December 4, 2024 • 27 mins
Allison and LIMB founder Tiffany McLain, LMFT, discuss three reasons to stay on insurance. Prefer video? This podcast episode is also available to stream on our YouTube channel!
Attention Abundance Community members: Tiffany McLain is the December 2024 Abundance Community trainer. For details on the live training via Zoom, email the HelpDesk or check out the event listing in our private Abundance Community Facebook group.
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Episode Transcript
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(00:08):
(Transcribed by TurboScribe.ai. Go Unlimited to remove this message.) Hi, welcome to the Abundant Practice Podcast.
I'm Allison from Abundance Practice Building.
I have a nearly diagnosable obsession with helping
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If you want to fill your practice with
ideal clients, we have loads of free resources
(00:29):
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Welcome back to the Abundant Practice Podcast.
I'm Alison Puryear, founder of AbundancePracticeBuilding.com.
I'm here with my good friend, my biz
bestie, Tiffany McClain of LeanAndMakeBank.com.
Y'all should know Tiffany if you don't
(02:34):
already.
She's going to sort out your money shit.
Yeah.
What are you...
Did you just raise your...
I'm just waving hi to the people.
Got it.
So we're actually going to talk about reasons
to stay on insurance, which you hear most
consultants railing against getting off insurance, and these
are some really important things to consider before
you jump ship.
(02:54):
Yeah.
So, and yeah, I mean, Tiffany's the queen
of premium fees.
So this is kind of different from her
usual talk on here.
So thanks for being here.
Thank you.
I definitely am.
You know, if people have any familiarity with
me, they're like, Tiffany, you want every therapist
(03:15):
to be off insurance panels.
Why are you talking about staying on them?
And I don't want people to have the
misconception that I think every therapist should be
cash pay premium fee, although I do wish
every therapist was cash pay premium fee.
And I'm also aware that therapists have reasons
to be on insurance panels.
They're not the devil, even though I railed
against them.
I like the idea of kind of taking
(03:38):
the other side for a little bit and
thinking about why would it make sense to
stay?
Yeah.
I love this.
So let's talk a little bit about, let's
talk about reason number one.
They've heard us talk about reasons.
They've heard other people talk about reasons to
get off.
What's reason number one for you to stay
on?
When we're thinking about getting off insurance panels
or staying on, we need to think about
what season of life we're in.
(03:59):
This is something as I've grown up, had
children, really had to deal with all of
the things that life throws at us.
I'm like, oh, there are times when it
doesn't make sense to make huge changes, when
it does make sense to choose ease in
our professional life instead of shaking everything up.
So I think it's really important for therapists
to consider, ask themselves, what phase of life
(04:20):
am I in?
What's my bandwidth, emotional, psychic, financial, how much
bandwidth do I have to make a big
change in my practice?
Maybe even if you have family money, some
people have family money, some people have a
spouse who has a lot of money.
If you're in a particular season of life
where you could actually just chill out and
you don't need to make changes in your
practice or you cannot, you don't have to.
(04:42):
Yeah.
I think there can feel like a lot
of pressure.
As friends get off panels and things like
that, and they're making more money and they're
like, no, really, you can do it.
You can do it.
But there are times when life is hard
enough and we don't need to add hard
on top of it.
That's right.
I don't know.
So I know where this is coming out
in December, early December, the time we're recording
(05:04):
it is election time.
And even on this election day, I'm feeling
so much tension.
Yeah.
Like, oh, I don't want to make any
big change today.
And some people have that for a month,
a quarter, a year where something's happening in
our lives where a big change.
It's just not the time for it.
And it's okay to have it not be
the time for it.
Yeah.
Yeah.
I mean, I think about my local therapist
(05:25):
here in Asheville.
We had the hurricane last month.
Last month wouldn't have been a great time
to decide to get off panels because like
we're still, we don't have water still.
It's been a month.
So like there are times, there are times
like when your kids are really small, I've
worked with students whose kids are really small
and they're like, I have to get off
insurance because I can't pay for daycare if
(05:46):
I don't.
And so there were sometimes compelling reasons to
get off insurance, but sometimes they're compelling reasons
to stay.
So phase of life is such an important
one.
I think it's important for people to be
honest with themselves about these things.
I know when I moved from Seattle to
Asheville, I got on insurance panels here because
(06:07):
I knew it was going to be a
big enough shift and like I needed to
hit the ground making money.
We moved kind of sooner than we wanted
to.
We wanted to stay in Seattle for a
long time, but we moved sooner because my
mother-in-law was sick.
And so like we didn't have months and
months or a year or whatever we would
have done to save up to make whatever
cushion I need because I need a cushion,
a big cushion because anxiety.
(06:30):
And so I knew I just needed to
get on panels to make my life easier
with a one-year-old moving cross country
with a sick mother-in-law to make
it make sense.
And then when things had settled down some
and I felt like I could, I got
off the panels because that's what I wanted
to do.
I love what you're talking about in terms
of you had a clear plan.
I'm not just going to get on panels
(06:51):
and then I don't know what's coming next.
You were like, I need a cushion.
I was willing to work a lot of
hours at the beginning to save up this
cushion so I can prepare myself for the
next phase of my business.
You were clear on your strategy.
And so I think when we're talking about
phases of life, it makes sense to both
be in reality about what's my bandwidth like
(07:12):
right now.
And also be honest with yourself about if
you want to get off, what's your exit
strategy?
If you don't want to be here forever,
what are you going to do?
And if you're working, seeing 40 clients a
week, 30 a week, if you have little
kids at home it's really easy to get
complacent and get stuck in that for years
if we're not really being conscious and intentional
(07:34):
about what our plan really is, what kind
of life do we really want to have?
So yes, phase of life.
Yes, season of life.
And also have somewhere in the back of
your mind awareness about is this something I
want to stick with or do I want
to get off at some point in my
practice, in my career?
And I think there's a parallel process with
leaving an agency job too, while you have
(07:56):
a private practice on the side of you
can stay working 60 hours a week doing
both for a long time or you can
be like, okay, once I hit 10 clients
in my private practice, I'm putting in my
notice as long as I have some consistent
referrals.
So yeah, we can't just keep going on
and on and on without examining what's working
for us and what's not and maintain a
(08:19):
healthy life and practice.
That's interesting.
So what I'm curious, what have you noticed
when working with your students are pivotal points
in which they pop their head up and
say, oh, let me examine whether this is
still working.
What seasons of life have you noticed that?
So it's interesting.
So I have my newbies who are starting
private practices or are plateaued somewhere in between.
(08:40):
So that's like one set of people that
we work with, but we also in Limitless
Practice work with people who are full and
miserable.
So they're making these big changes.
So I always think about them first when
you ask a question like that, because all
these people have raised their hand of like,
I am working my tail off and I
am making not as much money as I
need to make to be able to retire.
(09:02):
So I'm thinking a lot of them have
kids who are no longer babies, like they're
toddlers, but it's like maybe a more manageable
version of toddler where their brain is back
in a way that it wasn't initially with
an infant.
They're getting more sleep.
So phase of life wise, I see a
lot of people who have toddlers or younger
(09:23):
kids.
I see some people who they just kind
of realized like they were exposed to people
who are not on insurance through consultants, through
social media, through whatever.
It's kind of like they're waking up to
that being a thing.
Because what I see, and I think you
probably see this too, is people who take
insurance tend to clump with one another and
(09:44):
therapists who don't take insurance tend to clump
with one another.
And so it just feels like it's what
everybody's doing.
So they start to get exposure to other
people who are not taking insurance and realize
they don't have to.
And I guess it's not necessarily a phase
of life as much as just like wearing
down and eroding of bandwidth with insurance companies
(10:08):
that are not paying, that are not, you
know, they're not paying in a timely way.
They have to spend a lot of time
and energy or money on an assistant to
get the payments that they need and that
they've earned.
So, but we're talking about keeping people on
insurance.
I don't want to spend too much time
on that.
But you can stay.
So I'll just use that to talk about,
it's interesting because the very season that might
(10:31):
lead one person to get off insurance panels
is the season that might bring someone else
to stay on.
So, you know, some people might say, I'm
pregnant, I'm going to have a kid, let
me stay on insurance panels for security.
We have students who do the opposite, which
is I'm pregnant, I'm going to have a
kid, let me use this time to actually
get off panels and come back after Matt
leave without being on insurance panels.
Let me be cash paid.
(10:51):
So really, again, it comes back to being
honest with ourselves, having a really assessing what
do we need for ourselves now and where
are we going in the future?
And then trusting yourself to make that decision.
Yes.
And not leaning on other people, not asking
other people what they think you should do
because they're coming at it from their lens
too.
So I think like you know yourself best
(11:13):
and while for some people getting off insurance
during Matt leave and starting their practice then
is the way to go for others, that's
just adding so much more work and so
much more anxiety to being a parent of
an infant.
So knowing what you need and if you
do eventually want to get up panels, having
(11:33):
a really clear path for that, that feels
safer for you because that's, you know me,
I'm a pusher, right?
And I want to like move people along
really fast and I have to remember that
and I've had some really great students that
helped me realize that my pace is not
the pace that people are going to move
slower sometimes and that is what is right
(11:55):
for them and that's the support they need
is to support that pace.
Yes.
Yeah.
And if you want to stay on insurance
forever because it makes sense for you, that's
great.
Which I think could lead into that second
reason to stay on insurance panels.
Yes.
The second one is if you just are
the kind of person you have just made
a choice in your life that you are
(12:15):
not going to market, you don't want to
learn how to market, you don't want to
be out there marketing, you don't want to
spend your money that way or your energy
that way.
You simply want clients to come to you
even if it means you see more people,
even if it means you're working more hours,
that is a price you're happy to pay
to not have to get into this whole
marketing world.
That's another reason to stay on panels.
And I don't want that to be a
(12:36):
fear-driven decision like I'm afraid of being
seen or I don't know how and I
feel like I'd look stupid, that kind of
thing.
I want that to be a decision based
on I've learned some marketing things and it's
just honestly not how I want to spend
my time and it's not worth it to
me to spend that time for more money.
Because the truth of the matter is many,
(12:57):
many insurance panels in most of this country
are paying you more for a lot less
work than you made in agencies.
So it's still an upgrade and I want
people to hear that if the marketing piece
is what's been holding them back, it's still
an upgrade from most agency work to take
insurance in your own private practice and see
25 clients a week.
(13:20):
That's right.
It's not, you know, people like me, people
like you, we're like, get out there, market,
you can do it.
All those things are true and it still
takes time.
It's not like you're going to be suddenly
seeing 20 cash pay clients a week, easy
$200 as soon as you get off insurance
panels.
It's a process.
It takes time and energy.
(13:40):
You have to be able to play the
long game, figure out what works for you.
There's no quick and easy magic bullet solution.
And so if you're somebody who, who is
saying like, I just don't want to play
that game, stay on insurance panels.
You don't have to play that game.
If, if you don't want to, yeah, actually,
let me ask you this.
In terms of marketing, I want to come
(14:01):
back to this.
You mentioned briefly, you know, if people are
not marketing because they're afraid or they're, they
don't want to be seen.
I wonder about those people.
Like if those people are like, I just
know, I don't want to show up in
the world or I don't want to be
seen.
I'm I like you want to push them.
There's so much on the other side of
(14:21):
that.
There are some, you'll come to know about
yourself by putting yourself in the world.
And what about the people who are like,
I just don't want to know that.
I think that's a difference.
There's a distinction between the people who are
like, I don't know, I just don't really
care.
And the people who are like, I don't
want to look stupid, but I don't want
to look stupid.
I want them to push themselves because there's
(14:41):
good, juicy, emotional work there.
Right.
It could lead them to a better practice
if they want to work through it or
could just lead to feeling really good about
not being afraid anymore.
I just don't want any of our decisions
to be fear-based right.
In an ideal world.
Not that not that all my decisions are
free and clear of fear, but I want
(15:02):
everybody's decisions to come from what they want
instead of what they're afraid of.
The thing I really appreciate about that is
what I heard in that this is going
to be challenging to some therapists out there
listening.
But also I think about it clinically from
a clinical lens, if you're not marketing or
you're not growing your practice out of fear,
then that is impacting your clinical work.
(15:24):
How can you fully show up?
How can you fully support your clients in
their transformation, helping them lean into fear, helping
them move through the hard stuff if you're
actually avoiding that in your own life or
your own business.
So that's another way for those of you
who are like, well, I don't want to
market because it's scary or I don't want
to be seen or I'm embarrassed.
That is, sorry to say, you're a less
(15:44):
effective clinician because you're avoiding those parts of
yourself and your journey.
And not necessarily less than other people, but
less than you could be.
Yes.
A hundred percent.
Yeah.
How are you?
I mean, it's similar for those who are
like, well, this is different.
Like not all of us are business people.
It's the same exact thing as you not
having that conversation with your mother-in-law
that you need to have, but encouraging your
(16:04):
clients to do it all the same.
Like avoiding tough conversations when that's what you're
preaching.
So versus the person you bring up, who's
just like, I just really don't care.
Like I really don't care to learn how
to do SEO, for instance, that doesn't mean
I'm not going to do SEO.
It means I'm going to pay somebody to
do my SEO.
But like, I really have absolutely no interest
(16:25):
in it.
And if that's the way people feel about
the entirety of marketing, which I find hard
to believe because marketing includes so many different
things.
But if it's the way you feel about
the entirety of marketing, yeah, okay.
That's cool.
Insurance will help get you full.
We have more therapists out there in private
practice now, so it might be a slower
journey than it might've been a few years
ago.
And I'm starting to see, I don't know
(16:46):
if you're seeing this in your students, a
slight drop in the rate of referrals that
people are getting.
It's looking more like pre-pandemic now in
terms of like frequency of referrals for the
average therapist versus post-pandemic where it was
a lot easier to get full faster in
the three-ish years after the pandemic.
(17:09):
Yeah.
We're seeing similar, like people still can do
it.
People are doing it and it's not pandemic
times when people are just rushing out, clients
are rushing out to find their therapist.
I would say for people who are like,
oh no, I just wanted to start my
practice this month.
It's still fine.
We're seeing it with our students who are
in our high level, our mentorship, for instance,
we're seeing it more in six months than
(17:30):
in three months.
So it's still happening relatively quickly, but it's
not as easy as it was two years
ago, for instance.
Yeah.
Really interesting to think about that.
So people who, it's interesting because you and
I, we're kind of finding ourselves back into
just the market.
We're kind of like, if you never want
to market, it's fine, keep your practice on
(17:50):
insurance.
And we're asking the questions, are you avoiding
marketing because you're afraid?
Are you avoiding marketing because you don't want
to be seen?
Are you avoiding marketing?
Are you just avoiding marketing or are you
simply making a determination?
I'm not interested in that.
It's a really important thing to ask yourself
as you're reflecting on how you're running your
business that you have chosen to embark upon.
And it ties back into the phase of
(18:10):
life.
You might be like, I don't have any
sort of bandwidth or interest in marketing right
now while I've got a toddler and a
baby.
No, thank you.
Totally get that.
Or, you know, I've got parents who are
aging and I'm sandwich generationing, or I'm taking
care of my parents or I'm getting married
next month or whatever huge big thing can
be going on.
(18:31):
That's going to impact your energy and your
desire to market.
And unless you have systems in place already,
it just might not be the place to
pick it up.
So, yeah, the third reason we're going to
go in the entirely opposite direction.
The third reason to stay on panels or
to have an insurance based practice is if
you're trying to grow a private practice, a
(18:52):
group practice and scale it so that you
can sell it or keep it, but you
want to scale it big.
But especially if you're thinking, I want to
build a practice and then sell it from
what I've seen and from people I've talked
to, you have to take insurance in order
to sell that practice to a, one of
these big conglomerates who are buying up group
practices everywhere.
(19:13):
A private practice insurance panels at scale make
sense in a way that insurance panels as
an individual practitioner doesn't always make sense, right?
If you have a group practice, you can
have an administrator, a manager, you're having bulk
reimbursements.
And so you can actually pay your, your
own therapist relatively well.
You can give them a good salary, not
(19:35):
like they could have as a cash pay
in their own private practice, but you know,
they can make 80, a hundred thousand, 60
to 80, a hundred thousand a year.
And you as a business owner can be
able to, to sell your business ultimately.
Oh yeah.
I have a lot of friends in this
position.
A lot of friends who've been approached by
these VC firms, venture capital funds wanting to
buy their practice for a lot of money.
(19:56):
So far, most of my friends have decided
not to sell at this point, even though
they were offered enormous amounts of money because
the way that things would change within their
practice, which is like a baby of theirs,
you know, like it's, they really love what
they've created because once things are, are bought
by VC, usually it's all about the investors
(20:19):
and what they want, which is their money
back.
And not so much about the people doing
the work or the clients.
So that's the tough part.
And I haven't figured out a way around
that with any of my friends.
I don't know.
I've had a lot of conversations about it
where it's just like, I just don't want,
(20:39):
I don't want my people to get pay
cuts.
I don't want the direction that they were
wanting to go with VC.
Now I don't know every single situation.
So there are some groups that might approach
a group to purchase them that are wonderful
and that are interested in maintaining systems as
they were created.
It depends on the profitability of the business
ultimately, but it's something to consider.
(21:03):
If you were like, Ooh, I'd like to
be bought out for millions of dollars with
a group practice.
If that was your first knee-jerk reaction
to be like, yeah.
And just think through the whole process first,
it's not right or wrong.
Just think through the process and kind of
like being on insurance or not.
What's your plan?
What's your plan?
Ultimately.
That's right.
A VC backed group practice is not going
to have the same heart or intention or
(21:25):
presence as a therapist owned group practice.
And if you have scaled your group practice,
or if you're working to scale a group
practice to the point where it's very profitable,
you can get someone to come in and
run your practice, make sure they're still running
by your values and be profitable.
A hundred percent.
I think a lot of therapists who come
from agency backgrounds with agency takes insurance.
(21:45):
They just automatically assume I'll go into my
private practice and I'll also take insurance without
realizing that the scale factor, that having a
lot of people on insurance is what allows
that agency to run and be profitable.
And it doesn't translate to quality of life,
ease, financial abundance, usually in a one-to
-one private practice setting, but you can recreate
(22:06):
it in your group practice.
So that's a reason to use insurance.
Absolutely.
I think if I were, I was never,
I never took insurance, but I certainly had
low fees in the early days of my
private practice.
And if I were listening to this conversation,
I might be feeling pushed or challenged or
defensive.
Well, wait a minute.
So I'm encouraging people to listen.
If you're listening and feeling like, yeah, this
(22:27):
makes sense.
I feel easeful.
I love that I'm on insurance based on
what Allison and Tiffany are saying.
It makes sense for me to stay on
right now.
Yay.
That's the goal.
If you're feeling a little stressed or called
out or pushed or called in, then I
encourage those of you to think about, oh,
maybe there is a part of me that
actually is resonating with, bucking against, wanting to
(22:49):
experience an insurance-free private practice, a cash
-based practice.
So if that's you, yay.
Welcome.
I encourage you to listen to those parts,
wrestle with us in this conversation, fight with
us in the comments, and we can kind
of help you think about what makes sense
for you at this season of your life.
Yeah.
Because nothing is right or wrong.
I mean, I think you and I have
(23:10):
both always had this tenant of like, what
a therapist chooses to do with their own
practice, that's their choice.
There's no bullying people in one way or
the other.
I mean, like certainly happens on the therapist
Facebook groups, right?
But not in our paid groups where people
are in our programs.
So it's interesting how people feel pressured on
(23:32):
both sides, depending on who's around them, who's
talking to them.
And ultimately it is your practice.
And I want each therapist to be fully
responsible for the choices that they make in
their practice and not victims of the choices
they make in their practice.
And that doesn't look just one way.
I love that.
(23:53):
Be fully responsible for the choices you're making
and the results that come from those choices
versus a victim to the circumstances.
That's as always very empowering.
You're the boss, right?
I'm the boss.
And when you hear, by the way, Alison
or I, we have strong opinions.
We will put things out forcefully.
And when we do, we're talking to the
people who resonate.
If you're hearing that and you're like, that's
(24:14):
not me.
How dare you?
Everybody can't live that way.
We're not asking everyone to live this way.
So I really, I love this conversation that
gives you the freedom to take responsibility for
the choices you're making and the outcomes that
come from that, the results of those choices
and always be willing and ready to reflect,
check in and see if this is still
working for me.
And if it is, keep it up.
(24:35):
If it's not, you have so many options
about how to change so much support and
going in another direction.
Absolutely.
Yay.
Well, I should say one of the supports
is Tiffany over at leanandmakebank.com.
I have all of our students do your
fun with fees calculator.
I recommend it for all of our, especially
our, the students we work the closest with
and limitless in the mentorship, because knowing what
(24:59):
you need to make per session, it may
be insurance covers that, and then you can
rest a little.
It may be.
And so doing that calculator helps people understand
instead of just basing their number off what
they hear in their area, it's actually easier
to stand behind too, when it's like, I
need this fee in order to put away
(25:20):
for vacation, in order to have sick time,
in order to send my kid to camp,
you know, those kinds of things.
Say for retirement.
I mean, I'm thinking about that.
I'm sure you are too.
Like, are we going to be taken care
of?
And then we see our parents.
So definitely having a clear number grounded in
each person's unique set of circumstances and desires
is vital when making a decision around, do
(25:43):
I want to stay on panels?
Do I want to leave?
How many hours do I want to work?
And also what's my long game?
So someone might do the fun with fee
calculator and there'll be a link, you can
drop a link for them.
Someone might do the fun with fee calculator
and get a number that feels just way
out of what feels possible for them.
And I encourage you to think about, okay,
maybe not today, but what would it look
(26:04):
like for me to take the next five
years to figure out how to make that
my reality?
So at least you're grounded in what's true
for you, what your desires are, and not
kind of just living in this gray, I
don't know what, back to this idea of
victim to your circumstances.
You're going to be the captain of your
ship.
Absolutely.
Yay.
Well, thank you, Tiffany.
(26:25):
My pleasure.
And I'll also direct people if you, if
you like podcasts, we have our podcast back
the money sessions back after like a two
year, uh, Tiffany having children, raising those children
to three and five hiatus, they're back.
So you can also go check out the
money sessions.
Absolutely.
And you're also doing a training for in
the abundance party.
So I'm psyched about that.
(26:47):
Oh yeah.
Folks get in the abundance, if you're not
in the abundance party, A, well, maybe you're
one of those therapists who never wants to
market, but if you are willing to push
yourself and learn more, um, definitely join the
abundance party and I'll see you in there.
And we'll have Q and a and actual
live, like how do we actually do this
thing, which is going to be fabulous.
Yeah.
Love it.
Awesome.
Well, thanks.
I'll see you soon.
Thank you.
(27:09):
If you're ready for a much easier practice,
therapy notes is the way to go go
to therapy notes.com and use the promo
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If you're listening, you probably need some support
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If you're a super newbie, grab our free
checklist using the link in the show notes.
(27:29):
I'd love for you to follow rate and
review, but I really want you to share
this episode with a therapist friend.
Let's help all our colleagues build what they
want.
(Transcribed by TurboScribe.ai. Go Unlimited to remove this message.) Hi, welcome to the Abundant Practice Podcast.
I'm Allison from Abundance Practice Building.
I have a nearly diagnosable obsession with helping
therapists build sustainable, joy-filled private practices, just
like I've done for tens of thousands of
therapists across the world.
I'm excited to help you too.
If you want to fill your practice with
ideal clients, we have loads of free resources
(00:29):
and paid support.
Go to abundancepracticebuilding.com slash links.
All right, onto the show.
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(01:12):
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see why everyone is switching to TherapyNotes now
featuring ePrescribe.
You really wish grad school had covered how
(01:32):
to fill a private practice.
In grad school, you had a professor you
could ask questions, someone who could tell you
what you were doing wrong and how to
fix it.
You had classmates working towards the same goal.
Think of Party Plus like that grad school
class you wish you had.
You get individual consultation about your specific practice
with clear feedback and guidance.
You get group calls with other people building
(01:52):
their practices who have your back.
We cover everything from marketing to mindset, and
you have access to everything in the Abundance
Party, all the courses and trainings that have
filled thousands of therapists' practices.
Thanks to the feedback, the support, and the
clear step-by-step, people in Party Plus
get full faster.
The majority of Party Plus members fill their
practice in three months.
(02:13):
Check out Party Plus in the link in
the show notes and join the interest list
if you're ready to build what you've been
dreaming of.
Welcome back to the Abundant Practice Podcast.
I'm Alison Puryear, founder of AbundancePracticeBuilding.com.
I'm here with my good friend, my biz
bestie, Tiffany McClain of LeanAndMakeBank.com.
Y'all should know Tiffany if you don't
(02:34):
already.
She's going to sort out your money shit.
Yeah.
What are you...
Did you just raise your...
I'm just waving hi to the people.
Got it.
So we're actually going to talk about reasons
to stay on insurance, which you hear most
consultants railing against getting off insurance, and these
are some really important things to consider before
you jump ship.
(02:54):
Yeah.
So, and yeah, I mean, Tiffany's the queen
of premium fees.
So this is kind of different from her
usual talk on here.
So thanks for being here.
Thank you.
I definitely am.
You know, if people have any familiarity with
me, they're like, Tiffany, you want every therapist
(03:15):
to be off insurance panels.
Why are you talking about staying on them?
And I don't want people to have the
misconception that I think every therapist should be
cash pay premium fee, although I do wish
every therapist was cash pay premium fee.
And I'm also aware that therapists have reasons
to be on insurance panels.
They're not the devil, even though I railed
against them.
I like the idea of kind of taking
(03:38):
the other side for a little bit and
thinking about why would it make sense to
stay?
Yeah.
I love this.
So let's talk a little bit about, let's
talk about reason number one.
They've heard us talk about reasons.
They've heard other people talk about reasons to
get off.
What's reason number one for you to stay
on?
When we're thinking about getting off insurance panels
or staying on, we need to think about
what season of life we're in.
(03:59):
This is something as I've grown up, had
children, really had to deal with all of
the things that life throws at us.
I'm like, oh, there are times when it
doesn't make sense to make huge changes, when
it does make sense to choose ease in
our professional life instead of shaking everything up.
So I think it's really important for therapists
to consider, ask themselves, what phase of life
(04:20):
am I in?
What's my bandwidth, emotional, psychic, financial, how much
bandwidth do I have to make a big
change in my practice?
Maybe even if you have family money, some
people have family money, some people have a
spouse who has a lot of money.
If you're in a particular season of life
where you could actually just chill out and
you don't need to make changes in your
practice or you cannot, you don't have to.
(04:42):
Yeah.
I think there can feel like a lot
of pressure.
As friends get off panels and things like
that, and they're making more money and they're
like, no, really, you can do it.
You can do it.
But there are times when life is hard
enough and we don't need to add hard
on top of it.
That's right.
I don't know.
So I know where this is coming out
in December, early December, the time we're recording
(05:04):
it is election time.
And even on this election day, I'm feeling
so much tension.
Yeah.
Like, oh, I don't want to make any
big change today.
And some people have that for a month,
a quarter, a year where something's happening in
our lives where a big change.
It's just not the time for it.
And it's okay to have it not be
the time for it.
Yeah.
Yeah.
I mean, I think about my local therapist
(05:25):
here in Asheville.
We had the hurricane last month.
Last month wouldn't have been a great time
to decide to get off panels because like
we're still, we don't have water still.
It's been a month.
So like there are times, there are times
like when your kids are really small, I've
worked with students whose kids are really small
and they're like, I have to get off
insurance because I can't pay for daycare if
(05:46):
I don't.
And so there were sometimes compelling reasons to
get off insurance, but sometimes they're compelling reasons
to stay.
So phase of life is such an important
one.
I think it's important for people to be
honest with themselves about these things.
I know when I moved from Seattle to
Asheville, I got on insurance panels here because
(06:07):
I knew it was going to be a
big enough shift and like I needed to
hit the ground making money.
We moved kind of sooner than we wanted
to.
We wanted to stay in Seattle for a
long time, but we moved sooner because my
mother-in-law was sick.
And so like we didn't have months and
months or a year or whatever we would
have done to save up to make whatever
cushion I need because I need a cushion,
a big cushion because anxiety.
(06:30):
And so I knew I just needed to
get on panels to make my life easier
with a one-year-old moving cross country
with a sick mother-in-law to make
it make sense.
And then when things had settled down some
and I felt like I could, I got
off the panels because that's what I wanted
to do.
I love what you're talking about in terms
of you had a clear plan.
I'm not just going to get on panels
(06:51):
and then I don't know what's coming next.
You were like, I need a cushion.
I was willing to work a lot of
hours at the beginning to save up this
cushion so I can prepare myself for the
next phase of my business.
You were clear on your strategy.
And so I think when we're talking about
phases of life, it makes sense to both
be in reality about what's my bandwidth like
(07:12):
right now.
And also be honest with yourself about if
you want to get off, what's your exit
strategy?
If you don't want to be here forever,
what are you going to do?
And if you're working, seeing 40 clients a
week, 30 a week, if you have little
kids at home it's really easy to get
complacent and get stuck in that for years
if we're not really being conscious and intentional
(07:34):
about what our plan really is, what kind
of life do we really want to have?
So yes, phase of life.
Yes, season of life.
And also have somewhere in the back of
your mind awareness about is this something I
want to stick with or do I want
to get off at some point in my
practice, in my career?
And I think there's a parallel process with
leaving an agency job too, while you have
(07:56):
a private practice on the side of you
can stay working 60 hours a week doing
both for a long time or you can
be like, okay, once I hit 10 clients
in my private practice, I'm putting in my
notice as long as I have some consistent
referrals.
So yeah, we can't just keep going on
and on and on without examining what's working
for us and what's not and maintain a
(08:19):
healthy life and practice.
That's interesting.
So what I'm curious, what have you noticed
when working with your students are pivotal points
in which they pop their head up and
say, oh, let me examine whether this is
still working.
What seasons of life have you noticed that?
So it's interesting.
So I have my newbies who are starting
private practices or are plateaued somewhere in between.
(08:40):
So that's like one set of people that
we work with, but we also in Limitless
Practice work with people who are full and
miserable.
So they're making these big changes.
So I always think about them first when
you ask a question like that, because all
these people have raised their hand of like,
I am working my tail off and I
am making not as much money as I
need to make to be able to retire.
(09:02):
So I'm thinking a lot of them have
kids who are no longer babies, like they're
toddlers, but it's like maybe a more manageable
version of toddler where their brain is back
in a way that it wasn't initially with
an infant.
They're getting more sleep.
So phase of life wise, I see a
lot of people who have toddlers or younger
(09:23):
kids.
I see some people who they just kind
of realized like they were exposed to people
who are not on insurance through consultants, through
social media, through whatever.
It's kind of like they're waking up to
that being a thing.
Because what I see, and I think you
probably see this too, is people who take
insurance tend to clump with one another and
(09:44):
therapists who don't take insurance tend to clump
with one another.
And so it just feels like it's what
everybody's doing.
So they start to get exposure to other
people who are not taking insurance and realize
they don't have to.
And I guess it's not necessarily a phase
of life as much as just like wearing
down and eroding of bandwidth with insurance companies
(10:08):
that are not paying, that are not, you
know, they're not paying in a timely way.
They have to spend a lot of time
and energy or money on an assistant to
get the payments that they need and that
they've earned.
So, but we're talking about keeping people on
insurance.
I don't want to spend too much time
on that.
But you can stay.
So I'll just use that to talk about,
it's interesting because the very season that might
(10:31):
lead one person to get off insurance panels
is the season that might bring someone else
to stay on.
So, you know, some people might say, I'm
pregnant, I'm going to have a kid, let
me stay on insurance panels for security.
We have students who do the opposite, which
is I'm pregnant, I'm going to have a
kid, let me use this time to actually
get off panels and come back after Matt
leave without being on insurance panels.
Let me be cash paid.
(10:51):
So really, again, it comes back to being
honest with ourselves, having a really assessing what
do we need for ourselves now and where
are we going in the future?
And then trusting yourself to make that decision.
Yes.
And not leaning on other people, not asking
other people what they think you should do
because they're coming at it from their lens
too.
So I think like you know yourself best
(11:13):
and while for some people getting off insurance
during Matt leave and starting their practice then
is the way to go for others, that's
just adding so much more work and so
much more anxiety to being a parent of
an infant.
So knowing what you need and if you
do eventually want to get up panels, having
(11:33):
a really clear path for that, that feels
safer for you because that's, you know me,
I'm a pusher, right?
And I want to like move people along
really fast and I have to remember that
and I've had some really great students that
helped me realize that my pace is not
the pace that people are going to move
slower sometimes and that is what is right
(11:55):
for them and that's the support they need
is to support that pace.
Yes.
Yeah.
And if you want to stay on insurance
forever because it makes sense for you, that's
great.
Which I think could lead into that second
reason to stay on insurance panels.
Yes.
The second one is if you just are
the kind of person you have just made
a choice in your life that you are
(12:15):
not going to market, you don't want to
learn how to market, you don't want to
be out there marketing, you don't want to
spend your money that way or your energy
that way.
You simply want clients to come to you
even if it means you see more people,
even if it means you're working more hours,
that is a price you're happy to pay
to not have to get into this whole
marketing world.
That's another reason to stay on panels.
And I don't want that to be a
(12:36):
fear-driven decision like I'm afraid of being
seen or I don't know how and I
feel like I'd look stupid, that kind of
thing.
I want that to be a decision based
on I've learned some marketing things and it's
just honestly not how I want to spend
my time and it's not worth it to
me to spend that time for more money.
Because the truth of the matter is many,
(12:57):
many insurance panels in most of this country
are paying you more for a lot less
work than you made in agencies.
So it's still an upgrade and I want
people to hear that if the marketing piece
is what's been holding them back, it's still
an upgrade from most agency work to take
insurance in your own private practice and see
25 clients a week.
(13:20):
That's right.
It's not, you know, people like me, people
like you, we're like, get out there, market,
you can do it.
All those things are true and it still
takes time.
It's not like you're going to be suddenly
seeing 20 cash pay clients a week, easy
$200 as soon as you get off insurance
panels.
It's a process.
It takes time and energy.
(13:40):
You have to be able to play the
long game, figure out what works for you.
There's no quick and easy magic bullet solution.
And so if you're somebody who, who is
saying like, I just don't want to play
that game, stay on insurance panels.
You don't have to play that game.
If, if you don't want to, yeah, actually,
let me ask you this.
In terms of marketing, I want to come
(14:01):
back to this.
You mentioned briefly, you know, if people are
not marketing because they're afraid or they're, they
don't want to be seen.
I wonder about those people.
Like if those people are like, I just
know, I don't want to show up in
the world or I don't want to be
seen.
I'm I like you want to push them.
There's so much on the other side of
(14:21):
that.
There are some, you'll come to know about
yourself by putting yourself in the world.
And what about the people who are like,
I just don't want to know that.
I think that's a difference.
There's a distinction between the people who are
like, I don't know, I just don't really
care.
And the people who are like, I don't
want to look stupid, but I don't want
to look stupid.
I want them to push themselves because there's
(14:41):
good, juicy, emotional work there.
Right.
It could lead them to a better practice
if they want to work through it or
could just lead to feeling really good about
not being afraid anymore.
I just don't want any of our decisions
to be fear-based right.
In an ideal world.
Not that not that all my decisions are
free and clear of fear, but I want
(15:02):
everybody's decisions to come from what they want
instead of what they're afraid of.
The thing I really appreciate about that is
what I heard in that this is going
to be challenging to some therapists out there
listening.
But also I think about it clinically from
a clinical lens, if you're not marketing or
you're not growing your practice out of fear,
then that is impacting your clinical work.
(15:24):
How can you fully show up?
How can you fully support your clients in
their transformation, helping them lean into fear, helping
them move through the hard stuff if you're
actually avoiding that in your own life or
your own business.
So that's another way for those of you
who are like, well, I don't want to
market because it's scary or I don't want
to be seen or I'm embarrassed.
That is, sorry to say, you're a less
(15:44):
effective clinician because you're avoiding those parts of
yourself and your journey.
And not necessarily less than other people, but
less than you could be.
Yes.
A hundred percent.
Yeah.
How are you?
I mean, it's similar for those who are
like, well, this is different.
Like not all of us are business people.
It's the same exact thing as you not
having that conversation with your mother-in-law
that you need to have, but encouraging your
(16:04):
clients to do it all the same.
Like avoiding tough conversations when that's what you're
preaching.
So versus the person you bring up, who's
just like, I just really don't care.
Like I really don't care to learn how
to do SEO, for instance, that doesn't mean
I'm not going to do SEO.
It means I'm going to pay somebody to
do my SEO.
But like, I really have absolutely no interest
(16:25):
in it.
And if that's the way people feel about
the entirety of marketing, which I find hard
to believe because marketing includes so many different
things.
But if it's the way you feel about
the entirety of marketing, yeah, okay.
That's cool.
Insurance will help get you full.
We have more therapists out there in private
practice now, so it might be a slower
journey than it might've been a few years
ago.
And I'm starting to see, I don't know
(16:46):
if you're seeing this in your students, a
slight drop in the rate of referrals that
people are getting.
It's looking more like pre-pandemic now in
terms of like frequency of referrals for the
average therapist versus post-pandemic where it was
a lot easier to get full faster in
the three-ish years after the pandemic.
(17:09):
Yeah.
We're seeing similar, like people still can do
it.
People are doing it and it's not pandemic
times when people are just rushing out, clients
are rushing out to find their therapist.
I would say for people who are like,
oh no, I just wanted to start my
practice this month.
It's still fine.
We're seeing it with our students who are
in our high level, our mentorship, for instance,
we're seeing it more in six months than
(17:30):
in three months.
So it's still happening relatively quickly, but it's
not as easy as it was two years
ago, for instance.
Yeah.
Really interesting to think about that.
So people who, it's interesting because you and
I, we're kind of finding ourselves back into
just the market.
We're kind of like, if you never want
to market, it's fine, keep your practice on
(17:50):
insurance.
And we're asking the questions, are you avoiding
marketing because you're afraid?
Are you avoiding marketing because you don't want
to be seen?
Are you avoiding marketing?
Are you just avoiding marketing or are you
simply making a determination?
I'm not interested in that.
It's a really important thing to ask yourself
as you're reflecting on how you're running your
business that you have chosen to embark upon.
And it ties back into the phase of
(18:10):
life.
You might be like, I don't have any
sort of bandwidth or interest in marketing right
now while I've got a toddler and a
baby.
No, thank you.
Totally get that.
Or, you know, I've got parents who are
aging and I'm sandwich generationing, or I'm taking
care of my parents or I'm getting married
next month or whatever huge big thing can
be going on.
(18:31):
That's going to impact your energy and your
desire to market.
And unless you have systems in place already,
it just might not be the place to
pick it up.
So, yeah, the third reason we're going to
go in the entirely opposite direction.
The third reason to stay on panels or
to have an insurance based practice is if
you're trying to grow a private practice, a
(18:52):
group practice and scale it so that you
can sell it or keep it, but you
want to scale it big.
But especially if you're thinking, I want to
build a practice and then sell it from
what I've seen and from people I've talked
to, you have to take insurance in order
to sell that practice to a, one of
these big conglomerates who are buying up group
practices everywhere.
(19:13):
A private practice insurance panels at scale make
sense in a way that insurance panels as
an individual practitioner doesn't always make sense, right?
If you have a group practice, you can
have an administrator, a manager, you're having bulk
reimbursements.
And so you can actually pay your, your
own therapist relatively well.
You can give them a good salary, not
(19:35):
like they could have as a cash pay
in their own private practice, but you know,
they can make 80, a hundred thousand, 60
to 80, a hundred thousand a year.
And you as a business owner can be
able to, to sell your business ultimately.
Oh yeah.
I have a lot of friends in this
position.
A lot of friends who've been approached by
these VC firms, venture capital funds wanting to
buy their practice for a lot of money.
(19:56):
So far, most of my friends have decided
not to sell at this point, even though
they were offered enormous amounts of money because
the way that things would change within their
practice, which is like a baby of theirs,
you know, like it's, they really love what
they've created because once things are, are bought
by VC, usually it's all about the investors
(20:19):
and what they want, which is their money
back.
And not so much about the people doing
the work or the clients.
So that's the tough part.
And I haven't figured out a way around
that with any of my friends.
I don't know.
I've had a lot of conversations about it
where it's just like, I just don't want,
(20:39):
I don't want my people to get pay
cuts.
I don't want the direction that they were
wanting to go with VC.
Now I don't know every single situation.
So there are some groups that might approach
a group to purchase them that are wonderful
and that are interested in maintaining systems as
they were created.
It depends on the profitability of the business
ultimately, but it's something to consider.
(21:03):
If you were like, Ooh, I'd like to
be bought out for millions of dollars with
a group practice.
If that was your first knee-jerk reaction
to be like, yeah.
And just think through the whole process first,
it's not right or wrong.
Just think through the process and kind of
like being on insurance or not.
What's your plan?
What's your plan?
Ultimately.
That's right.
A VC backed group practice is not going
to have the same heart or intention or
(21:25):
presence as a therapist owned group practice.
And if you have scaled your group practice,
or if you're working to scale a group
practice to the point where it's very profitable,
you can get someone to come in and
run your practice, make sure they're still running
by your values and be profitable.
A hundred percent.
I think a lot of therapists who come
from agency backgrounds with agency takes insurance.
(21:45):
They just automatically assume I'll go into my
private practice and I'll also take insurance without
realizing that the scale factor, that having a
lot of people on insurance is what allows
that agency to run and be profitable.
And it doesn't translate to quality of life,
ease, financial abundance, usually in a one-to
-one private practice setting, but you can recreate
(22:06):
it in your group practice.
So that's a reason to use insurance.
Absolutely.
I think if I were, I was never,
I never took insurance, but I certainly had
low fees in the early days of my
private practice.
And if I were listening to this conversation,
I might be feeling pushed or challenged or
defensive.
Well, wait a minute.
So I'm encouraging people to listen.
If you're listening and feeling like, yeah, this
(22:27):
makes sense.
I feel easeful.
I love that I'm on insurance based on
what Allison and Tiffany are saying.
It makes sense for me to stay on
right now.
Yay.
That's the goal.
If you're feeling a little stressed or called
out or pushed or called in, then I
encourage those of you to think about, oh,
maybe there is a part of me that
actually is resonating with, bucking against, wanting to
(22:49):
experience an insurance-free private practice, a cash
-based practice.
So if that's you, yay.
Welcome.
I encourage you to listen to those parts,
wrestle with us in this conversation, fight with
us in the comments, and we can kind
of help you think about what makes sense
for you at this season of your life.
Yeah.
Because nothing is right or wrong.
I mean, I think you and I have
(23:10):
both always had this tenant of like, what
a therapist chooses to do with their own
practice, that's their choice.
There's no bullying people in one way or
the other.
I mean, like certainly happens on the therapist
Facebook groups, right?
But not in our paid groups where people
are in our programs.
So it's interesting how people feel pressured on
(23:32):
both sides, depending on who's around them, who's
talking to them.
And ultimately it is your practice.
And I want each therapist to be fully
responsible for the choices that they make in
their practice and not victims of the choices
they make in their practice.
And that doesn't look just one way.
I love that.
(23:53):
Be fully responsible for the choices you're making
and the results that come from those choices
versus a victim to the circumstances.
That's as always very empowering.
You're the boss, right?
I'm the boss.
And when you hear, by the way, Alison
or I, we have strong opinions.
We will put things out forcefully.
And when we do, we're talking to the
people who resonate.
If you're hearing that and you're like, that's
(24:14):
not me.
How dare you?
Everybody can't live that way.
We're not asking everyone to live this way.
So I really, I love this conversation that
gives you the freedom to take responsibility for
the choices you're making and the outcomes that
come from that, the results of those choices
and always be willing and ready to reflect,
check in and see if this is still
working for me.
And if it is, keep it up.
(24:35):
If it's not, you have so many options
about how to change so much support and
going in another direction.
Absolutely.
Yay.
Well, I should say one of the supports
is Tiffany over at leanandmakebank.com.
I have all of our students do your
fun with fees calculator.
I recommend it for all of our, especially
our, the students we work the closest with
and limitless in the mentorship, because knowing what
(24:59):
you need to make per session, it may
be insurance covers that, and then you can
rest a little.
It may be.
And so doing that calculator helps people understand
instead of just basing their number off what
they hear in their area, it's actually easier
to stand behind too, when it's like, I
need this fee in order to put away
(25:20):
for vacation, in order to have sick time,
in order to send my kid to camp,
you know, those kinds of things.
Say for retirement.
I mean, I'm thinking about that.
I'm sure you are too.
Like, are we going to be taken care
of?
And then we see our parents.
So definitely having a clear number grounded in
each person's unique set of circumstances and desires
is vital when making a decision around, do
(25:43):
I want to stay on panels?
Do I want to leave?
How many hours do I want to work?
And also what's my long game?
So someone might do the fun with fee
calculator and there'll be a link, you can
drop a link for them.
Someone might do the fun with fee calculator
and get a number that feels just way
out of what feels possible for them.
And I encourage you to think about, okay,
maybe not today, but what would it look
(26:04):
like for me to take the next five
years to figure out how to make that
my reality?
So at least you're grounded in what's true
for you, what your desires are, and not
kind of just living in this gray, I
don't know what, back to this idea of
victim to your circumstances.
You're going to be the captain of your
ship.
Absolutely.
Yay.
Well, thank you, Tiffany.
(26:25):
My pleasure.
And I'll also direct people if you, if
you like podcasts, we have our podcast back
the money sessions back after like a two
year, uh, Tiffany having children, raising those children
to three and five hiatus, they're back.
So you can also go check out the
money sessions.
Absolutely.
And you're also doing a training for in
the abundance party.
So I'm psyched about that.
(26:47):
Oh yeah.
Folks get in the abundance, if you're not
in the abundance party, A, well, maybe you're
one of those therapists who never wants to
market, but if you are willing to push
yourself and learn more, um, definitely join the
abundance party and I'll see you in there.
And we'll have Q and a and actual
live, like how do we actually do this
thing, which is going to be fabulous.
Yeah.
Love it.
Awesome.
Well, thanks.
I'll see you soon.
Thank you.
(27:09):
If you're ready for a much easier practice,
therapy notes is the way to go go
to therapy notes.com and use the promo
code abundant for two months free.
If you're listening, you probably need some support
building your practice.
If you're a super newbie, grab our free
checklist using the link in the show notes.
(27:29):
I'd love for you to follow rate and
review, but I really want you to share
this episode with a therapist friend.
Let's help all our colleagues build what they
want.
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