The Practice of Therapy

Gordon Brewer
This episode is brought to you by blueprint health. Blueprint health is a measurement based care platform for mental health providers. You can find out more about them by going to practice of therapy.com/blueprint health. And also this episode is brought to you by therapy notes therapy notes.com, the leading electronic health record system for mental health providers in private practice there who I use in my practice, check them out at practice of therapy.com/therapy notes.

This is the practice of therapy podcast with Gordon Brewer, helping you to navigate your private practice journey.

Well, hello, everyone, and welcome to the podcast. This is episode number 204 of the practice of therapy podcast. And I'm so glad you've joined me. If this is your first time listening to the podcast, glad you stumbled upon us. Glad you found us. And B for coming back for more glad you're here and glad you're with me on this journey, as always, and if you're listening, be sure and take time to follow us or subscribe to the podcast wherever you might be listening to it. So I'm tackling a topic that I realized that I've not spent a lot of time on in the past. And I realized just from comments I've gotten from other people and just feedback I've gotten from other other private private practice consultants that this is probably something I need to talk about. And that is about being on insurance panels. And so in this episode, I'm going to talk about some of the myths and some of the misperceptions that people have about being on insurance panels and kind of delve into this topic and let you know what I've learned about it my practice. Kingsport counseling Associates is an insurance based practice. So I know a fair amount about being on insurance panels. And I want to kind of pull back the curtain again and let you know, just some stuff that I've learned about it and some things for you to think about. But before we get to the episode, I also want to invite you to enough new upcoming will live webinar. Again, I'm partnering with my friend and colleague, Dr. David Hall over at Site Maven, and we're doing this together. And it's a webinar on this particular topic that we're covering today on the podcast. And the webinar is just going to be called Managed Care finances for therapy practices. And in this webinar, we're going to talk we're going to do kind of a deep dive into some of the things you need to know about being on insurance panels. And if it's something you should consider for your practice. Again, as I said a minute ago, I think there are a lot of myths around it. And I think a lot of Ms. Person misconceptions, misperceptions or misconceptions about being on insurance panels. So again, want to invite you to that. And you can find out more about that by going to practice of therapy.com/insurance practice. And we're going to be doing a great introduction to this whole topic within that webinar. And I think it'll be well worth your time. Again, practice of therapy.com/insurance practice. And that'll take you to the webinar ninja registration page where you can register for this free webinar. Oh, and by the way, it's going to be on November the 19th at 1pm. Eastern time. So it's coming up pretty soon. It's November is already seeming to fly by for me, at least. So I hope hope to see you there also is this particular episode is coming out I still got a few spots left in the focus group that I'm starting the next cohort and focus groups are a way for you to meet some colleagues and learn from others on facilitating this particular group. And if you want to really learn how to grow and scale your practice, this is one of the best ways I know to learn this and that is through just being with a small group of trusted colleagues, where you can share things and also learn from each other all the ins and outs of being in private practice. I know every time I've ever been in a focus group, also known as mastermind groups, it has absolutely been a game changer for me. And some of them have actually been life changing to some degree, not to boast too much. But that's actually the truth for me in my own practice of just learning from others, and really getting affirmation from people, but also having that trusted group of colleagues where you can bounce things off of them. And so that's coming up on November the 18th, the first cohort is going to start. And I'm taking applications now. And you can find out about that by going to practice of therapy.com/focus Group, and we'd love for you to apply. And if you don't make it, well, you'll be in the loop on the next one that I start. And if depending on the number of people that apply, we might have more than one focus group. So but anyway, there's going to cut there's a cut off, in so just create a little bit of urgency go ahead and apply today, whenever you hear this to the focus group, so you can get it on that next cohort. So be sure and check that out. So before we get to the remainder of this episode, I'd love for you to hear from our sponsors for the podcast or and those are therapy notes, therapy notes, calm, but also you can get to them by going to practice of therapy.com/therapy notes, and the other sponsor for our podcasts that I'm really thrilled to have on board and that is blueprint health. Blueprint health is a management based care platform for mental health providers. And they will help you learn how to be more evidence based in your practice by using their platform. So anyway, you can check them out by going to practice of therapy.com/blueprint health but then again, once you had hear more from these sponsors of the podcast

you know as your practice grows, the systems and processes you have in place will keep your practice running smoothly. That's why it's important to have an electronic health record system that is specific to mental health providers. therapy notes is a complete practice management system. With everything you need to manage patient records, schedule appointments, meet with patients remotely, create rich documentation, and bill insurance all right at your fingertips. Their streamlined software is accessible, wherever and whenever you need it. There are who I use in my practice, and that I mentioned that they are one of the top rated EHRs for mental health providers. Their support is also second to none. So be sure to check them out at practice of therapy.com/therapy notes. And be sure to use the promo code Gordon just GLR do in and you can try them out for two months for free. That's therapy notes.com. And this episode is also brought to you by blueprint health. You know one of the best ways to serve clients in your practice is through measurement based outcomes. In fact, more and more third party payers, aka insurance companies are demanding measurable outcomes. And with more and more emphasis on good mental health. Having a way to measure your outcomes just make sense. Introducing blueprint the measurement based care platform that administers scores and charts, hundreds of symptom rating scales to give clinicians deeper insights into treatment progress. Ultimately, by helping helping behavioral health providers to grow top line, practice revenue, increased clinician satisfaction and deliver more effective care. So be unsure and check them out by going to practice of therapy.com/blueprint health and by going to that URL, you can also get your first month free again that's practice of therapy.com/blueprint health.

Well, hello, everyone and welcome back to the podcast. You know, it's interesting, as I thought about doing this particular episode, I realized that I had not really tackled this topic in depth, just around being on insurance panels and if it is a good fit for your business or for your practice, and also sharing with you some of my thoughts around being on insurance panels and, and why ultimately that I decided to create a practice that was insurance based. I've mentioned that in previous episodes of the podcast, but haven't really delve into that very much. And I realized that there's a big need for that. And that there are a lot of people that are curious about accepting insurance, and if they if they should or not. And, you know, I don't know that there is any right answer. But I think if you start to look at it, and you really kind of delve into your mindset, and just really think about it all, it might just be something that you would want to consider doing. One of the things too, that I want to mention here is that when you when you look at all that is out there, there are so many great resources around building a private practice. And it seems like kind of the, the leanings or if you will, the kind of the push is for a person to go. When you're starting a practice to go strictly cash pay. And there's to some degree, and I might be misreading this, but the first some degree, there seems to be a little bit of a stigma against having an insurance based practice. In other words, a lot of what you see and read out there is, Oh, you don't want to do that you don't want to be controlled by the insurance companies, you don't want to be this or that and, and just people thinking that if they don't have a cash based practice, then they're somehow another second class citizens for having a insurance based practice. So I want to dispel that myth. I don't agree with that. And my my success in my own private practice, and I can probably name a dozen more dozen other private practices across the country that Mo, were of that are very successful, and very large practices that our insurance based. And so I want to kind of in that stigma, kind of in this episode of, if you decide to be insurance based, there is no shame in that. And so I just wanted to kind of address that name that, to put that out there. You are just as successful if you're whether you're you can make your practice as successful as you want it to be, regardless of whether you're insurance based or not. So a little bit bit of background around my decision to become an insurance based practice. And I really agonized over whether or not to do it just because of kind of the buzz that was out there. At the time that I was making this decision was, you know, kind of, oh no, you don't want to be you don't want to accept insurance. You don't want to get caught up in all that. It's just going to be too controlling going to be too hard. It's going to consume too much of your time. And on and on. I would hear reasons for not being insurance based. But I was what I was really struggling with is I knew the demographics of my area and and I think that is a place to start in thinking about being on insurance panels and whether or not you want to accept insurance in your practice is to know the demographics of your area. Where I live here in Kingsport, Tennessee, which if you get out your map of Tennessee, we're in the upper northeast corner of Tennessee, right up where Virginia and Kentucky touch the tight state of Tennessee. And Kingsport is part of the Tri Cities which is a small metropolitan area made up of Bristol, Tennessee and Virginia and Johnson City, Tennessee and Kingsport, Tennessee, and it's uh, the population of just kind of this small metropolitan area is is probably around 300,000 people. So it's not a huge place, but then we're surrounded by a much larger rural area that encompasses those three states, Kentucky, Virginia and Tennessee. And so the client base that we have here in our practice is covers a pretty large geographic area. The other thing that I know about the demographics of our area, as that as compared to other parts of the country Our standards of living are probably lower. In other words, the main salary, the main family income, is probably much lower as compared to other parts of the country. So knowing all of that, I know that the majority of the people in our region in our community are dependent on using their health care services, their health insurance. And I'm the same way I know, for me, if I go to my doctor, I expect that my insurance is going to cover cover that and I'm paying a lot of money for my premiums, particularly as a small business owner. And so I want to be able to get the return on the investment of that when I go see my health care providers, or if I need health care services, recently had to have some tests done. And they were, what else got the bill, I was just shocked at the the actual cost of those. But fortunately, because of my insurance, I only had to pay a small portion of that. So my own personal conviction is and I just feel like ethically, we need to be able to offer that to our clients as well. If you're living in a larger metropolitan area, where maybe the standards of living are much higher, yes, it's probably going to be easier for you to be just simply cash pay or cash, a cash cash based practice. So anyway, it's a lot to think about. But I think when you make the decision either way you make the decision, it needs to be based on the facts of your area and the demographics of your area and really understanding that. The other advantage to being on insurance panels, there are a lot of pros and cons. Certainly one of the cons of being insurance based is that you've got to have more systems and processes in place. And I'll talk a little bit more about that here in a minute. But you've got to do more work on the front end as well, to get prepared for that. And being able to have those things in place when you start accepting third party, third party payers and being reimbursed by insurance companies for your services. So there is some work on the front end of being insurance based. But the the cons, those are some of the cons. But the pros for being insurance based are that you've got really a built in referral source by being on insurance panels. I can't tell you the number of people and I've tracked it in the past, but I would say at least half the people that we get either found found us found us, you know that really kind of the number one reason people found us is because of our website. But the secondary reason that people found us or they came to us or chose us is that they we we were all in the directory on their insurance provider. In other words, they checked with their insurance provider first, to see who would accept their insurance in the area. And I dare say that the vast majority of questions that people ask, when making an appointment with us is, is how much does it cost to come get the services? And then also do you accept my insurance? In that sense, I just felt like with all of those things, the demographics of the area, the fact that people are dependent on that, I just felt like it was kind of in to some degree, morally and ethically my responsibility as a practice owner, to be able to accept their insurance because they're the people are dependent upon it. So again, that's not to get too much on a soapbox around that particular topic. But that's something to really think about. So if you if you make the decision to go on insurance panels if you haven't already. Where do you start? So here's here's the first thing that I would do is redo some more research in your area to really find out, which are which insurance panels are the most prevalent are the ones that people use the most or are members of the most. So in my area, for example, and I think this is true across the state of Tennessee, the vast majority of people have Blue Cross Blue Shield, health insurance, and there's some other insurance companies that are smattered in there, but the biggest majority are using Blue Cross Blue Shield and a lot of what people which insurance they carry is dependent on their employers as much as anything so another thing to research is looking are major employers for your area. So in here, my town, there's a large chemical company that is the employees, probably

a large number, I know that they, they have probably close to 15,000 employees, and of course getting people from different parts of the parts of the areas. So the insurance company that they use, not that I'm pushing any insurance companies is Cigna. So I knew that when I started getting on insurance companies, that would be an important panel for me to get on, because that particular company provides Cigna insurance to their employees, you know, state employees, all of those kinds of things are going to be your larger employer. So look in your area, look at who your larger employers, employers are, and find out which insurance companies they are using, and then use that data to decide which insurance companies you want to be paneled with. The other. Another part of that is, is that a lot of larger companies also provide Employee Assistance Services and EAP s. And so different companies might use different EAP companies, depending on what they negotiate through their human resources department. So again, it might be that they're providing health insurance through one particular company, but providing EAP services through another company that's totally separate from that. So it's worthwhile to look into that and get your information about what is being offered through employers in your area. So it's been very beneficial for us to get on some of those EAP panels as well. Now, I will say this, my experience within the insurance in between accepting insurance and being on EAP panels, is your EAP panels don't generally pay out as much. In other words, they typical, the typical reimbursement rate is lower than what it is probably for some health insurances. But what I would do is just look at your averages with that. And again, this is going to be getting into my next next kind of point I want to make but look at those different companies, contact them, look at what their average, reimbursement rates are, all of those kinds of things as you make your decisions, make your decisions based on data. And I can't say that enough. And this goes back to a theme that you hear from me all the time, and that is knowing your numbers. And so yeah, so know that data as you make your decisions about being on insure insurance panels. The other thing too, is that when you go to be paneled with insurance companies, again, get to get your ducks in a row and research a little bit about what you can expect as far as reimbursement rates, and what they offer you in a contract their initial contract. That's negotiable. And most people don't know that. Or a lot of people don't realize that is that you? And again, this kind of dispels a myth with accepting insurance as is that you can negotiate what rate you're going to you're going to accept for, for their, for their customers, and for their clients of being able to look at that. And I think it's always worthwhile to kind of renegotiate that. And certainly look at that every time your contract is renewed. So the way it works with insurance companies is is that you have when you're credentialed is that you sign a contract with them about what your reimbursement rates are going to be in the fact that you're going to be willing to take their clients when they refer them to you. So again,

educate yourself on all of that, and that sort of thing around around those kinds of things. I'm going to be talking, have mentioned that I've got an upcoming webinar that's going to on this and so I'm gonna put some more information in the show notes in the show summary about the upcoming free webinar where I'm going to go into more details around just doing insurance credentialing and why you might want to be on insurance panels. The other thing to think about with being on insurance panels, besides the reimbursement rates is to really figure out your systems and your processes around filing insurance claims. One of the things that is this an absolute must, if you're on insurance panels has been having a regular way to send claims off. And the best way I know to do that is through an EHR through an electronic health record system system. And guess what I can promote, and say that therapy notes absolutely helps my practice with this. And so it's once you get everything set up, and once you get all of your insurance companies entered is just a few clicks of a button to send your insurance claims off to the insurance company to be reimbursed. And for the most part, most insurance companies nowadays have a pretty quick turnaround for electronic health claim submission. So, you know, within a week from sending off the claim where you're getting paid, there's a deposit in our bank account for where we sent off the coin. And then we've already collected the copay from the from the client or from the patient on the front end. So again, wanted to part of me, my reason for saying this is kind of dispelling the myth around having to wait to get paid for from insurance companies. Now, if you're, you do not want to be in the trap of just doing all paper claims. In fact, most insurance companies won't even accept paper claims. So having a way to submit those claims. And having that automated as much as possible, is going to be a big game changer when it comes to being on insurance panels. If you're not using an electronic health record system, I would really recommend that you look into that and invest in that, if you're going to be on insurance panels. Otherwise, what you would be having to do is going to each insurance company, each insurance company's website to submit the claims on line individually for each patient. Whereas with an electronic health record system, you can you fill out your notes, you click Save the note in automatically loads it, to submit the claim. And so at the end of the day, or the end of the week, or whatever, you can submit your claims all in one batch, and they're all sent to the insurance company. So again, a big plug for electronic health record systems if you're going to be insurance based, and in particular, find that therapy notes is very pleased with that I've used some others. And so therapy notes is really still the leading electronic health record system. For for mental health providers. The other thing that I'll mention here, just thinking about being on insurance panels, is to consider it a lot of people do this is to consider kind of having a hybrid to some degree to where you accept both insurance paying clients and cash pay point clients. And that's again, is how I've got my practice set up. Essentially, we give people a choice of whether or not they want to pay for our services through a third party payer. Ultimately, they're responsible for our fee. But if they want us to file insurance claims on their behalf, we will and so that we do it, whether we are in network, or out of network with them, but also we give them the choice of whether or not they want to use their insurance to pay for our services. And if they choose not to, we offer them a sliding scale. Now here's one hot tip about filing insurance claims that I want to share with you. And hopefully I'm not getting too far down the rabbit hole. But one thing is that set your full fee at at a reasonable place. So it does not need to your fee, what you put on the insurance claim needs to be your full fee. And a lot of people get confused about that in that they think that they have to what they send in to the insurance company, through their billing or through their electronic health record system has to be billed for exactly what your contract rate is. That is not the case. So it all of our claims, we pull put our full fee on those claims. The insurance company is going to pay us what they pay us. And then we are we essentially write off the difference between our full fee and the contract break. And again, that's not not to get too technical with the accounting stuff. there, if if a person if a client or a person chooses not to use their insurance, and I've had a lot of clients like that, because they, because of confidentiality, they just prefer not to let their insurance company know, or their employer no or whatever, if they were seeking mental health services, hopefully that stigma is starting to go away. But for whatever reason, they chose not to use their insurance. And so what we do is we just offer a sliding scale based on family income. And we don't go into trying to check their income or any of that we just use used go on the honor system, we give them a sliding scale pay sheet for them to check off and then sign off on what their fee is going to be based on a sliding scale. Now, here's my tip on this on using sliding scale, make sure that the lowest rate on your sliding scale fee schedule is in the ballpark of your average reimbursement rate from insurance companies, that just makes your math much easier. So essentially, we're getting paid about the same if not more, because one of the things about a sliding scale fee can do is up your average investment, right? reimbursement, right are your average

per session, right is what I'm trying to say. So say hypothetically, you had a full rate of $150 for your sessions. In other words, that's what your published rate is that you put out there. When you build the insurance company, you put what you charge for that was $150. And say you collected, you collected, say $30 is a copay from the client. And then your contract rate with insurance company is saying $90, so they pay the difference of that they pay you the $40 that they owe you, the client has paid the $30. So you get the $90. So on your sliding scale fee, based on that kind of hypothetical scenario, your lowest reimbursement rate is going to be $90. Though your lowest fee. So essentially, with your sliding scale, you're offering clients the contract break that you have, with insurance companies, if they either they choose not to use their insurance, or if they don't have insurance at all, you're still getting that average rate, hopefully, that that math makes sense to you. But it's a it's what I found is is that when I do it that way, it is much easier for me to make calculations on the back end around what I pay my employees, what I pay my therapist and all of that are based on those averages, the average per session, right that we collect. So hopefully that's that's something to think about. Another thing that you can do, just around accepting insurance. And again, this could be considered kind of a hybrid way of doing things is to bill is to offer a super bill. You know, there are a lot of private pay providers out there are private practices, where they do just make it known up front that we we are cash pay, but we are going to give you an invoice that you can turn into your insurance company to be possibly reimbursed and most insurance plans are not as much as it used to be but a lot of insurance plans do pay for out of network providers, depending on what sort of plan you've got. There are some of the PPO plans, for example, that you can't use any out of network providers but for some of the other managed care, third party payers insurance companies they do allow for out of network but they pay at a higher the the patient ends up paying a higher out of pocket or a higher rate of out of pocket for those services. So again, you can offer this again is referred to as a super bail. When the client comes in and pays you you give them a super bill. Most of the electronic health records systems, no therapy notes does this, if I give a client that is maybe out of network or super bill, it just generates it automatically based on the information I put into therapy notes. So again, that's another option for people, if you want to remain cash pay, or if you decide that you want to be a cache pay practice, is just to offer people a super bill for being able to use your services. And that way they can get possibly reimbursed, I think it helps to some degree with that whole kind of ethical dilemma about people being able to use their insurance. So again, just to kind of recap, some of the stuff I've talked about it I know, I've had a lot of stuff that I've covered here is, first of all, I want you to reconsider the some of the stigma around accepting insurance, I think that if you have a practice that accepts insurance, you're just as valid, you're just as good a business person, all of those kinds of things by allowing, allowing clients to use their insurance. In fact, I think it's a smart move for for a lot of practices. Secondly, is when you make the decision to whether or not to accept

insurance as make it on some good data. In other words, based on either the demographics of your area of understanding all of that. And then also just looking at your own personal convictions around around that, of just doing what is fair for our clients and doing what is ethical in that sense. And then also do your research around which panels to be on you don't have to be on all of them. I don't know if I've mentioned that originally, but you don't have to be on all the panels, you can pick and choose which panels you want to be on, and then offer people to give them a super bill or even filed directly within your electronic health record system for their out of network benefits. And, again, a lot of details to go into on that that I'm not going to be able to cover in the podcast. But we do have the up coming free webinar. Again, you'll find links to that in the show summary in the show notes. Also, be sure to set up if you decide to go on insurance panels, and accept insurance, make sure you have systems and processes in place to automate and make that as easy as possible for yourself. It really should only once you have everything set up and everything done, it really should be only a few clicks of your mouse or taps on your screen to send off electronic health electronic claims. And usually when it's all done electronically, you're reimbursed really quickly on those usually a short turnaround time when you do that. And then to maybe consider offering a sliding scale that is really based on your numbers within your practice of your full fee. And also kind of your minimum that you're willing to take. That is compared to your insurance reimbursement rates. So hopefully all that makes sense. Again, I covered a lot of this covered a lot. I will be covering a lot of this in the upcoming free webinar. And hope to see you there. And you can find out more about that by going to practice of therapy.com in slash insurance practice. And that's a free webinar that are partnering with a friend, Dr. David Hall from psych Maven. And hope to see you there.

Well, folks, I hope I've given you a lot to think about in this episode, just around being on insurance panels. Again, one of the things that I'm really kind of tied to and really have a conviction about and that is just being able to make mental health care accessible to people. I think that is something that we can do and in our industry, we are the ones that can kind of control that and I think about being on insurance panels. That is a one great way of doing that. And hopefully you've learned a little bit in this episode. I would invite you again to join us for that A free webinar where we're really going to do a deep dive into this whole topic. And that is a webinar called Managed Care finances for therapy practices. And it is going to be on November the 19th at 1pm, Eastern Time. And if you'll go to practice of therapy.com/insurance practice, that will get you to the registration page, so you can register for that webinar. And even if you're not able to join that day, I would encourage you to register. So that way you get the automated replay of the webinar, when it went once we do it. So be sure to check that out practice of therapy.com/insurance practice. And all as always, be sure and check out our sponsors for the podcast, therapy, notes, therapy, notes, calm and also blueprint health. As you heard from me earlier, they are two platforms that can absolutely be game changers for you in your practice, so be sure to check them out. And again, with all of this information, you can find roots here in our show notes and show summary for easy access to all of this. So take care folks, I look forward to you being with me. On some future episodes. Got a lot of great guests coming up. And I'm excited for you to hear from them. And thanks for being with me on this journey. And I look forward to being in your ears here in the future. And be sure and take time to follow the podcast hit that little plus button if you're on Apple podcasts up in the top right hand corner, or the subscribe button or the Follow button. We're in whatever platform you might be listening to this podcast. So take care folks hope I hope you have a good rest of your week or weekend.

You have been listening to the practice of therapy podcast with Gordon Brewer. Please visit us at practice of therapy.com For more information, resources and tools to help you starting building and growing your private practice. And if you haven't done so already, please sign up to receive the free private practice startup guide and practice of therapy.com. The information in this podcast is intended to be accurate and authoritative concerning the subject matter covered. It is given with the understanding that neither the host guests or producers are rendering legal accounting or clinical advice. If you need a professional, you should find the right person for them.