away, like within days, and it goes directly into my bank account. So okay, so I think that there, there is a wide array of experiences here. I think if you have a panel where you’re not getting paid, or if you get clawbacks meaning they think they say, Hey, we thought it was covered, but it’s not give us the money back. I’ve never had a clawback. Maybe I should knock on wood here. But like, that sounds awful and horrible. And I think that there are things where we can just say there are times when insurance companies are evil and and are they unnecessary evil? Some people say yes, some people say no, but But yeah, I think there is typically a financial stability when you take insurance. However, if you’re not getting paid that financial stability doesn’t actually exist. And so you want to be pay attention to it. But let’s go to the what you were talking about the kind of the CPT codes as well as number of clients. Sure. So the vast majority of clinicians that bill through simple practice, and this is like over 100,000 users, not all of them are mental health therapists. Some of them have other types of practices. But the vast majority, like 10 times the number of sessions were billed as 90837, which is the 60 minute session or 60 Plus minute session versus 90834, which is 38 to 52 minutes, which fits into that 15 minute hour, right? And insurance companies assume that therapists are going to build that 15 minute hour. And they say that most of our colleagues are billing the 15 minute hour but we know thank you simple practice that most of us are billing 90837 which means it’s 53 minutes or more. And it means you actually have to be working clinically with a client for 53 minutes or more. And I think some people may fudge that it can’t be you waiting, it can’t be the documentation. It can’t be the scheduling time that you spend in the in the session. It’s actual clinical time. That being said, some folks are getting pushed back and they’re having to prove medical necessity for the longer session, which is the 90837. I think that is BS. I think it’s it’s something where insurance companies, I mean, and the rates for 90837 are way higher. So you do a 52 minute session. And it’s like $40, less than or $30, less than a 53 minutes session. It’s ridiculous. It’s, you know, and so insurance trying to get people to bill last are saying do these shorter sessions? Well, Ben’s idea is that we’ll just do these 90834, you can do a session, as short as what was it? 38 minutes, you could do a 40 minute session. And then if you can see more clients that way. And that might be a way to make more money in less time, because you do a certain number, there’s this is in the thing, but like a certain number of 40 minute sessions, versus a certain number of 60 minute sessions. You know, it’s about the same and you’re spending less time. And I don’t agree, sorry, Ben, I just don’t agree. Because it’s not just the session time, it’s also all the paperwork. But then there’s also the clinical case management. If you’ve got 20 people in crisis versus 30 people in crisis. It’s a very different workload.

Curt Widhalm  26:41

Yeah, I, I see where Ben is coming from on this from just a nuts and bolts number thing, and I will always remind people that Ben has not been a practicing therapist for several years.

Katie Vernoy  26:59

And love you, Ben, we love you.

Curt Widhalm  27:03

And, honestly, you know, we do have a lot of love and respect for bed and all of the work that he does, and, you know, simple practice, and practice learning and everything that he’s got going on. But I think it’s easy to forget the Practice Management sides of things. Yeah. And a lot of the managing caseload sides of things that I’m sure that he will very much acknowledge that he’s a little bit out of touch on. It’s just not practical. I mean, it’s just, it’s, it’s somebody saying, like, well, if people want more money, why don’t they just work more? And?

Katie Vernoy  27:46

Well, I think the argument isn’t actually the, to work more, it’s, Hey, do shorter sessions, so that you, you have less time in the chair. But it’s like, but there’s, you know, like, even the task switching of seeing one client versus the next client. I mean, that’s not even to mention what we just talked about with billing and, and case management. So I get it. And I actually think that that the other message I want, I want to add to Ben’s message and say, Why not allow for some of these shorter sessions, because you could see your client twice a week for 40 minutes. And, and have more of that flexibility of billing code. I mean, there’s also information in here, and I’m sure this came from Barbara, which was about, you know, kind of using some of these other codes, like, you know, 90846 is the client is family therapy without the clients you can talk to parents and have it paid for, you know, there’s there’s crisis codes, there’s a lot of stuff there that I think is pretty interesting. But, but you can use insurance a little bit more flexibly, you know, and Bill for everything, it’s just then you’re taking the time to build for everything. I think the other thing is, I think there was a statement like to avoid burnout See, five to seven clients, five days a week. And 25 doesn’t sound bad, but 35 sounds awful. And so I think that there’s, there’s a need to assess your for yourself. If you have 35 clients and they’re mostly insurance, I would recommend having a biller so you’re not chasing down, you know, fees, you’re not dealing with benefits, checks, that kind of stuff. But if if you can see 35 clients a week, then you’re different than me. I can’t do it. I don’t know that I can do 25. So I think it’s something where it’s it’s sorting out what that looks like. And you can you can do some simple math and I think you had started it. You can make a good living seeing mostly insurance clients. It just is really important that you all have your systems are very clean. Probably you have a biller, at least someone to check benefits and chase down things you know, because insurance on simple practice is literally pushing a button once it’s all set up. But it’s sorting out how many clients you actually want to see. And do you want to do some of these other things? I mean, to your point earlier, I would rather go out and do some networking, then see another client, right at times, you know, like, I would rather write a little blog post or do a podcast episode with you then see another client, like, when I’ve gotten through the number of clients that’s comfortable for me in the week, I could make more money seeing more clients. But I choose to do that in other ways, and to charge more for those times.

Curt Widhalm  30:33

And it’s not that we don’t like seeing clients. It’s that for

Katie Vernoy  30:38

other things, too. Yeah, exactly.

Curt Widhalm  30:42

So, you know, I do hear and read in some of the therapist forums about, you know, some of these clawbacks things that are happening, some of the rejections of that 90837. Is there anything that can really be done about that?

Katie Vernoy  31:00

There’s some specific things in the e book. And I think that the most important thing is to make sure that you’re writing actual start and stop times, you know, simple practice defaults to either an hour or 15 minutes, and it starts on the hour, or the whatever the time is that you set the appointment, making sure you actually have the time in there to the minute, if you see somebody for less than 53 minutes that you down, code it to 90834. And I think you want to make sure that you know, we’ve got different episodes on documentation, I can put in the in the links in the show notes. But it’s something where being able to document medical necessity for a longer session, that kind of stuff. I think it’s important. I think I got something from one of the insurance panels I was on that basically said, You need to make sure that your notes show that you spent that much time and so anyone that’s been in committed mental health knows like, you have to have enough interventions. In your note for that for that long of a session. You know, if you’re going to go a full hour, or 53 minutes, plus, you need to make sure your documentation shows that you’re not processing one thing. And that’s all that you’ve put down in your note. So those are the things that you can do. It’s just Ben’s idea of doing shorter sessions and seeing more clients may keep you under the radar radar of insurance companies, they don’t see you as overusing 90837. I just don’t think it’s worth it. I think just do the documentation, make sure that you’re you’re staying true to the start and stop times and hope for the best.

Curt Widhalm  32:36

Overall reading through this, I can say that my reaction is insurance companies aren’t paying as badly as I had thought that they were. Yes. And I don’t know how to convey to our listeners how much it actually pains me to say that, that. But there are a lot of individual factors that you have to decide for yourself that if you’re wanting to see clients, you’re wanting the marketing and the phone calls to be kind of funneled to you being on a panel makes sense. If you’re somebody who needs to get out of the office a little bit more, you want to put in a little bit more of that work, and you want to operate partially or fully outside of the insurance systems. There’s pathways for you there to both have their advantages and disadvantages. But I was really surprised to see that out of the 1000s of users that simple practice has those rates are a lot closer than I would have expected them to be.

Katie Vernoy  33:49

Yeah, well, and I think a big point there is that if you’re wanting to have an accessible practice, and you’re wanting to do that, for a lot of clients, insurance is potentially a better way to do it, because clients will pay, I think the median copay was about $15. Whereas if you slide down to $30, or 50 $60, or $70, or $80, you’re going to make less than insurance. Now, if you’re doing it for a couple of spots, you’re doing it through open path or you’re doing those kinds of things as a small give back, I think that’s very much appropriate. But if you’re doing it for your whole caseload, where your whole caseload is sitting around the median insurance fee, you will make the same amount potentially more because you will not have to market it yourself. Your clients will pay less than they’re paying you now. You just have to get through the the insurance paperwork and that kind of stuff. So I think I think there’s going to be different factors for everyone. But if you’re sliding your fee, down to 100 or below $100 typically anyway You may make more on insurance than you are right now.

Curt Widhalm  35:04

We would love to hear your feedback and what you’re doing with your practice. And the best way to do that is join our Facebook community, the modern therapist group, you can also let us know on our social media. And we’ll include links to all of that and the stuff from simple practice and what Katie mentioned in our show notes, you’ll find those over at MTS G podcast calm. And until next time, I’m Curt Widhalm with Katie Vernoy.

Katie Vernoy  35:30

Thanks again to our sponsors simplified SEO consulting.

Curt Widhalm  35:33

These days, word of mouth referrals just aren’t enough to fill your caseload. Instead, most people go to Google when they’re looking for a therapist. And when they start searching, you want to make sure they find you. That’s where simplified SEO consulting comes in. It’s founded and run by a private practice owner who understands the needs of a private practice, and they can help you learn to optimize your own website, or they can do the optimizing for you.

Katie Vernoy  35:57

Visit simplified Seo consulting.com forward slash modern therapist to learn more. And if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO courses using the code modern therapist. Once again, visit simplified Seo consulting.com forward slash modern therapist and use the code modern therapist all caps.

Announcer  36:22

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