Can you build a private pay counseling private practice in this day and age?
That is the question that therapist and business coach Keri Nola and I explore in Session 4 of the Selling the Couch podcast.
In this episode, you’ll learn about:
- How to overcome the fear of telling a client that you’re private pay.
- How to use “out of network benefits” for a client who wants to use their insurance.
- How to employ a “superbill”
- What to say to clients when discussing an increase in fees.
- How often to consider increasing fees.
- How do setup a practice so you can increase fees as demand grows.
LINKS AND RESOURCE MENTIONED IN THIS EPISODE:
- Keri’s Website
- Note from Melvin: Keri no longer offers the freebie mentioned in this episode.
THANKS FOR LISTENING!
I hope you enjoyed my chat with Keri Nola on building a private practice without relying on insurance.
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Keri, thank you again for joining me. Your energy and passion are infectious!
Until next time!
HERE'S THE FULL TRANSCRIPT OF THIS EPISODE
Intro: Welcome to The Selling the Couch Podcast where our goal is to help you achieve your counseling private practice dreams, and now the man who once dumped a football on a 10 foot goal, and then got rejected when he tried it with basketball, psychologist, and podcaster Melvin Varghese.
Melvin: Hey, what's up everyone, thank you very much for joining me for another session of the Selling the Couch Podcast. My guest today is Keri Nola, and Keri and I are going to be talking about all things related to insurance. Well, it's not that boring but we're going to be talking about how to build a private practice that is based on private pay, and some of the different aspects that go into that. The first portion of the interview is really about more of the psychological aspects of even asking clients, or even when a new client calls you, how to tell them that you are doing private pay. Then we get down to the more nitty-gritty things with regard to insurance, and how you can actually make and create a private practice that doesn’t rely on insurance.
I think you're really going to enjoy this episode, so here is my conversation with Keri Nola.
Keri welcome to the show.
Keri: Thank you so much Melvin it's a joy to be here today, I am looking forward to our conversation.
Melvin: Yeah, I'm really looking forward as well. Tell us a little bit about you and about how you help therapists and who are in private practice?
Keri: Absolutely, well I am a licensed psycho therapist and in a clinical practice and healing centre here in Central Florida. What I found was that I had such a passion for supporting other healers in growing and designing the practices that they wanted. I feel like it’s a skill we don’t often get in school, we learn so much about supporting our clients and what that looks like and how to do it well. But then when we think of the settings with which we want to use those skills in, we're a little bit limited in terms of the education of what it looks like to be an entrepreneur in our field. That’s what led me to– it started real local in my own community and once I realized it was working so well for them I took it online, and now I help therapists and healers all over the world, in gaining the confidence, the clarity, and the skills they need to grow their businesses.
Melvin: Yeah, that’s so cool, I absolutely agree with you. I think that business skill and how to run a private practice, I think that’s something a lot of clinicians don’t learn about, and it's so neat you're providing the service to them.
Keri: Thank you, it's a joy to wake up every day and see my calendar full of therapists who want to do this work, and not only do it clinically well, but feel confident in the business end too.
Melvin: Yeah, absolutely. We picked a great topic today and so we're going to be talking today about, how to actually build a private practice without relying on insurance. And I thought Keri is like the perfect person to talk about this. I think I'm going to ask the obvious question; in 2015 is it actually possible to build a private practice without relying on insurance?
Keri: Absolutely, Melvin it's not only possible, it is probable, and necessary for a lot of people. I think we have never been freer to create the practice exactly as we want it, and if 2015 is the year that you would like to consider being managed carefree in your practice, then it's absolutely an option that you can very viably consider.
Melvin: That's very encouraging to hear that. What are some of the main reasons why someone might actually want to go insurance free?
Keri: Sure, well there's many of them, and I want to be really clear off the bat that I don’t believe that insurance managed care is a bad thing. I think we just need to open up to remembering that it's our right to choose the way that we want to do business. So I just like to be clear about that off the bat, I'm not bashing insurance, I'm not bashing private pay, I'm team follow your won heart and know that whichever way you choose, it's possible for you to make it work. Some things about insurance and why I often talk about often introducing this freedom to you and your practice, is that insurance billing leaves you relying on a third party for running your practice.
You're going to be following policies and procedures; you're going to be signing contacts and agreements that are going to require you to run your practice in a very certain way. So what this might look like is say a client comes in and they want to be seen as a couple, but the best treatment plan is really to see them as an individual. And what's this all going to mean for insurance billing? A lot of insurances don’t cover couples work, so now we're in the position of an ethical situation, am I going to bill the insurance for a code for an individual even though I'm treating them as a couple? Or am I going to tell them, “I'm sorry I can't take your insurance, it doesn’t cover this service?” There's a lot of freedom that comes with running our business in a private cash kind of way.
Melvin: No, absolutely I think what I hear you saying is that a couple of things, one is that it's very important to leave ourselves open to the possibility that we don’t have to be and do– be in insurance. But ultimately I think you're also saying you have to figure out what works well for you.
Keri: Yes definitely.
Melvin: When you first start out and or even just thinking about a private practice how do you even get started with this whole private pay and just being out of– off of insurance?
Keri: Absolutely, well I'll say that, I'd like to share a bit of my own story, so I started my private practice right out of graduate school. It was something that wasn’t very common in my town at the time about a decade ago. And it was just something that was really on my heart and soul. I knew that I wanted to do practice. The way that I wanted to do it, I wanted to work with certain client populations and I just said, “Why not start that right out of the gate?” Having practiced in agencies and different things during my internship, and even prior to graduate school, I knew that this was for me.
The cool thing that happened for me is that I wasn’t allowed to take insurance as a registered intern in my state. It opened me up to– there was no plan B. There was run a private paid practice for at least two years, or I’m going to have to work for an agency, which for me it just wasn’t an option I was willing to put on the table, because it didn’t resonate with how I wanted to do the work in the world that I’m here to do.
In terms of starting out, I think the first and most important thing is clarity. Are you willing to align yourself with the mentality that is required to run a cash paid practice? And to set your fees, to get really comfortable with your money story and your figures around, to accept an exchange of energy in the form of payment, for the services that you're providing. I think one of the biggest differences between private practice and agency work is that we’re directly collecting payment for our services. And it invites all other issues around worthiness, and inadequacy, and competences right to the surface for our processing. Can you relate to that Melvin? I feel like that is huge.
Melvin: Oh, absolutely. I think I remember one of the most intimidating things was just asking for money from a client. And I think you're absolutely right. If there’s one encounter in therapy that brings up about all of those insecurities is that exchange.
Keri: For sure. I think being mindful upfront about the inner work that will likely need to be done if you’re going to practice this way, is also really important. Because I think sometime we try to build a practice without doing the inner work. And a lot of my model of working with [Inaudible] [00:08:10] is about building our practices from the inside out. And that starts with our mind set. It starts with acknowledging our fears. It starts with dancing with all the stories we have about how we can, or can’t do this kind of work in the world. The traditional model is one that relies on managed care, but it’s not necessarily the only model. So starting out absolutely looking at that inner piece is going to be crucial.
The second piece is around the marketing plan that’s going to help you to draw in clients, because if you're not tasking insurance– see insurance companies essentially market for you, right? Because they are generating and driving traffic to your practices from their customers, that are on their insurance plan. So we than have to go out, and find our own people. So where are your ideal clients hanging out, and how can you communicate with them about what you have to offer? So That might be online therapist directories, that may be organizations, agencies, other therapists who have different specialties than you do, may be that is psychiatrists, or primary care practitioners. We’ve got to think about who our ideal clients are and where they’re are spending time.
I think that’s another piece of this puzzle is, try to be a general practitioner where we’re servicing everybody. That makes marketing very-very challenging, because when we try to talk to everyone, we really end up talking to no one. And when people come to our websites, or they look at our online profiles, they don’t feel seen and heard, because there’s this really general statement that we try to use to draw them in, rather than saying something really specific. Let’s say you want to work with single parents, then you need to talk to them on the front page of your website, or on your directory. So they’re like, “Wow! That’s who knows what I’ve got going on, and who can help solve this problem I'm experiencing.”
Melvin: Yeah. As you're talking about this, it reminds me of a phrase that I heard which is– it’s something like ‘the riches are in the niches.’ And I think that’s what you’re saying, right? Like when you build your private practice, you have to try to identify what the need is in the community that you're serving, and then try to niche down. If you try to go too general, then it’s too broad…
Keri: Exactly. And there’s a big fear, and I want to speak to it now because I’m sure as you’re listening to us you might be thinking, “But wait, I’m just new. I don’t want to rule anybody out I want to help anybody that can come.” I hear that fear, and I know that it can feel counter intuitive as we talk about niching down and specializing. But what I can tell you is, you want a flow of your ideal client. And those other general mental health issues will continue to trickle into your practice, and that’s okay. We’re not talking about turning people away; we’re talking about making sure that we are specifically speaking to the people that you want, so that they can follow through on the referrals, and actually call you and get into your office.
Melvin: Yeah, I’d like that too, because I think the more specific you get, the more energy that you can spend toward marketing to that specific population, right? As opposed trying to market to multiple populations, or multiple groups of people. I think which then is just– I feel like that’s [crosstalk]…
Keri: Yes. It’s so overwhelming to imagine that we have to speak every single person on the planet. So I say, think of that one client in your internship, or in your career at any point where you just felt like you got them. You really loved sitting across from them. You felt like it was a flow of creativity, and clarity when you supported them. And then begin speaking to that person in your marketing. Think of what’s keeping them up at night, and what their greatest fear is in terms of their struggle right now. And when you speak to that in your marketing, you end up having a full practice in no time at all.
I think that’s the biggest issue with therapist, is we don’t learn how to speak to our ideal clients in a lets them in and that lets them know that we have what they want. And that really is the psychology of selling our products and services, is understanding who we’re serving.
Melvin: Right, absolutely. You said something earlier which I thought was really interesting, so how does one actually go about changing their mind set? Because I think what you said earlier is absolutely right. When someone is just jumping into private practice, the fear of ‘I got to get my first client, I got to get my first client’ that’s there. How do you actually go about changing that mind set, and in a way I think being able to hold that fear and still act?
Keri: Yeah, and I love the way you put that Melvin, that’s my perspective as well. How do we hold the fear and still take inspired action? Because I think a lot times, what we try to do is bulldoze through the fear, or ignore it, or pretend it’s not there or shame it. And the reality is that private practice is challenging. Work is scary. It is about holding that fear.
Step one in that– just like we tell our clients is acknowledgement. ‘I’m really scared. I don’t know if this can work. I don’t know if I trust myself to really take this step.’ And just in acknowledging that, we start to build a relationship with our fear. One of my favorite questions to ask myself when I’m scared is, “What does that fear need?” In order to move forward, what does that part of me need? And a lot of times it’s comfort. It’s support. It’s just me hearing it, and being present with, and then in that space it kind of creates a little bit more room for me to be able to move forward.
It’s a constant relationship. It’s not I’m scared at the beginning, and I’m not scared anymore. I’ve been doing this for ten years, and I’m scared every time I take a new step, or even an old step, sometimes fear resurfaces. It’s a human part of our process.
Melvin: I’m glad you said it that way, because I think that is so true. Even as I'm thinking about creating this podcast, I’ve so much fear and anxiety about how this is going to work out, and learning all these new things. I love that you said that because no matter how seasoned you are, that fear, I think in a way, I think it’s always kind of a companion that we have.
Keri: Yes. Yes.
Melvin: And I think part of our growth is really making peace with its presence. As individuals start to make sense out of that fear and start to change their mind set, how do they actually go in to the more practical things? I think the first question is how do they determine how much to actually charge…
Keri: The cool thing about this is you do have some flexibility and freedom here as well. I always say, “Never charge more than you have been willing to pay.” I do believe there’s an energy of congruence around money in our practices. Often times, I see people trying to charge something that they haven’t been willing to invest. And it really creates this incongruence in the financial piece of our practice. We find that we can’t really draw in the clients that are willing to pay something that we haven’t been willing to pay. So be mindful of that. If you have wanted to be taking the short cuts in budget strategies in your own healing, then you're probably going to draw those clients into you. Which is perfectly fine, it’s not a judgment, it’s just a reality and we want to honor that.
I say don’t force yourself to compete with everybody else in the field, or to raise the bar on your fees. Start with where you're comfortable. Imagine yourself answering the phone, and somebody is ready to book and they say, “But I just need it know how much it costs.” And then play with a couple of different fees. Now you're going to find your general range by going on to some of the online therapist directories, and doing a search for your zip code, and finding out the range of people with your similar credentials, and what they seem to be charging. And then imagine yourself charging some of those things, and notice what your body says, as you throw around some of those fees.
Most importantly can you say that fee, and then pause before you start inviting a sliding scale, or lowering yourself, or freaking out that the person is not going to be willing to pay it.
Melvin: Right. In other words can you say that fee and be comfortable?
Keri: Yes, or can you be willing to pause in the uncomfortability, because sometimes…
Melvin: Yeah, absolutely,
Keri: Sometimes it’s not always comfortable, but is it so anxiety provoking that you're crawling out of your skin and selling yourself out right up. “Or I could do something less” or– how many times have I done that in my own practice. Yes, I have absolutely been there. So meet yourself with compassion at the fee that resonates with you that you could imagine receiving, and know that you can change fees whenever you want, as long as you're communicating that in your informed consent.
This is the other thing I invite you to do is, write it up in your informed consent that you revisit your fee structure. I say twice a year. That way it gives me the flexibility as I become more comfortable, as I gain more experience, more skills, and I adjust my fees, it gives me the flexibility and freedom to do that. I can’t tell you how many therapists feel locked into their fee because they never gave themselves that room in their informed consent, and had that conversation with clients.
Melvin: Your recommendation is to do it, to at least go through that process twice a year?
Keri: Yeah. And whether or not you change it is completely up to you. But at least you have given yourself that freedom, and to not catch your clients of guard, about all the sudden raise in your fees. It was like, “No remember we discussed that upfront, it's right here in my policies and you can give your–” and I usually say I'll give you a six weeks' notice in writing, if I were to adjust my fees. And then you've got that all laid out in the boundaries and understanding of it. It's is mutual from that get go.
Melvin: Okay, nice. Sometimes I have heard about this phrase like, ‘a super bill', can you explain that, and I guess I'm still a little confused on what that is, and how that relates to the whole going without insurance.
Keri: Absolutely, so a super bill is basically a receipt for the services that you have provided that your clients have paid out of pocket for, that includes their diagnosis, and their code for the type session that you provided, whether that be individual, couples, an hour, half hour. Whether it's an intake assessment, there's all the coding for that which you can easily look up on the internet. And they're universal for every state as well.
And you put that information on this super bill, and the client can submit it to their insurance provider, to see if they can get reimbursed for out of network benefits, which some plans have and some don’t. So I always use the disclaimer, I don’t know what your insurance company will provide for you, or if they'll reimburse any of the services you have received here, but I'll gladly provide you with this receipt and we'll call it a super bill and you can submit it if you wish.
Melvin: Okay, so that’s another option if someone wants to use their insurance to get reimbursed later.
Keri: Exactly, and another thing I'll say at this note is you can also become and out of network provider with insurances, and you can bill them directly without having to contract as a one of their panel members. Now the freedom in this is beautiful, because you're not having to negotiate your rate less than what it would normally be, you're able to take clients from that insurance company when you want. And a great way to do this is to look at some of the larger corporations that maybe in your city. So for example, I'm in Central Florida, we've got Disney here, we have some very large engineering firms, and if you look– or also school systems are a great place to look, and find out what insurance companies are being used within those organizations.
You can become and out of network provider, so you know that there's a lot of people in your town that are contracted with those insurance companies, and you can bill out of network for those. And every company does that a little bit differently, but you can call the companies and educate yourself about their process for billing out of network. And then you can charge your full rate and often likely get reimbursed at your full rate.
Melvin: Oh, wow that’s amazing. That’s definitely another option, so in essence what you're saying is you could have a private practice where you're doing non insurance base, but then you could also do this out of network with certain insurance carriers.
Keri: Yes, yes.
Melvin: Oh, wow.
Keri: And it can be very abundant, and it's much different because you still have that freedom and flexibility where you don’t have to do business with them if you don’t want to, but you can if it's resonating.
Melvin: Right, so you have that flexibility and you get to decide?
Keri: Yes, because once you have panel with them you're agreeing to do services at the rate which they have set. And generally that’s going to be anywhere from $60 a session, it could be lower, and it can range up to 100 or maybe a little bit more depending on your credentials, your experience, and the area of which you practice in, and also the code for the types of sessions that you're doing, but– and not get your full rate.
Melvin: Well we're just about out of time, I feel like this conversation went so quickly.
Keri: It sure did, there's so much to talk about. I have a feeling we gave a lot of really powerful nuggets today for people to begin applying.
Melvin: Keri, thank you so much for coming on the show. Yeah, I just felt like this conversation, the whole idea of being out of network, and being able to do that, those are things that I hadn't even realized so.
Keri: Wonderful, I am glad they are helpful and I wish everybody so well as you make the decisions in doing your practice the way that it resonates with you, and knowing that you're able to set that up exactly as you want, with insurance or without.
Melvin: Keri you had said there's this awesome resource that was on your website that you wanted to share with the audience, and I'll link to that definitely in the show notes.
Keri: A free audio gift that I'd love for you all to come over and check out. It's my three marketing secrets for how I kept my phone ringing and clients filling my office for a decade and…
Melvin: I love that title by the way.
Keri: Thank you, thank you, it's part of that marketing language, but it is true I share the top three ways that I have done that. And if it's resonating with you to check that out, my website is Kerinola.com and this is I believe slash freebie. I don’t have it sitting in front of me Melvin, but I know you're going to link to it.
Melvin: Yeah, it's slash freebie.
Keri: Perfect and I got a blog where I do weekly practice building tip videos, and there's other resources, and free webinars, and live events. So however I can support you please come over and visit.
Melvin: Awesome Keri thank you again for coming on this episode, and thank you so much for answering all these questions relating to insurance.
Keri: My pleasure, thanks for having me Melvin.
Melvin: Hope you enjoyed that conversation with Keri Nola. There was so many things that I learned in that episode pertaining to insurance. For example, I never quite understood the difference between the super bill and exactly what that was, and I think Keri explained it really well. And the other thing is I never realized about out of network, I'd often heard that term but I didn’t actually know how it applied pertaining to a private practice. My hope with this episode was that it just gives you some other options especially if you're thinking about the private pay route, and especially gives you some options thinking about how you might be able to incorporate the insurance element in, and especially if clients do want to go through their insurance.
I have the full transcript of Keri's interview as well as show notes and any of the resources that she's mentioned at sellingthecouch.com/session4. Thank you again everyone and have a great week.
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