Episode Transcript
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Speaker 1 (00:00):
If you accept
insurance for your therapy, you
know firsthand how frustratingit is when rates don't increase.
Your reimbursements kind of getstuck and you hit the ceiling
and, no matter what you do, itjust feels like you're capped
out on how much you can earn.
Well, too often we find thattherapists are not actually
seeking out rate increases andin fact, many don't even realize
(00:22):
that it's something they can do.
Today, I'm going to walk youthrough how to ask your
insurance providers for rateincreases so that you can start
making more from them.
My name is Craig and I'm theowner of Daisy Financial
Coaching.
Our team is on a mission tomake your therapy practice
permanently profitable.
If you own a solo or grouppractice, we're here to help you
(00:43):
build a business that createsmore time, makes more money and
serves more people.
This is the Therapy BusinessPodcast.
I remember years ago we werewith an auto insurance company a
really popular one, and we'vebeen with them for a really long
time and we just noticed thatthe cost of our insurance was
(01:04):
just getting higher and higher,and I was, like you know, it's
been a while since we've shoppedquotes, and so we did.
I shopped some quotes and Iended up finding a provider who
was going to give us the samelevel of coverage for almost
half the monthly fee.
And so we signed up with themand we went to cancel the old
one.
And of course, I get a callfrom someone with that insurance
company and they're going hey,we saw that you're canceling,
(01:26):
can you tell us why?
And I told them it's because itjust got too expensive, and
they go well.
Actually it turns out we foundout that there is a discount for
you because you're in the stateof Texas, and so we can drop
your rate in half.
And I was like, why didn't youcall and tell me this, or why
was this not something youreached out to do on my behalf?
So because of that, I ended upleaving.
Now, the reason I share thisstory is because I want to
(01:47):
reiterate and just highlight thefact that no one is going to
call you and offer you a rateincrease and we're thinking
about you getting more money,reimbursements from providing
your therapy practices.
Most likely they're not goingto reach out to you and say, hey
, we're going to start payingyou more for doing your service.
Sometimes they will.
Sometimes they will go aheadand do that, but not as
(02:08):
frequently and likely not asmuch as we would like.
That's what I learned from thisinsurance company myself was
they weren't going to call me.
I would have kept paying themtoo much forever probably,
before they finally, until Iwould have realized that now I
would have had to ask for areduced rate.
So, as I'm walking you throughthis process, really the key
here is being proactive.
Most of the practices we workwith don't even know that they
(02:31):
can ask for a rate increase,that they can reach out to
insurance companies, and this issomething we recommend doing,
probably a couple times per year, depending on your success rate
.
So I would say annually, reachout to the ones.
If they've given you raises,reach out again in a year and
try again.
It does not hurt to ask.
That is kind of the theme fortoday is it doesn't hurt to ask?
(02:53):
The worst they can say is noand you stay at the current rate
that you're getting reimbursed.
But if you are taking multipleinsurance companies, the
likelihood that at least one ortwo of them will give you the
increase that you ask for ispretty good, and so I highly
recommend doing this Now.
If they say no, putting it intoyour system and rhythm of every
three to six months.
Maybe you're trying again.
(03:13):
You're asking again because itmay just depend on who you speak
to.
There's a lot of differentfactors, so let's dig into.
How do we go about getting thisrate reimbursement increase
from your insurance providers.
So, first of all, what we wantto do is probably call and reach
out and talk to somebody on thephone first.
Each insurance provider isgoing to have somewhat of a
(03:37):
different process, so I'm a bigfan of talking to someone and
letting them know hey, I'mlooking to get a reimbursement
increase, a rate increase.
What's that process look like?
Who do I need to talk to?
Where do I need to submitsomething formally in writing?
Get to know them.
What is their process forincreasing rates for their
providers?
Now, most of the time probablyall of them at least, or most
(04:00):
likely, if not most of them aregoing to require you to submit
it in writing.
Sometimes, if you get someone onthe phone, you might be able to
start that conversation.
They might be able to ask yousome questions, things that you
would include in the formalletter that you're going to send
in.
But at least getting to talk toa human being and figure out
what does this process look like?
What does the timeline looklike?
What can I expect?
(04:22):
What kind of information wouldhelp me get this increase?
Again, the more specific we canget to each provider, the
better.
So look into who is therelationship person, who is the
person that you could talk towith Cigna or with Aetna, or
with Blue Cross, blue Shield,where you can ask these
questions.
Then we're going to need to prepa letter and when you talk to
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this person, ask where do I sendthis request to?
Where would I send a letter ofincrease to?
And so get that informationfrom them, whether it's email,
whether it's hard copy, snailmail, find out where to send it
Now in your letter.
There is a fantastic templatethat I found on therathinkcom.
(05:02):
I'm going to link it in theshow notes because, on this blog
post they created, itencourages you to just copy
paste and tweak it to your needs, and so, instead of reinventing
the wheel, I always think it'sbest to take advantage of those
things.
So I will link this blog postwhere you can snag some of this
copy paste templated letter.
But I'm gonna guide you throughsome of the key elements of
(05:25):
what is important to have in oneof these rate increase letters.
So, first of all, we wanna gothrough who you are and why
you're asking for this increase.
Usually, what we wannahighlight is what are your
credentials Like?
What is it about you that ismaking you valuable?
There's a good chance.
Maybe you've added somedifferent tools to your toolkit
since you started working withthis insurance provider.
(05:47):
Have you gotten any newcertifications?
Have you gone through any newcontinuing education trainings?
Is there anything that you havedone to enhance your craft or
make you more valuable since youlast Asked for a rate increase
or since you started workingwith that insurance provider?
Highlight these things.
What credentials have you added?
What acronyms have you added tothe back of your name?
(06:08):
What are the key elements, thekey things about you that might
make it seem worthwhile to giveyou a rate increase?
How long has it been sinceyou've asked for a rate increase
?
You've even gotten one.
I think it's important tohighlight this.
When's the last time youreceived a bump from them?
If ever, maybe you've been withthem for five years and you've
never gotten a pay bump fromthem.
(06:29):
How long have you been withthem in general?
So highlighting that I've beena you know, a partner of yours
since this time.
So the more longevity we have.
If you've been with them, ifyou're getting a ton of business
from them, if you're serving alot of their clientele, then
that's a relationship thatthey're going to likely want to
nurture, be more likely tonurture.
(06:49):
So highlighting thoserelationships.
We've been together for Xnumber of years.
I haven't had a rate increase inthis timeframe, really honing
in on those pieces, but I'm abig believer in highlighting
your value.
Why are you more valuable now?
Why do you deserve a rateincrease?
Is there any specialty areasthat maybe you serve in that not
(07:11):
every therapist does?
There's a ton.
There's a long list ofdifferent things you can serve
in that might be valuable tothem.
But you know ADHD, trauma, ptsd, maybe you work with
adolescents or kids, so thingslike that, if you do that,
already highlight those thingsagain.
Maybe they don't know that youdo serve these areas.
Maybe you've added some in.
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Maybe you've hired team memberswho have specialties that you
don't.
So all of these elements thatwe can add in and really help
our case, showing the value thatwe have.
So to recap that, any newcertifications or continuing
education courses that maybeyou've completed, how long has
it been since you've received arate increase?
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How long have you been workingwith this insurance provider?
And then, any specialty areasthat you specialize in that
you're an authority in that youcan highlight, to show these are
key ways that we can betterserve your customers who are
coming to us for therapy.
So, highlighting this, this isjust an opportunity for you to
(08:12):
showcase you and why you deservea pay raise.
This is just like if you wereto step into a boss's office.
You're working a nine to fiveand you're going to step into
your boss's office and ask for apay raise.
You're not just going to go inthere and say I want more money
just because I want more moneybecause I've been here for a
while.
Yeah, I mean, you've been herefor a while.
That's helpful to know, but whyare you more valuable now than
(08:34):
what you were when we gave youthis pay structure?
How are you providing morevalue to them now?
This is a great area toshowcase that.
Next, it's okay to mention somefinancial challenges, maybe,
that you're facing, so I wouldrather focus heavily on the
value piece, but I also thinkit's important to highlight the
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world we're in now.
I mean, inflation has been nutsover the past few years While
it's starting to settle backdown.
If you didn't receive a rateincrease over the past few years
when inflation was peaking,then you are likely hurting from
that.
So let's say inflation wasincreased by 5% but you didn't
(09:16):
receive a bump in what yourreimbursement rate is.
That means you've lost 5% ofyour hourly rate because your
costs have increased withoutyour income increasing in
relation to it.
So we need to be really key onthat.
Honing on that.
If you haven't received a ratereimbursement since before the
pandemic, I highly recommendhighlighting the pandemic,
(09:37):
talking about the effects of thepandemic and the again the
inflation rate afterward on youand your practice, and that
you're getting paid the sameamount you were before all that
stuff happened, and so it'sreally key to hone in on some of
those factors.
I wouldn't necessarily go intoyour financial woes, your
financial troubles, buthighlighting that your overhead
(10:00):
is increasing.
Therefore, we need our incometo increase in what we are
receiving per therapy session orper hourly session.
So, getting into the effects,the financial challenges that
maybe you're facing on that backend, why do we need this on
that side of it?
Okay, then we want to go intospecifically asking for certain
(10:24):
amounts.
So in this letter we're goingto go through and you're going
to put the CPT codes of eacharea of focus that you do and
what rate increase you'relooking for.
Now there's not necessarily ahard fast rule for what you
should be asking for.
I've seen a variety ofdifferent ones.
Some are a percentage like.
So maybe a 10% rate increase.
I've seen some just say a goodrule of thumb is $20.
(10:47):
Ask for $20 more dollars perarea of specialty you do so.
I tend to err on the side ofasking for more just because
maybe they'll meet you in themiddle.
So let's just say you do a $20rate, go through each of the
things that you do, thedifferent specialties you have,
put the codes in and say we'rerequesting a rate increase of
$20.
So instead of being reimburseda hundred, we want to be
(11:10):
reimbursed $120 for this one.
And then and moving down thelist and putting specific
amounts Again, if you prefer todo 10 to 15%, you can do that.
But just highlightingspecifically here's how much we
would like to receive in returnas a reimbursement.
Again, not guaranteed, kind ofboils back to what I said at the
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beginning it never hurts to ask.
It never hurts to ask for thesethings.
So we've talked to someone onthe phone.
Then we're going to submit thisletter and we're going to send
it in to wherever they recommendputting it into.
Again, I will link to atemplate so you can copy and
paste.
Get some really good wording inthere.
You can always go to your goodold buddy chat GPT if you need
(11:52):
help crafting one as well.
But getting something reallycohesive that's going to
highlight all those areas thatwe just talked about.
Now, if you find that you'reunsuccessful, if you get a lot
of no's which is okay, you know,I mean, this is kind of like
sales You're selling them onpaying you more, so you're going
to get some no's that's when Iwould try again.
(12:13):
It doesn't hurt to continue totry.
So every few months you alreadyhave the letter written up.
This is also where, kind ofgoing back to when you talk to
that person, ask if there'sanything that you could do to
receive a rate increase.
What are they looking for?
What specific things wouldwarrant them giving a rate
increase, and they might tellyou some things that you could
(12:33):
turn around and maybe implementor look into to see is this
worth doing to get that rateincrease, but trying again every
three to six months.
Just put it in your calendarOnce a year at least, sending
out letters to everybody.
Even if they've given you arate increase within the last
year Once again, it doesn't hurtto ask again a year later.
The worst they say is no, andthen you'll try again in a year.
(12:54):
So making this part of yourannual to semi-annual rhythm is
going to be really, reallyimportant so that you can stay
on top of it, so that you cancontinue to maximize what you're
making.
Now.
Of course, outside of this, ifyou find that you're just having
no success, if you're gettingminimal rate increases or you're
getting a lot of no's maybe youonly work with one or two
(13:15):
insurance providers and both ofthem are just telling you to
kick rocks right Then privatepay is going to be your next
best bet is trying to focus moreon generating more private pay
clients and balancing out thenumber of insurance clients
you're taking versus the numberof private pay clients.
But here's what I recommend Try, go for it.
(13:35):
If you haven't done it in along time, lean into the things
we just highlighted, draft upthat letter and the beauty is in
six months when you try itagain, your letter is going to
be drafted.
So all you got to do is go inand tweak If you've added any
new things, if you have anyother points you want to hit on,
and then you're good to goagain.
So really, right now would bemore of the upfront work.
If you haven't done this before, get after it, shoot me an
(13:56):
email.
If you have some success, Iwould love to hear if you were
able to take this, implement itand get a rate increase and
start getting some more moneyback into your pocket for the
amazing, valuable, life-changingwork that you're doing for your
clients.
Thanks for joining us on theTherapy Business Podcast.
Be sure to subscribe, leave areview and share it with a
practice owner that you may know.
(14:17):
If your practice needs helpgetting organized with its
finances or just growing yourpractice, head to
therapybusinesspodcom to learnhow we can help.