The Practice of Therapy

Gordon Brewer: Well, hello folks, and welcome again to the podcast and I'm really looking forward to you hearing today from Mark Florian. Welcome, mark.
Mark Florian: Thank you, Gordon. Super happy to be here.
Gordon Brewer: Uh, yes, and Mark, mark and I are gonna be talking a little bit about insurance and super bills and just some of the problems around all of that.
And also Mark is, um, has a, his company is called Deputy Care, and so we're gonna learn about that as well. But Mark is, I start with everyone. Tell folks a little more about yourself and how you've landed where you've landed.
Mark Florian: Yeah. Great. Thank you Gordon. Um, yeah, so I, I've spent, you know, the past 15 years under the hood of healthcare tech.
I am a software engineer by training. I was an early engineer at at Zocdoc. Some of your listeners might be familiar with that platform. Spent about five years there helping them build the pipelines that, you know, helped patients find care. Since then, I've led teams at a few other health tech staples, but for the last six years really, um, my heart and efforts really been entirely in the behavioral health.
Space in terms of product builds, engineering work and trying to find solutions to some of the problems there. On a more personal note, you know, I, I, I've seen the impact of mental illness directly on my own family. It's changed how I look at my own work. Um, if you look at the ecosystem today, there's a lot of great stuff and, you know, therapists who are also being asked to be business owners.
Uh, are still stuck with a lot of admin work and, really when they, they want to be helping people. You know, you, you, you sign up to help people and then, and you find yourself doing a lot of other things, so,
Gordon Brewer: right.
Mark Florian: Yeah, as you mentioned, you know, I started this company, deputy Care to try to take some of the sophisticated tool set and really try to put in the hands of, of the practitioner.
At the end of the day, I'm a firm believer that the business of therapy, it shouldn't be, you know, a barrier to the work of therapy that that you all are doing.
Gordon Brewer: Right.
Mark Florian: So I'd love to dive into some of that today.
Gordon Brewer: Yeah, yeah. That's great. That's great. And I know that that's, uh, yeah. One of the reasons that I started this whole podcast and is just really none of us in the.
Therapy field, really get the training on the business and administrative and operational side of things. And, um, most of us kinda learn it as I like to say, the hard way. And I, I like to help people not have to do it the hard way and, and really tap into resources. So, um, I know we were chatting a little bit before we started recording and one of the things that, um, I know is just kind of a.
A tough decision is, it's interesting how this podcast goes on talking about themes. I've had a a, a past episode here with my friend Avi v Fisher, who, um. Help works with, um, therapists around marketing, particularly cash pay practices. But I think a lot of us have to make that decision along the way of whether we're gonna accept insurance, making that more accessible to people, that sort of thing.
And one of the workarounds is with super bills and. Billing out of network, and I know that's an area that you've got some expertise in, and maybe that's just a good way to start. Tell us your thoughts on all of that.
Mark Florian: Yeah, I'd love to and, and kind of I'll, I'll launch into that and just to kind of set the stage, let's just talk a little bit about what the therapist journey is like.
You know, you go to school for. A hundred years, what it seems like, right? Mm-hmm. And then after school, the real work starts. You know, focus on getting your license, you're, you're putting in the hours, practicing you're doing the continuing education on the weekends, maybe. Um, so you're putting a lot of work in here.
You finally get to the end of the tunnel and, you know, then we say, Hey, in order to help people, you gotta become a small business owner. Um, it's like, okay. Mm-hmm. Wow. Now I wasn't, I wasn't necessarily expecting this. Um, mm-hmm. And, and really the, you know, the payers, they, they're always looming in the background.
You know, it's, it's so appealing, especially when you're a new therapist, you know, as, as, as we've seen at deputy care, that they're, they're saying, no, no, look, look over here. Sign on this dotted line. Sign this contract, and you'll have clients in abundance. And it, it is really great. The mo, the model works incredibly well, particularly for new practices.
The therapists, you know. Then gives a sigh of relief until they get their first paycheck. And, you know, as, as it's, it's well known. Um. As a professional, you know, you put in all this work, you go to school, you're accruing debt and you want to help people. And sometimes these reimbursement rates for these paneled networks are just not what they don't they don't match with the value that's being provided.
So we, we see this trend where, you know, after some number of years on the panels you're getting work to the bone. You're seeing maybe 30 clients a week. Um, it's, it's a lot. And, you know, we, we see a lot of practitioners wanting to move. Off the panels and, and go out of network cash pay.
But that's extremely difficult. You gotta do the marketing. You have to become more of a billing admin in, in, in that scenario. And that's kind of really where we try to step in and, and help that transition. If you think about just how the payer ecosystem is built. As an out-of-network client, you are in a way already paying for a lower cost of therapy through your premiums because all of these out-of-network plans, they have access to coverage for behavioral health.
The trick is in, is in getting the refund back from the payer and it's an extremely difficult process and really we're putting it all on the. Practitioner, the therapist themselves, to educate the client. Hey, what is a deductible? What is it? What does it mean to be post deductible? What is a co-insurance?
And you forget about the education. You, you learn all that and then you say, okay, now what do I do? How do I access this stuff? Mm-hmm. Um, and, you know, the, the payers don't make it easy because it's maybe not in their best interest to be doling money out all, all over the place. So I. You know, you have a clerical error on a claim a miscoding of some sort.
The wrong CPT code A mistake in the NPI, all these reasons why a claim's gonna get denied and, you know, up, up to about a quarter of claims for out of network coverage get denied. Um, which is absolutely bonkers.
Gordon Brewer: Yeah,
Mark Florian: but it's a, it's a, it's a system riddled with friction. And as a result, um, it's estimated about 40% of out of network therapy sessions are not being reimbursed because the claims are not even being submitted.
So that ultimately amounts to about a $2 billion leak in the ecosystem. Mm-hmm. These are all unclaimed refund checks, essentially.
Gordon Brewer: Right.
Mark Florian: So. That's just to give a little context about the problem and, and, you know, the tools that we have right now are the super bill, right? So you, you see a client and everyone runs their practice different.
One, one therapist might be proactive about providing superbills to the clients. While I, I think most in I would practice this way. Like, why, why give a super bill unless ask for one? Because it's gonna go to waste unless the client knows what to do with it.
Gordon Brewer: Right.
Mark Florian: So that's the tool that we have right now.
But, but it's, it's not very, it's not very patient first, and it leads, it ultimately leads to a retention problem because mm-hmm. You know, like I said, these sessions are already paid for through premiums. And clients are now being asked to pay a full cash rate with really not an easy way to get the money that is theirs back into their pocket.
Yeah.
Gordon Brewer: Yeah. And I know, I know, um, just from my experience when we have, um, you know, one, one option that people that are on insurance panels, and I know my practice is this way, is if you're out of network with a particular. Insurance company would be to file the claim with them directly anyway, but that leads to a whole lot of whole other set of problems and that they want to verify your credentialing, want to verify your licensure, and all of those kinds of things.
And so it ends up being much more work, trying to be, trying to help out clients, um, by filing out of network when. You know, it's just not worth the time and the trouble for us.
Mark Florian: Yep.
Gordon Brewer: Yeah.
Mark Florian: Yeah. That, that, that's exactly right. Um, and that, and that's, that's a point that, is not often discussed.
The, the whole Regi the payer registration process for the provider themselves.
Gordon Brewer: Mm-hmm.
Mark Florian: Right. Like that is, that is step one before their clients are even capable of, of submitting that claim. Right. To the out
Gordon Brewer: network.
Mark Florian: To the out network payer.
Gordon Brewer: Right, right, right.
Mark Florian: And the other, and, and the other really, big, big problem just with this model.
Um, you know, so I mentioned denials, you know, and, and a claim gets denied. You have to figure out why appeal it. You're on the phone with the payer for however long. But, but even in the best case scenario, um, let's say you as a therapist, you are. Registered as an out of network provider, and the client submits the claim correctly.
They're still floating the cost. They, they're essentially playing the bank, right? Mm-hmm. Let's say a session is $200, but the patient has a 20% co-insurance. They're responsible for $40. They have to pay the $200 upfront, and then they have to go through this, request a super bill, submit a claim process, and, I don't know, six or eight weeks later, they get a check back.
Mm-hmm. So they're, they're essentially. Performing the role of a bank. Yeah, and that's also not easy to do. And what we're asking, you know, what the ecosystem is asking the client to do is to float 600 $800 a month. Right. While, while they're waiting for reimbursement checks to come back and mm-hmm.
You know, that might lead to a reduction of session frequency or quitting therapy altogether. Um, and that's, that's real, that's one of the problems that we're directly tackling, um, at deputy care. Mm-hmm. So, you know mm-hmm. When a client on the platform is post deductible, they've hit their deductible where we are going to estimate or will know because we're already managing their claims.
What's the exact amount that you're responsible for? And that's what you're gonna pay. We're, we're kind of making this out of network experience. Feel like an in-network experience, kind of like a copay, right? So here's a $200 session. Mm-hmm. You owe $53, so you pay that, we'll float the rest of the money to the therapist.
They get their full $200. And then we are the ones that are responsible for. Chasing down that money from the payer.
Gordon Brewer: Yeah.
Mark Florian: Um, and it, it's an incredible model. It works really well. It keeps people in therapy longer. I mean, if you're, you know, as a therapist, you're happy, you're getting your cash rate immediately.
Mm-hmm. Mm-hmm. You know, the client is paying. Nothing to go to therapy. They're, they're never gonna stop. So, so it's, it's, it's a model that works really well. And, and we've seen a lot of success with it. And, you know, like, like I said, the intention was to, to really attack this friction problem in the ecosystem that kind of starts with the Super Bill.
Gordon Brewer: Right.
Mark Florian: It's a, it's an antiquated system. It really shouldn't exist anymore. Super Bill. It's kind of, it's kind of silly. In my opinion.
Gordon Brewer: Yeah. So yeah, so that's a, that's exciting. And so walk us through kind of the process for the therapist, the client and that sort of thing, and working with the, with Deputy Care.
Mark Florian: Yeah, yeah, sure. So signing up is easy. Uh, you can sign, sign up for Freea on the platform and we always start with the practitioner. So that is kind of our first primary client. Because there is all of the registration of Auto Network. Payer systems. So you do a quick onboarding. We collect all your information, tax information, NPI license information, see that you're in good standing.
We register you with the payers. And then you know, the next day you're ready to start inviting clients. So you invite your clients to the platform. During the client onboarding, they give us insurance information. Payment information. That's basically it. So the first thing we do is we verify the out of network coverage that the client has.
So before they even go to their first session with that therapist, they have an email. They have a dashboard with their benefit coverage broken down. Mm-hmm. This is how much you're gonna pay before your deductibles met. This is how many sessions it's going to take to hit your deductible.
After your deductible, this is how much you're gonna pay. So we give them the whole financial story before they even go to the first therapy session.
Gordon Brewer: Right.
Mark Florian: At that point, we're good to go. We've collected what we've needed. We've, we've registered, the provider and the systems that they need to be registered in.
Um, and we have the client's information as well.
Gordon Brewer: Yeah. That's great. Yeah, that's great. And then, so what's generally the turnaround time for a therapist? As far as getting, getting paid for their sessions and that kind of thing? Yep. I'm assuming that the, the client pays on the front end, right?
Mark Florian: Yep.
Gordon Brewer: And so they're, it's not really, nothing changes for the therapist that's a cash pay therapist or an out of network therapist would be a better way to say that.
And so then the, then the. The client just deals with deputy care to, to get reimbursed.
Mark Florian: Yeah. And Andre, and really it's invisible. The plumbing, the insurance, plumbing is completely invisible to both the therapist and the client. Yeah. So, so we, you can view the, and track your claims as they're being processed, but mm-hmm.
There, there's no such thing as a super bill on the platform. There, there's no insurance jargon or need to contact an insurance payer yourself. But to answer your question about the payments yeah. So. The clients themselves, they, they, they log in pretty infrequently because they don't care about the tech really.
Um, and mm-hmm. They, they just wanna save money, but you have your session. After your session, you open your dashboard, you click, I completed my session. That kicks off the whole payment cycle. We charge the client immediate. Therapists themselves, they pick a payday. So we, we, we did a lot of kind of, uh, solicitation of feedback on this and feeling like you're getting paid on a consistent day every week mm-hmm.
With something valuable. So you pick your payday, it's, you know, Monday, Wednesday, Friday any session you submit up until that day on the week prior, you just get paid on that day.
Gordon Brewer: Okay. Awesome. Yeah. Awesome. Yeah. That's such a, such a great great service and I know there's been. Different companies along the way, and some of them work well and some of them don't.
But I love the fact that you give the client a dashboard to go to and put their information. And it sounds like, um, for the therapist to sign up for this, um, it's really no cost involved, just the time to put your credentialing information and that sort of thing, which is a one time thing.
Mark Florian: Yeah. The, the setup process is extremely easy.
It's a very modern platform. That's the benefit of, you know, my, my years having been a software engineer myself and a product engineer. It's, it's sleek, it's easy, uh, it's modern. And yeah, we, we have a subscription for some of the premium kind of payment options. So when we are floating money you know, we, mm-hmm.
There's a, a, a, a small subscription just for the therapist to join the platform. You know, we'll we'd give your listeners three months free to try it out, see if it works for them in, benefits to practice. Okay.
Gordon Brewer: Okay. Yeah, I think that's a great kind of thing. What is the cost that's involved in general?
I know there's probably, um, on both sides, I guess, because people will be curious about that.
Mark Florian: Yeah so the, the core platform is free for a therapist to sign up, do billing. Mm-hmm. It's free using, we call Simple Pay our product that allows you to. Give your client the ability to pay less upfront, have us float the, the full cash payment to the therapist.
We call that simple pay. We require a therapist to be on a subscription for that. It's a $19 a month subscription.
And the way we make money is through the transactions that we're performing, so
Gordon Brewer: mm-hmm.
Mark Florian: Managing claims, broadly speaking, it's a, there's a 3% transaction fee. And then there's an additional fee only that applies if we are essentially floating money for a client.
Gordon Brewer: Right. Yeah, no, that makes sense. That makes sense. Sounds like a good, a good, uh, a good deal really. If you think about it in terms of, um, kind of a win-win both for the therapist and for the client in
Mark Florian: terms of it is, you know.
Gordon Brewer: Yeah.
Mark Florian: And for the practitioner, you know. It 1 50, 180. This can be maybe like an average cost of a session.
Um mm-hmm. If you compare that to the payer's paneled rate 70 or $80. Um, right,
right.
Mark Florian: You, you can really kind of see the difference of, of value there.
Gordon Brewer: Yeah. And then, so it would certainly pay for itself from that standpoint when you
Mark Florian: Yeah.
Gordon Brewer: Look at the numbers. Yeah. Well, great. Yeah. Great. Well, um, mark, I've gotta be mindful of our time and your time.
Yeah. And tell folks how they can get in touch with you and and I think we've, uh, we, you're setting up a special URL for people to, uh, try it out.
Mark Florian: Yeah, yeah, for sure. So, uh, to try it out and get the three months free, you can go to deputy care.com/pt and just sign up and, you know, the three months will automatically be applied to anybody that uses that URL.
Gordon Brewer: Mm-hmm.
Mark Florian: Um, and you could find us on Instagram the normal social media outlets. Um, or reach us directly at team@deputycare.com.
Gordon Brewer: All right. And we'll have links in the show notes and the show summary for that. Well, mark, this has been great to get to know about deputy care and just what you're doing to help both therapists and clients, you know, with this, this whole navigating out of network benefits from insurance companies.
So yeah, this has been great. Hopefully we can have another conversation here soon.
Mark Florian: I love that. Thanks a lot, Gordon. This was, uh, this was incredible to talk with you today.
Gordon Brewer: Great.