It’s usually the first question I am asked when a potential client calls or emails me. Do you take United/Aetna/Humana/BCBS/Tricare?
No, no, no, no and no. And here’s why:
Before opening my doors of my practice back in July of 2016, I struggled with this choice. Being a cash-pay only clinician is not for everyone. The advantage of paneling with insurance companies is that there is a built-in referral network and a relatively full clinic in a short amount of time.
But here’s the deal with insurance: if you come to me even once or twice needing to sort out a work problem or a relationship problem or just trying to figure out a general struggle or issue, I have to slap a mental health diagnosis, or ICD-10 code on you so I get paid. And that stays on your permanent medical record. And I’m just not okay with that.
Oftentimes, insurance companies limit the number of sessions for a client (depending on diagnosis). So eventually, if you wanted to continue with me for a longer term (and I have many long-term clients), you’d max out your benefit and have to pay cash anyway. I’ve heard a few horror stories from some of my clinician friends who were audited by the insurance companies (and one who had to refund payment!) and see messages on many of the social media business groups I am in griping about delayed payment or submitted billing that was kicked back or questioned.
No thanks.
When I opened my clinic, I didn’t have one paying client (Read more about that craziness here). I knew I’d have to hustle and grind and market myself hard to fill my clinic with cash-pay clients. The funny thing is that my clinic filled relatively quickly, with many clients that called originally asking what insurance I took and hearing my answer of “none.” In 2017, my sales increased by 526% over my opening year. So far as of this writing in 2018, my sales are up 74%.
It’s risky being cash-pay. I meet with many other clinicians and physicians that are in the insurance game, and there is a love/hate relationship. They battle the insurance companies and spend lots of time and money billing – but their clinics are full. And oftentimes, their clinics have waiting lists.
The advantages of seeing a cash-pay only clinician? There are many. I’m not bound by the limitations set by insurance companies, and especially ones I don’t agree with for the treatment path of my clients. I also spend my time reading and educating myself on the latest news, trends and counseling techniques instead of billing and battling. Another advantage is that if my client’s insurance changes and I’m not on that panel, it doesn’t affect them in the least. They can continue their care with me instead of making a switch.
I have recently been afforded some opportunities that continue to help me circumvent taking insurance. These include two EAP contracts – one with a Fortune 500 company, and one with – ahem, an insurance company – as well as a contract with a state agency for substance use and abuse assessments and various writing assignments. How do I get paid for all of those?
In cash.
As the insurance companies get bigger and their mental health benefits shrink or change, it has zero bearing on how I run my business or serve my clients. And in the end, that’s all I care about.
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This morning our little community of Stone Oak in San Antonio, Texas was devastated by the news of an 8th grade boy who, last night, took his own life.
I am a trauma-informed trained crisis counselor who works with many of the youth in our community. This one hits particularly close to home. While I don’t know the family personally, I know many people who are connected with them or to them in some way or another. The kids in our community, whether they are ours or friends of our children, are all of our kids.
As our community grieves, I want to give parents and kids some resources and ways to open up dialogue and communication in your own home about this often-silent topic.
Here are some tips for parents to talk with your kids about suicide:
Use the word: When you talk about it, use the words “suicide” and “killing yourself.” Be direct with your child. Don’t circumvent the issue. Don’t say, “Have you ever thought about, you know, doing something to yourself?” Say it out loud. The words make it real for everyone.
Ask: The National Suicide Prevention Lifeline recommends the following questions be asked to address current suicide ideation or intent (commanly referred to as S/I): Are you thinking of suicide? Have you thought about suicide in the last two months? Have you ever attempted to kill yourself? As uncomfortable as these questions can be to ask, they are important ones. It’s also important to ask if they know of people or friends that talk about suicide or ending their lives.
Be prepared: If your child answers “yes” to any of the three questions, take it seriously. It is not a ploy or gimmick for attention. I can’t tell you how many parents I have had call me over the years tell me “I think they are just attention-seeking.” If your child tells you they have thought about killing themselves, believe them.
Check-In Often: Things change on a dime in a child or teenager’s life – friendships shift or end, romantic relationships go awry, pressure for grades can mount, peer-pressure, feeling like they don’t fit in or have a purpose…..there’s a litany of things that can pile on, and fast. Talk with your child about their goals, how they feel about the changes in their life, and what pressures or stress they are currently feeling.
Seek Help: If you think your child is depressed or has changes in behavior, contact a professional immediately. Don’t wait to see if it “blows over” or “is just a phase.” A counselor that specializes in depression, self-injury and one that has crisis and suicide experience is important.
Listen: Someone asked me today what the signs are for someone in trouble. The answer to that is……there is no perfect formula or way to know exactly. Sometimes there are whispers. Sometimes there are screams. Often there is silence. Watch for all three, along with the below warning signs.
The National Suicide Prevention Lifeline has the following list of warning signs to help determine if a loved one is at risk for suicide:
– Talking about wanting to die or kill themselves
– Looking for a way to kill themselves, such as searching online or buying a gun
– Talking about feeling hopeless or having no reason to live
– Talking about feeling trapped or in unbearable pain
– Talking about being a burden to others
– Increasing their use of alcohol or drugs
– Acting anxious or agitated; behaving recklessly
– Sleeping too little or too much
– Withdrawing or isolating themselves
– Showing rage or talking about seeking revenge
– Displaying extreme mood swings
I give my clients (teenage and otherwise) the following resources to plug into their phones:
National Suicide Prevention Lifeline: 800-273-8255
24/7 Crisis Text Line: Type “Hello” or “Hi” or “I’m Here” to 741741 and a Trained Crisis Professional will respond instantly.
Keep the dialogue in your home open. Let’s reach out to those that feel alone, hopeless and desperate. Talking about suicide is uncomfortable and painful, but necessary. And could save someone’s life.
So you’ve decided to go to therapy. Congrats on making such a big decision, and giving the gift of “you” to yourself! Of course I’m biased, but I believe therapy is one of the greatest things you can do for your overall health and wellness.
Finding a therapist can be daunting, and oftentimes people aren’t sure how to begin the process – or they give up before they make a first appointment. Here are some things to consider when searching for a therapist:
Shop Around – You shouldn’t make an appointment with the first therapist you Google. Ask around for reccomendations in your area, either from friends or your primary care physician. Research a few different therapy websites to read about what kind of client they serve and the type of therapy they offer. Talk to a few for an initial free phone consultation (I give a free initial 15 minute one).
Get the Deets – Does the therapist take insurance, or are they cash-pay only? Do they offer after-working hour and weekend appointments, or M-F, 8-5 only? Do they see children under 18 or only adults over 18? Do they have specializations or certifications in an area that you are seeking, such as addiction, play therapy or hypnotherapy? Do you have to travel into their office, or are they willing to come to you or do video/phone sessions? Find out as many details about the practice as you can so you can ensure a good fit for your needs.
Commit – Therapy is a process, and not always a quick, one-or-two session fix. Therapy takes time and money, so be sure you are willing and able to commit to regularly, scheduled meetings for a few months (or more, depending on the issues). Teenagers and children especially benefit most from consistently scheduled appointments.
Do the Work – Anyone that comes into my office will be told this: I’m one hour of your week. There are 167 others. So if your therapist gives you readings to do, assignments to compete, or activities to participate in – do them. It’s all part of the work that needs to be done out of the therapy appointment time, and to maximize the overall success of your therapy.
Change – Much like a doctor, lawyer, or hairdresser, sometimes the therapist you try simply isn’t the right fit for you. That’s ok! Therapy will only work if you feel you can work with that person, so don’t be afraid to stop services with one and get referred elsewhere.
Give Feedback – Some of the best work I’ve done with clients were the ones who were truthful when I asked them, a few sessions in, how they thought therapy was going. Your therapist wants your feedback and honesty to ensure your are getting the most out of your therapy time. If your therapist isn’t working on the things you want or need, or you feel stalled – tell them! The best clients I have give me feedback on what they think is or isn’t working for them during our sessions.
I hope this helps in your search for a therapist. Best of luck!
I’m a year-and-a-half into owning my private practice (woot, woot!!). I wrote a blog back in June about my first set of Rookie Mistakes, and now I’m back to share Part Two of a few things I’ve learned the hard way.
I know in retrospect when I read these they seem so obvious…like, DUH-obvious……but the fact of the matter is these things are easy to overlook when you’re flying solo.
So here are five more Rookie Mistakes for you to avoid if/when you are thinking of opening your own private practice:
1) Keep your Forms Updated – Then Update some More – I had an emergency contact space on my original form…..oh wait, no I didn’t!!! I mean, can you believe I did that? How did I discover this huge oversight? When I had a client in a really bad situation contact me and I needed to get in touch with a family member. Only when I pulled his file did I realize this horrible mistake. I now get at LEAST one emergency contact name and number per client. And I’m constantly updating my forms to add other crucial info (pregnancies, miscarriages, etc.)
2) RUN the Credit Card your Clients give you to Keep on File – One of my business practices includes keeping a client’s credit card on file to charge future appointments (or no-shows and less than 24-hour’s notice of cancellation). I have a form where clients voluntarily fill in their Credit Card info, then I manually run them at the end of the day. Oh, how naive I was to think they were writing down the correct number!!!! This is especially crucial for a cash-pay only business. Run that card with them in the office first to ensure it is a valid card.
3) Don’t Scrimp on Office Space – My first office space didn’t have a window, because, quite frankly, I didn’t have any clients and a window seemed like an unneccessary luxury. My practice grew quickly, and soon my tiny windowless office just wasn’t adequate for my clients – or myself. Upgrading to an office with a window makes all the difference in the world. So get the best office space you can (even if it means you have to hustle extra). I chose a secure building in a nice area with a shared receptionist and coffee/tea service included. It’s a nice space for my clients, who are spending their hard-earned money to come and see me. And now they have a window!!!
4) Wasting Precious Advertising Dollars – When you start out, everyone and their brother is going to call you (and call on you) to advertise with them. I have a marketing background, so I know the value of advertising and I needed to grow my business. One of the worst investments I made was buying a very expensive print ad in a local paper. I didn’t receive one call or email from that ad, and I think I’m the only person that saw it. My dollars would have been better spent on online advertising, where I receive the most return on my investment.
5) Not Setting Personal Boundaries – Starting a business is a 24/7 venture. It’s not a 9-5, Monday through Friday job. You must feed it constantly, or it simply won’t grow. But here was my problem: You want a 7:00 a.m. slot? Yes. You want an 8:00 Saturday morning slot? Yes. You need to text me at 10:00 at night? Yes. You need an 8:00 pm slot? Yes. Answer my business line at 10:00 a.m or 10:00 p.m. on Sunday? Yes. Pretty soon all of these “Yeses” were taking a personal toll, on both myself and my family. I’m still working hard on this one, but I’m setting more limits starting with phone and email activity, and I have a hard and fast last 7:00 p.m. appointment during the week.
My mistakes are and have been an amazing way for me to learn and grow, both personally and professionally. What are your (if any) rookie mistakes? I’d love to hear about them, how you discovered them, and how you handled them.
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