Therapy Insurance and Billing Trends for Private Practice in 2025: An Interview with Sanjana Sathya

Curt and Katie chat with Sanjana Sathya, co-founder of Thrizer, about the current landscape of mental health billing and insurance. Drawing from the 2025 State of Mental Health Insurance and Marketing report, Sanjana shares insights from hundreds of clinicians on reimbursement trends, hybrid practice models, and strategies for reducing administrative burden. They explore how therapists can make sustainable choices about private pay, insurance, and out-of-network billing — all while preparing for future changes in the mental health field.

Transcript

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(Show notes provided in collaboration with Otter.ai and ChatGPT.)

An Interview with Sanjana Sathya, Co-Founder of Thrizer

Sanjana is a co-founder at Thrizer. She is passionate about helping people access quality and affordable mental healthcare. Thrizer’s mission is to make therapy more accessible and equitable. With Thrizer, clients with out-of-network benefits just pay a copay for sessions all while therapists earn their full private pay rate upfront. She is a long-time therapy-goer herself who credits much of her own growth to her therapist, and she can’t wait to chat more about therapy, insurance companies, and everything in between.

 

In this podcast episode, we talk about how insurance is working for therapy right now

Therapists in private practice must make choices between insurance, private pay, or hybrid billing. They all have pros and cons that can shift as the economy and insurance reimbursement rates change. We talked with our partner, Sanjana Sathya from Thrizer about a survey they conducted to identify what the state of insurance is now.

Survey insights on therapist billing models

• Only 8% of surveyed clinicians are fully insurance-based.
• 32% are entirely private pay; 60% use a hybrid model.
• The average in-network reimbursement is $112 per session.
• Ideal private pay rates reported: $180–$200 per session.
• 47% of respondents say insurance is not worth the effort.

“[Taking insurance based versus private pay] doesn’t have to be either/or it doesn’t have to be, I’m fully insurance based or I’m fully private pay. There’s a lot of benefit of being in that hybrid middle section… that’s kind of where we’re seeing, I think, a lot of people leaning towards because both sides aren’t perfect.” – Sanjana Sathya

Pros and cons of accepting insurance as a therapist

• Benefits: improved accessibility, consistent caseload, lower barrier for new clients.
• Drawbacks: lower reimbursement, administrative workload, and high denial rates (50% had at least one denial in the last year).
• Many therapists find themselves leaving insurance panels due to these challenges.

Exploring private pay and hybrid models for therapy practices

• Private pay practices allow for greater clinical autonomy and potentially higher income.
• Hybrid models offer flexibility by combining private pay with selected insurance panels.
• Clinicians may also offer super bills or courtesy billing for out-of-network clients.

“We’re in an imperfect system…Until we can get to a place where insurance companies are paying clinicians a reasonable and fair rate for everyone, and clients are able to pay a reasonable and fair rate and something they can afford, we’re going to be operating in this mess, right?” – Sanjana Sathya

What is out-of-network billing and how can therapists use this model to best effect?

• Therapists can submit a CMS1500 form to insurance, without accepting assignment, so that insurance plans can reimburse clients for their out of network benefits.
• Thrizer acts as a courtesy billing provider to make OON benefits feel in-network.
• They report denial rates of less than 0.1%.
• The service aims to streamline the process for both clinicians and clients.

How therapists can choose a trustworthy billing service

• Evaluate services based on denial rates, support responsiveness, transparency, and fees.
• Talk to colleagues and request referrals.
• Consider using a free trial to test workflows before committing.

How to future-proof your therapy practices

• Consider licensure in multiple states to reach more clients.
• Diversify income with services like group therapy, workshops, or supervision.
• Invest in tools like EHRs and virtual assistants to reduce time spent on administrative tasks.
• Stay informed about healthcare policy trends and changing economic conditions.

 

Resources for Modern Therapists mentioned in this Podcast Episode:

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Thrizer

Try Thrizer for free using the link https://join.thrizer.com/moderntherapists or code moderntherapists and receive waived credit card fees for your first $2500 in payments

 

Relevant Episodes of MTSG Podcast:

Should Private Practice Therapists Take Insurance?

How Do Therapists Get Paid?

Busting Insurance Myths: An Interview with Barbara Griswold, MFT

Topic: Money

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:

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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 the podcast for therapists about things that go on in our work, the things that go on in our field, and the economy has been all over the place. And one of the things that we talk about occasionally, and we’ve talked about historically, is ways about future proofing your practice, ways that potentially working with insurances is something that people might want to consider or if you’re already working with insurances and totally not happy with what that process is, we always like to invite some friends to help us out with some of the conversations that Katie and I are at least aware of, but don’t necessarily have all of the expertise to be able to speak to it ourselves. And we are joined today by Sanjana Sathya. She is the co founder at Thrizer and very willing to spend some time talking about just the state of where things interacting with insurance are for us as mental health professionals. So thank you so much for joining us here today.

Sanjana Sathya 1:19
Thank you so much for having me Katie and Curt is a conversation I’ve really been looking forward to.

Katie Vernoy 1:24
We’ve been looking forward to it as well. But before we get started, we want to ask you the question we ask all our guests, which is, who are you and what are you putting out into the world?

Sanjana Sathya 1:33
Yeah, I am Sanjana. I’m as Curt mentioned, co founder of Thrizer. We are an out of network billing service. But honestly, a big part of why I’m here today is, I think that advocacy starts with education, right? Like, a big part of what we’re putting out into the world at Thrizer is, how can clinicians better support themselves while still being accessible to their clients? And a lot of times, insurance, you know, accepting insurance can feel like the obvious answer, but it may not work for everyone. It may work partially for some people, and maybe they want to incorporate private pay as a part of, you know, supporting their income sources. So, you know, I love having these conversations, because there isn’t a one size fits all for everyone. And really just talking about it, about the state of insurance, about, you know, how super bills work, and out of network benefits work, and just in general, right? What can we be kind of navigating when we’re thinking about building a private practice? I love having these conversations, because I feel like it goes in all different directions and fun to kind of hear from the hosts. And you know what is most salient for your listeners? So yeah, that’s kind of what I’m putting into the world.

Curt Widhalm 2:43
So just to frame where you’re coming from, a little bit on this episode, Thrizer has been involved with this pretty important report that’s been coming out.

Sanjana Sathya 2:51
Yes, yes. So we have partnered with Beacon, you know, media marketing, on this really exciting report called the 2025 State of Mental Health Insurance and Marketing. What we did is that, you know, at the end of 2024 we sent out a survey to a bunch of, you know, hundreds of clinicians, therapists and just mental health professionals on what is their current sentiment towards accepting insurance. You know, the reimbursement rates that they’re receiving across the board, what their ideal private pay rates might be, if that’s different from their reimbursement rates within the in network system. You know what clawbacks look like, what denials look like. It really kind of just a deep dive on is insurance supporting them. And if they’ve decided to leave the insurance panels, why have they done so? Right? And I think that the biggest takeaway from we’ll get into the data and stuff, but the biggest takeaway from all of this is that people have a lot to say, and there’s just, you know, a lot of conversation about this, and we just want to normalize, if there’s any feelings towards or against insurance. We want to normalize those feelings, right? Because we, I think we can all acknowledge we’re not in a perfect system right now. So, yeah.

Katie Vernoy 4:05
So we’ll link to that report in our show notes over at mtsgpodcast.com. But what are the current stats on how many folks are taking insurance, the average pay, that kind of stuff? Like, what are the what are the big data points that are important for today’s conversation?

Sanjana Sathya 4:20
We surveyed about, you know, 300 400 clinicians to kind of understand where the current state of accepting insurance is, and of that, just to kind of level set on the sample size, just because I know we get questions around that is about 80% of them are solo practitioners. So it is more heavily leaned towards the smaller practices, kind of across the mental health spectrum in terms of professional counselors, LMHCs or LMFTs, you know, kind of just across the board in terms of the type of clinicians that we’ve surveyed. And what we’ve seen is that, kind of, looking at the numbers, only 8% at least of this sample size are fully insurance based, which was very interesting for me to see, 32% are entirely private pay, and 60% kind of that middle chunk, are part private pay, and then part insurance based. And that’s actually really interesting. And we’ll kind of dive into that middle segment, because I feel like that’s where there’s so much to learn from, but that’s the stats we’ve seen in terms of just the breakdown of our clinician, you know, base in terms of the survey size, average reimbursement rate, or kind of the pay that we’ve seen within a network is about $112 a session. And so, you know, obviously there will be some insurances that pay a little less, some that pay a little bit more, but across the board, the average we’ve heard, is about $112 or $110. Compare that to We also asked this question that was, what is your ideal private pay rate? Let’s say you switch into fully private pay, what would you want to charge your clients that you think is fair and supports your well being and financial goals? It was between the $180 to $200 per session range, right? So if you look at that, insurance reimbursement rates are about 60% of what clinicians or therapists feel like is fair and supports their work, their well being, their financial goals. And that’s kind of the biggest takeaway from all of this, right? We’re within the insurance system. We want to talk about how, you know, the entire system can support clinicians. And we also asked this question that was, overall, if you’re accepting insurance today, do you think it’s worth it? And 47% of the people said, No, it’s not worth it. It’s only half of them said it is supporting their goals. So yeah, those are kind of the top of mind stats that come to me of the current state of insurance. And of course, we have a lot more data on, you know, how clawbacks look, how denials look, why people left to go to private pay all of that, but that’s kind of the level setting of this entire conversation in the report.

Curt Widhalm 6:57
What are people saying are the advantages of doing insurance, either fully or part of their practice, towards their goals.

Sanjana Sathya 7:05
If we look at the pros of kind of what people are saying in terms of accepting insurance, the biggest one that comes up is accessibility, right? I think therapists come into this field to be able to offer services to people in need. It becomes kind of this ethical question of, if I’m not able to be accessible to the people I want to serve, am I making the level of impact that I want to be making? Right? So accessibility ends up being the biggest reason why people tend to stay in network. Another source is also easier client acquisition, just purely from a business perspective, right? If you’re running a private practice, you don’t have to worry as much about marketing. The insurance panels are doing the marketing for you. A lot of times the first line of order is that clients will hop onto their insurance portal. They’ll see, okay, who’s in network. I want to find a therapist. Let me just go to Aetna and find who is in my location and who kind of fits the fits what I’m looking for, right? So client, from a client acquisition perspective, especially because clinicians don’t want to focus on marketing and, you know, all these other things, they want to focus on providing care. So from a client acquisition perspective, it definitely is a huge pro. Because of that client acquisition the other aspect is a more predictable volume, right? Of course, we can talk about caseloads being large, but it is predictable. There’s not as much seasonality, right? As long as they have the insurance benefits, they’re paying a pretty small co pay in terms of the clients. And, you know, it’s, it’s more predictable in terms of what is my volume going to look like as a practice versus private pay becomes a little bit more difficult.

Katie Vernoy 8:43
I know for myself that when I was in network, that was definitely my experience, that there was a lot of if somebody called and I was on their panel, they were my client, and it was very easy, and you can predict, and I think that can be very appealing to a lot of folks, especially in the current economy. But there’s also cons, and I think that’s something that might be important to go into as well, because I, I moved out of network because of things like clawbacks and insurance making mistakes and the very long calls and other all those types of things. What did you find in your research around why folks either didn’t like taking insurance, or were getting off insurance panels?

Sanjana Sathya 9:23
Yeah, the three biggest reasons were, one, reimbursement rates, right? They felt like the reimbursement rates were not supporting what you know, their goals were, and just wasn’t fair, right? Like they’re not getting paid a fair, reasonable rate for the services they’re providing. Two, and this is kind of the top two were reimbursement rates and admin and paperwork and just dealing with insurance right. To your point, Katie, needing to even figure out, okay, how do I do the paperwork to submit claims to insurance? How long am I waiting to get the reimbursements, right? And then even after doing those two things, of course, and before that, it’s getting paneled with insurance, which is the whole process. But even after submitting claims, what we actually saw is that we kind of asked our respondents, we were like, Hey, so what percentage of your claims have been denied right in the past one year? And we found that one in two clinician has experienced a claim denial, so 50% have at least experienced one claim denial, right? And then if you look at the volume of claim denials, it’s between, most of them are saying it’s between 1% to 5% and then 5% to 10% in terms of the volume of claims that have been denied. And that’s not a very you know, if you’re looking at a system where one in two people are going to get a claim denial, it’s not a very supportive system, right? And if you look at clawback, one in four people had clawbacks in the past 365 days. And so those are kind of the reasons that we’re seeing that, you know, folks are choosing to leave insurance panels or, you know, just accept a few insurances instead of being paneled with everyone. On top of that, those are kind of the big reasons. Another reason that came up, which was kind of number three in the list, was clinical autonomy and privacy. So that was a big part of it. You know, they felt like there was just a lot of hoops and hurdles in terms of documentation and notes and, you know, needing to submit all that paperwork and even assigning diagnosis codes when they didn’t really feel like, you know, it was necessary or wanted to for insurance reimbursement. So those are kind of the other things. And, you know, other other things that came up was also just all of this leading to burnout, and burnout was cited as another reason. So those are kind of the cons that we’re seeing of accepting insurance. And yeah, it’s just kind of, I feel like it’s been normalized and accepted within within the system, but it is something that needs to be questioned and talked about.

Katie Vernoy 11:58
Well, and I think the big thing there is that’s really challenging to me, is that you can do quote, unquote, everything right…

Sanjana Sathya 12:05
Yeah.

Katie Vernoy 12:05
And still get either clawbacks or errors or those kinds of things. I’ve had even when I moved out of network, I started getting, you know, errors with clients who were trying to get out of network benefits, like it’s insurance companies are a little bit of a mess. And so it’s, it’s frustrating. When it works, it’s amazing, especially if the rates are reasonable, that it can be very amazing, because you don’t have to market. You can just see clients, you can focus on that effort. But when the insurance panels are really awful, both in rates and accuracy and fairness, it’s it’s just a whole other battle to fight, and so it’s something we’re making sure to be able to assess those things within, you know, whatever panels you’re on, or those kinds of things can be really important.

Sanjana Sathya 12:50
Yeah, absolutely.

… 12:51
(Advertisement Break)

Curt Widhalm 12:53
I know in our therapist communities, we tend to see the worst examples of people facing clawbacks, companies coming back for years and 1000s and 1000s of dollars. What kinds of things do you end up seeing clinicians talking about when it comes to clawbacks?

Sanjana Sathya 13:09
We asked this question too. We were like, Do you know why you got a clawback? Or do you know what the claim denial reason was? And honestly, insurance isn’t transparent about that. They use a bunch of gibberish language that says something along the lines of oh, like, need further documentation, or, you know, not able to justify continue, needing continual care. Or some, some random like, phrases like that that makes…

Katie Vernoy 13:36
Well, and they also have phrases like 07721…

Sanjana Sathya 13:40
Yeah.

Katie Vernoy 13:40
And then, and then a word that doesn’t make any sense.

Sanjana Sathya 13:44
Exactly. And so it’s, it’s a completely not a transparent process, not a, it’s a complete black box, honestly. And so I feel like my sense is a lot of people and, you know, at Thrizer, we process out a network claim. So I imagine in network is a whole other mess, right? But in your in network setting, in the out of network setting, we literally get claim denials that say this service wasn’t reimbursed because it wasn’t reimbursable. And it’s like, okay, what is that? What is that example? But why not? But why? Tell me more. And it’s a whole process to even find out why the claims were denied, or, you know, clawbacks are happening. And so it can be really frustrating, especially when on the in network side. As a clinician, you’re not getting paid, right? You have no idea why, and you can’t rely on that steady source of income that we were talking about. So.

Katie Vernoy 14:33
I think when people go out of network, they’ve decided that the nonsense that the insurance is doing they go completely private pay, typically.

Sanjana Sathya 14:43
Yeah.

Katie Vernoy 14:43
And what did you see as far as the pros and cons of private pay? What’s actually happening for clinicians who are private pay?

Sanjana Sathya 14:51
The reasons that I mentioned, that you know people have cited going private pay is, again, the higher reimbursement rate, so they can finally set and charge the rates that they feel is supportive of their well being and goals, and it’s fair to them, right? So that’s the biggest pro of private pay. Again, greater clinical autonomy. If they want to provide super bills, of course, they will need to provide a diagnosis code. But if they feel like they, you know, they don’t want to, and a lot of clients prefer to be, don’t want anything on their record and want to remain private in terms of mental health conditions, they don’t have to, right. Like they don’t need to assign any diagnosis codes and things like that. And then the trickle effect of not needing to deal with admin work and being able to charge what you want automatically leads to less burnout. And I think that’s the biggest thing that we’re hearing, right? And to your point, Katie, a lot of people start insurance based, and that’s what we’ve seen, right? A lot of people start insurance based, and then they decide to go private pay like, you know, it’s because they’ve tried to deal with it, and it just didn’t work for them. And so, yeah, the pros that we’re seeing is just less admin work, setting the rates that they want, more clinical autonomy, less burnout. But on the flip side, of course, there are, there are cons, absolutely, and that is kind of the direct opposite of the pros of being in network, right? Much more focus on needing to market yourself, right? You will be spending time on marketing, whether that’s SEO or hiring a coach or blogging or putting paid ads out, or, you know, networking more and focusing on referrals, things like that. You , you do have those aspects that you would need to focus on more as a private pay practice, and of course, then that could lead to more unpredictability in terms of your volume, right? Maybe you really focus on growth, and maybe the economy is doing great and people are able to afford your private pay rates, your private practice is booming, versus on the flip side, let’s say you are not focusing on marketing as much, and the economy isn’t doing great, then, you know, maybe you aren’t seeing the steady source of income that you would be receiving in network. And we’ll talk about this in terms of like, how do you mitigate the risks? But that’s why I think my strong, my strong hunch is there the reason, 60% of this population, of the survey respondents were in that middle category of hybrid. There’s a reason for that, right? It doesn’t have to be either/or it doesn’t have to be, I’m fully insurance based or I’m fully private pay. There’s a lot of benefit of being in that hybrid middle section, and we can talk about what those benefits are, but that’s kind of where we’re seeing, I think a lot of people leaning towards because both sides aren’t perfect.

Katie Vernoy 17:40
Well, and one thing that I remember reading in the report is that folks would like to have a fee of $180 to $200. What is actually happening?

Sanjana Sathya 17:50
Yeah, so the average rate that they are charging if you’re a private if they’re a private pay therapist, is $175. And so that’s the average that we’ve seen. So even if, and the most common rate is $150 right? And so even if they do feel like, you know, they they can charge more, their desired rate is higher. You’re right, they are undercutting still and charging $150 to $175.

Katie Vernoy 18:16
So it’s there’s not a magical button here that says, Hey, do this and you’ll get to make as much as you want. There’s really a lot of work regardless of the choices that you make.

Sanjana Sathya 18:27
Yes.

Curt Widhalm 18:28
You had mentioned about mitigating some of the risks that go along with this. What are some of the ways that people can mitigate some of these risks?

Sanjana Sathya 18:36
Great question, and I think this is I’m most excited to share about is, is the biggest takeaway for me from the report is we’re in an imperfect system. The answer is somewhere in the middle, right. Until we can get to a place where insurance companies are paying clinicians a reasonable and fair rate for everyone, and clients are able to pay a reasonable and fair rate and something they can afford, we’re going to be operating in this mess, right? And so the best thing I can say is that hybrid approach. And what does a hybrid approach look like, right? It is one picking a few insurance panels you want to be a part of, right? So whether that’s Medicaid and Medicare, right, because they don’t have out of network benefits. Or they’re the people you know within that population who have the least resources to access, whatever that might be, or it might be an insurance company that is the biggest in your location, right? Like, there are Aetna hubs. There are Cigna hubs, right? Like, figure out what that big hub is, so that you’re able to be accessible to most of your clients in your region, right? So picking a couple of insurance panels, and again, this is, you know, not me, advocating you should accept insurance, right? This is just, if you feel like you you want to try a few things out, a hybrid approach. could look like you accept a few insurances. Then there’s a subset of people who have out of network benefits, right? And so they’re the people with great PPO plans for insurances that you aren’t paneled with, POS plans. And you know, other plans that do have great out of network benefits, and you offer super bills to them, right? And that way you’re still getting your full rate, and they are getting back 50% or more of your session cost. And so that’s a great middle ground for them. And then finally, you might have those subset of clients that don’t have insurance, or don’t have great insurances, or have huge deductibles, even in network setting and things like that. And maybe you offer a sliding scale right for a few few of those clients. Again, the ratio of these three buckets is completely up to you, right? It’s up to what are your goals? Where do you feel comfortable? What do you think is fair to yourself and to your clients? Why did you get into this field? Like, is it supportive of that bigger mission that you had coming into it? And that is kind of the hybrid approach that, you know, we’ve seen from the report is that’s what I’ve been trying to do after years of trial and error. That’s where I’ve landed, right? And that seems to be something I can sit well with and I feel good about. So that’s kind of what we’re seeing.

Katie Vernoy 18:57
And that’s something we’ve talked about in other episodes. We’ll link to those over in the show notes, over at mtsgpodcast.com, and I think what you’re saying really makes sense. It’s looking at what makes the most sense as far as your location, what insurance are they taking? It could be, if you have a particular niche or group of folks that you’re seeing, what insurance do they take? And the other element of it is really doing the math on how many clients can you see in network versus out of network, versus private pay and all of those things. And so we have longer conversations about those in the show notes over at mtsgpodcast.com. However, I know for myself, when I’ve gone out of network for any type of services and I’ve gotten a super bill, it doesn’t always work. And so it’s a pain in the rear, I’ll say rear so we don’t have to put explicit on this one. It’s a pain in the rear. And I know for myself, there’s maybe a one in three chance I’ll get reimbursement from it. And so to me, I appreciate the super bill idea, because I think it does give clients some opportunity. But I’ve actually gone to doing courtesy billing out of network, because I think that that’s something that’s way more feasible, and I’ll just maybe I’m stepping over what you’re going to say next, but that’s one of the ways that I try to provide access and make sure that clients are actually getting reimbursement so that they can continue to come see me, even if the economy is going up and down like it is right now.

Sanjana Sathya 21:20
Yeah.

Katie Vernoy 21:23
What are your thoughts about out of network billing?

Sanjana Sathya 22:47
This is a leading question, Katie.

Katie Vernoy 22:49
I know, I know, and I have to full disclosure, I am, I am a client of Thrizer, and I do have some clients, my therapy clients, and they’re getting some out of network benefits. So So yes, this is a leading question, but talk a little bit about what out of network billing is, because not all of our all of our listeners, know what that actually is, because they just think, oh, super bills, and then how that can help folks with this. Because I think for me, that’s been huge when I’ve been able to actually do courtesy billing for folks who potentially don’t have the wherewithal to get their super bills actually reimbursed.

Sanjana Sathya 23:24
Absolutely, absolutely. I’m happy to kind of dive deep into this. So one thing I want to kind of address up front is courtesy billing can seem scary, right? It’s like…

Katie Vernoy 23:34
Sure.

Sanjana Sathya 23:35
You’ve stepped out of the insurance world because you don’t want to deal with insurance. And I think when you know folks are just hearing about courtesy billing, it can feel much more hands on than it needs to be if you are using an out of network biller or out of network billing service, right? And so you know, I’d love to hear your your experience with Thrizer, too. But what we try to tell people with these out of network billing services, not just Thrizer, there are other ones out there as well. Is it’s very hands off for you as a clinician, right? It’s basically you click a button. Everything happens in the back end, and these out of network billing services take care of 100% of the insurance burden and hassles that are presented with super bills. I like to say, out of network benefits are great, but super bills suck, and there’s [unintelligble] with that, because super bills are very archaic, right? Step number one is you request a super bill, a client who is already probably going through a lot and seeking services, the last thing they want to do is deal with insurance. So even submitting a super bill can feel very intimidating for clients. You know, in terms of where do I submit it? Do I go to my portal? Do I fax it in? Do I mail it in? Like there’s actually so many different processes depending on your specific insurance plan, right? So step one is already really intimidating. Step two is there’s no way to track super bills. There’s no online portal that says we’ve received your super bill. We’re working on your claim, and here’s how you how much you’re going to get back. Right? There is complete lack of transparency in the entire process, which adds more to the frustration and uncertainty of am I going to get paid back with my out of network benefits, right? And then next step is you it might take four to six weeks, if you’re lucky, to get back that reimbursement check, right? And so you’ve already fronted, you know, if your therapist is charging you $200 but you know you might get back $100 of it. You’ve already fronted the $200. So if you’re going to weekly sessions, you fronted $200, $200, $200, $200 likely for six sessions before receiving anything back from insurance. So you’re out $1,200 and you haven’t received anything back from insurance, right? And I am convinced all this is on purpose, right? Insurance companies don’t want you to rely on out of network benefits, and they perpetuated that rhetoric, and that’s why there’s a lot of perceptions out there that, oh, there are large deductibles. You know, out of network benefits are not reliable, all of which is true, but there are companies that are experts in that, and have really tried to figure out, how do we partner with insurance companies? How do we make sure that we are submitting claims in bulk. And of course, Thrizer, you know, we we’ve gone away with even doing reimbursement weights. We don’t, we don’t like reimbursement weights, and we just want you to pay a fee up front, and that’s it. So I think that’s where out of network billing can be really helpful. And I think the other part that I like to mention is, by helping your clients, you are helping your practice, right? If we’re talking about a decision that can support your practice, incorporating out of network benefits into your website, incorporating out of network benefits into your intake process, right? I’m not I don’t accept insurance, but you may have out of network benefits, I use a tool that can verify it for you instantly, and they’ll take care of your claims, right? That is a great marketing tool, and we’ve seen a lot of people kind of lean on that with Thrizer or other companies, because they’re able to say that, and then that automatically is like, oh, like, they’re still out of network, but I’m going to be supported by this clinician financially, right? And so that can actually be a great marketing tool that we’ve seen. So, yeah, that’s kind of why I would say, you know, out of network billing services are low touch. They’re not a lot of effort for clinicians, but they can be really great resources for clients and a great marketing tool as well for the for the practices.

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Curt Widhalm 27:42
When it comes it comes to this kind of extension of a practice, and for many people in smaller practices that are used to having their hands on every step of the way, and a lot of DIY kinds of things, when it comes to handing over some of the responsibilities, when it comes to especially things like money, how do you encourage clinicians to look for reliable billers or reliable extensions of this in order to have kind of that lifeblood of the practice? How do you ensure that trust is there? What do you encourage clinicians to do with that?

Sanjana Sathya 28:20
The biggest thing is do your research and ask the tough questions, right? So firstly, for everything that you’re considering, any service that you’re considering, go to, you know, go to their resources, go to their website. Talk to your peers. At this point, a lot of people are using these services. So you might have someone within your network who are, you know, using one of these billing services and out of network for out of network services. Have those conversations once you’ve done a good level of research, and talk to your peers. Get on calls with every company that you are considering right. Ask the tough questions, when am I going to get paid? How are claims submitted? If claims get denied, what assurances do you have in place? Right? What does the process actually look like? And you know what, what are the denial reasons and what are the denial rates? Right? Like just these kind of questions, ask the tough questions, and any, any company that you are evaluating should be able to answer those questions for you, and that’s kind of how you build trust. And of course, if you don’t have anyone in your peer who is using a company that you are considering, you can always ask the company for referrals to, you know, other clinicians who have been using that service for a while. So you know, we always have people who are like, Oh, we haven’t heard of Thrizer. We don’t know anyone who’s using it. Can we please get connected with people who’ve been using Thrizer? And we were always open to kind of linking people up and say, Okay, this is the state you’re in. This is the kind of, you know, services you provide. Let’s, let’s match you up with the right person who can give you their their honest opinion and experience. Yeah. So I would say those are, those are the big things, do the research, ask the tough questions. Ask for referrals, talk to your peers, and once you feel like it is something that that supports your practice, move forward. And there most these, these places offer free trials, so you don’t have to worry about losing money or any of that. You could try it off with a couple of clients and see what fit works for you.

Katie Vernoy 30:15
As a set point, so people have some ideas of what they might be hearing from other companies. What are Thrizer’sclawback rates, denial rates, you know, clean claims, that kind of stuff. Like, what are you seeing as far as that process? Because I can compare it kind of to my little where I do, I do some of my own out of network billing, and I do some through Thrizer, and then I also some clients get super bills. So, yeah, maybe, maybe, if folks want information on that, put that up over in our modern therapist group, and I can give some feedback on that too, but, but what are, what are Thrizer rates on those so that there’s a set point for other folks to.

Sanjana Sathya 30:49
Yeah, yeah, absolutely. So what we say is, in terms of denials, once we check benefits that they have out of network benefits, the denial rates are very low, especially because you know, when we when we hear or get back a claim denial, it’s usually because there’s some error in terms of the submission or something like that, that happens, and we’re able to correct it very quickly. So if you look at the actual rate of denials, it’s less than 0.1% of our entire claim volume. Right. On the flip side, what does happen, and I like to be very transparent about this, is insurance does not publish what the reimbursement rates are. So even using our instant benefits calculator will give you a directional sense until we hear back on the first claim, right? And unfortunately, that’s just kind of how insurance is structured, like you will, we will be able to let you know, for a client, exactly what their deductible is, and we will be able to let you know what the coinsurance is. But the allowed amount that you know, that number is not published in insurance plans, and they vary by individual client, and so we’ll kind of give our best guess of hey, similar plans have been reimbursed this in the past, and there will be variation on that, and we like to be very transparent about that. In the event that a clawback have clawback, meaning the claim gets denied. There are no clawbacks in the out of network setting, right? Because the client is on the hook to pay for sessions. That’s, there are no clinician clawbacks. And that’s that’s an important distinction to be made. Clinicians are paid up front. They they get their rate up front. Clients are the ones waiting for reimbursement. If a claim gets denied, and, you know, we’ve submitted it, and the client, you know, we have this co pay option where a client just has to pay a portion of, you know, reduced rate. We cover the rest of the rate for the clinician and then wait for reimbursement on the client’s behalf. If we’ve done that and a client has already paid a co pay, we are not going to back charge the client for that session. That’s a strict policy that we have because we want it to be something they can rely on. For that claim denial, we will submit it to insurance again. We’ll try to gather as much information why the claim was denied. If we have reason to believe that moving forward, claims will continue to be denied, we will let the client know, hey, looks like you know your insurance isn’t honoring your out of network benefits. We will you know you will be responsible for your full rate moving forward, but please contact your insurance and see if you can do something about it. Right? Because we’ve we’ve tried our best, essentially. That’s the safeguard that we always provided clients if they’ve submitted 10 claims and we haven’t heard back on their you know, whether it’s been approved or not, we’re not going to back charge them if they’ve been denied even all 10 claims. And so that’s kind of the safeguards that we’ve built into the process. In terms of claim submissions, at this point, everything is fully automated, right? We integrate with clearing houses, we have a pretty a very robust billing team that scours our claims make sure that everything is clean and submitted. We have a bunch of QA policies in check, and we make sure that every claim that goes out is accurate. And, you know, want to make sure that it is using the right pieces of information and everything, and it’s fully automated and sent directly to insurance. So I think those are kind of the big questions. Katie, did I miss anything in terms of the questions you had?

Katie Vernoy 34:12
I think that’s good, and we are running short on time, so I think it’s important that we get to the last question we wanted to make sure to hit, which is, there’s a lot going on. So how can clinicians future proof their practice?

Sanjana Sathya 34:26
Yeah, and I get this question a lot from from clinicians who, who I speak to. And first of all, I, I think I wanted to mention this earlier is, I think we need to offer or clinicians need to offer themselves a lot of grace, because everything’s difficult right now. The world is tough, but also being a clinician in this world is very tough, and a therapist in this world is very tough. And as we kind of established with the whole insurance conversation, there isn’t, it isn’t a perfect system, even if you find a hybrid approach that works, it can feel like you’re not doing enough. It can feel like you’re not getting paid enough. And I think the system’s just been built that way to make you feel that way, and it’s really unfortunate, and hoping that we’ll be able to find a solution. So given that context, like what, what can you do? Is one, of course, we’ve talked about the hybrid approach, right? Figure out, what is it that you need to support yourself and your family? What is the right mix of insurance, private pay, sliding scale, whatever you want to offer looks like. So you’re getting a steady stream and and reliable stream of income. Two is a lot of therapists are now finding other sources of income to keep themselves and their and their revenue diversified right? So whether that is offering group therapy and workshops right, whether that is offering seminars, whether that is, you know, in terms of offering courses or doing podcasts, right, and clinical supervision, you know, things like that that do help, kind of broaden the diversity of sources of income they’re getting, that can feel a little bit more comfortable than relying entirely on your therapy sessions. And that’s something that we’ve seen the trend go towards. And Katie, you probably know this much more in terms of a lot more people are investing in other side things that still big bring them joy, right? And honestly, it might be great for them to get their story out. You know, a lot of people are leaning into their social media pages and doing aligned sponsorships with with companies that they’re using, or brands that they really like. You know, find ethical and supportive of clinician goals. So that is another thing that we’ve seen a lot of people doing. Three is, in general, a lot of clinicians are, you know, leaning towards telehealth. And I think that happened, that intentional shift happened during, you know, the pandemic, and that can really, you know, reduce the burden and and have give you access to more clients, right? There are things like Psypact for psychologists, so you get, you know, you get licensed in multiple states. Getting licensed in multiple states might be a good option in general, in terms of being able to see a diversity of clients. Another thing that you know that could be really helpful is just investing in learning about what’s happening in terms of health policy and trends and things like that, so you can get ahead of it. And then finally, it’s just like the last piece I like to end on is just giving yourself grace. There isn’t a perfect thing to do right now, and the more we’re able to you know, you’ve done all the right things in terms of diversifying your your income, investing in tools. That’s another thing that I like to mention, finding tools that reduce your admin work. You know, a lot of people are relying on tools like their EHRs, that are doing much more, that they generate super bills on their own now, right? And you know, investing in virtual assistants, for example, you know, anything that can reduce the administrative burden can also be super helpful. So that was kind of all over the place, but top of mind, things that come to that come to my that come to mind in terms of things that that clinicians can do in this in this world.

Curt Widhalm 38:24
Where can people find out more about you and the work that you’re doing to keep up with all of the updates and the wonderful things that you’re putting out there?

Sanjana Sathya 38:33
Yep, so we are at thrizer.com so T, H, R, I, Z, E R.com. You’ll kind of find everything that you need to to learn more about us there. We’re also offering, you know, listeners of of the modern therapist podcast, a free trial if you’re ever interested. You know, you get waived credit card fees for your first $2500 in charges if you want to try us out. And we’re always more than happy to get on calls and kind of share how we can be helpful to your practice. So the website will be the best place to start.

Curt Widhalm 39:05
And we will include links to that in our show notes over at mtsgpodcast.com. Follow us on our social media, join our Facebook group, the Modern Therapist Group, to continue on with these conversations. And until next time, I’m Curt Widhalm with Katie Vernoy and Sanjana Sathya.

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