If you have historically relied on insurance companies to fill your case load with clients who are using that insurance, you may be noticing that that is no longer working.
We are having boots on the ground, information from therapists.
I talk to therapist every week and they are saying, Tiffany, my case load is not filling as fast.
You've probably heard this too, maybe you have noticed it.
, if you take private pay, maybe this is the case, but definitely if you are an insurance-based therapist, things have changed in our industry.
I'm gonna talk about what has changed, why it's happening, and what you can do about it on today's episode of the Money sessions.
But now, out, by the way, my name is Tiffany McLean.
I am the creator of Lean In, Make Bank.
We do not edit on the show because nobody has time, but I promise you the information you get.
Is going to transform the way you are thinking about yourself as a therapist, a business owner, a clinician, and a human being who needs and wants money, time, freedom, spaciousness and ease so you can show up more fully for your own life, show up more fully in your.
clinical practice and show more fully for your family, your kids.
So here's the situation.
Back in the day, you take us 10 years ago, even 5 years ago, if you're a therapist, you may have made the option, you may have taken or chosen the option to take insurance, get paneled with insurance.
Because even though the reimbursement rates were tough, if you're in a low cost of living town, you can make it work if you're seeing 25 to 30 people a week.
I think that's too many people for anyone to see at any time.
That's neither here or there, but you're gonna hear more about that later.
You put the shingle on your door as they used to do in the olden days.
Slap yourself onto an insurance panel and the clients start calling.
Maybe the clients aren't ideal.
Maybe the clients are kind of phoning it in.
Maybe you're kind of phoning it in, maybe the clinical work is subpar, especially after you've been doing it for 2 or 5 or 10 years, but you're able to make a living, right?
Your practice is full.
You don't have to worry about marketing.
You don't have to worry about how do I get people in the door, they're coming in.
That was 5 or 10 years ago.
It wasn't ideal.
But most therapists are just trying to make it, right?
Most human beings are not living their best lives.
Most human beings are trying to survive the day to day and do a little bit better than their families of origin, a little bit better than the generation before you.
So you just made do and said maybe one day I'll make a change, but for now I'm tired.
Got these kettle chips, got my Starbucks coffee.
I'm doing what I went to grad school to do, let's call it a day.
Now, I do, I, I, so I do trainings consistently, how to book your next $300 session, and then I do calls after that.
So I'm talking to therapists every single week.
Now therapists are coming to me like Tiffany.
This insurance thing is not working anymore.
It used to work.
I used to take mostly insurance patients.
Maybe I'd have a 1 or 2 or 3 or even 5 people on paying me cash and my practice was full.
Now it's not working.
Or if you've been following me for some time, you're realizing, especially if you have been in this game for over 5 years, much less 10 or 15 years, God bless you.
, you're like, I cannot see 25 or 30 people a week.
I cannot have 50 people on my case load and do good work as a therapist.
Some of you say, you know, I'm, I'm neurodivergent or I have health issues or, you know, chronic fatigue or whatever it is, ADHD that makes it impossible for me to see 30 people a week.
Let me tell you something.
Nobody.
Should be seeing 30 people a week.
Nobody can be seeing 30 individual clients a week without burning out, losing your mind, getting scattered, being disorganized, being exhausted, being overwhelmed, and not earning anywhere near enough money.
Nobody.
That's the stand I'm gonna take.
You don't have to be neurodivergent.
, or have sensitivities to be overwhelmed by seeing 30 people a week.
I think most therapists who I talk to have a sweet spot around 12 to 15 clients a week.
You cannot earn the living you want to earn while seeing 12 to 15 clients a week if you are taking insurance.
Now back to the point.
OK, so I'm seeing 25 to 30 people a week.
I'm burnt out. : I'm overwhelmed, and my phone is not ringing as much, or I'm having to see more clients because la la la la la, There's some new, there's some new players in town, my friend, there are companies who have.
Started negotiating rates with the insurance companies and then telling therapists, you come work with us, you come, basically they're like big virtual group practices, basically tech platforms that say we have gotten enough power to negotiate with the insurance companies.
So you come to us, Doctor Smith, you come to us, Tara, LMFT MSW, right?
And we'll negotiate higher rates for you.
And so the therapists rush over to join those groups that are promising to advocate on your behalf.
Can I just say?
, Well, let me, let me move forward.
I, I cannot verify this.
I don't know what, I'm not even gonna say what groups these are because who knows what's true.
But when big conglomerate companies.
Promise to advocate on your behalf and give you high reimbursement rates.
I suspect they're also talking to the big conglomerate insurance companies too, and they're like, let's get together now that we have all these therapists we've taken over psychology today.
We've taken over the top rankings in Google, we've taken over the advertising space, so the little guy, the little therapist in private practice has a really hard time.
Getting found unless you're part of one of these big conglomerates, so they've really done a number on taking over the space seemed good at first.
These folks can now go talk to the insurance companies and say we got all these therapists.
How about we make a deal for you, right?
Again, who knows if this is true, who can say anything, but just, you know, thinking about what's happening, putting the pieces together.
Working behind the scenes and you can even take a look at what's happening in your own town, what your friends are saying, what's happening in your own practice.
We know that insurance rates are being cut, reimbursement rates are being slashed, sometimes up to 40%.
I've heard from real therapists who've had this happen to them or their friends in certain states.
You thought you were not doing well before.
You thought your reimbursement rates were hard before, but you could make it work.
Try having them cut by 40%.
Try having even more technicalities be pushed upon you.
Having more of your power taken away, having more hoops to jump through, having more work to do when you get audited.
And then me making, you know, 40% less at the same time.
Now I just wanna say I don't hear so much about this anymore, but I used to hear therapists be in dread about I probably don't hear about it because I'm not on Facebook and I don't do anything in Facebook groups or talk to any kind of these places where therapists are really in a scarcity mindset, but I used to hear all the time from therapists who would be freaked out when I would talk about.
, what are your reimbursement rates?
how much are you bringing home? : And they're like, Tiffany, we're not allowed to say anything about our reimbursement rates.
There are clauses in our contracts that prohibit us from disclosing our negotiated reimbursement rates.
Therapists, this is maybe you are terrified about saying how much they're actually earning from insurance companies.
Meanwhile, those insurance companies who may or may not be partnering and having behind the scenes talks with these big conglomerates, they are not contractually obligated to be doing the best by you.
They're not keeping it quiet, they're crystal clear about what their numbers need to be and how they increase their profitability, and it has nothing to do with holding you in mind.
So if you're having a harder time getting insurance clients.
And you're not part of one of these big conglomerates, it's because you no longer have space in the marketplace, right?
You have been overtaken by people who have a lot more money, a lot more technological savvy, have a lot more ability to be making moves behind the scenes than you have as an individual provider.
If you've joined one of these big conglomerates, you might start noticing that insurance rates in your town are being cut.
Your rights are being taken.
I won't say rights because you have no rights.
The agreements you have made are being changed and finagled such that you're losing out and the insurance companies win.
Why? : Because the system is not set up for you.
Is the insurance company bad?
No, are they smart?
Yes, they are.
They're not wrong.
This is the this is their job is to make a profit.
They're giving you clients and in exchange you follow their rules.
That is not wrong, that is not right, that is what they do.
You have a choice to play this game or not.
Play this game or not.
For years, maybe decades, you have been saying, I'll play this game, it's good enough, and now it's no longer good enough.
This is what I'm hearing from therapists every day.
What used to be OK, what used to be good enough is no longer working.
I'm burnt out, I'm overwhelmed.
I'm behind on my notes. : I have no time to be with my family.
The kind of clinical work I'm doing is way subpar.
I'm not even proud of how I'm showing up and I need something to change.
What do you change?
I'm gonna talk to you about the road less taken, It's really hard, truth be told, to, to step outside of the status quo.
To step outside a system that promises to take care of you and give you some kind of consistency, even if that consistency is a prison, at least it's predictable, more or less.
At least you have somebody who kinda is taking care of you.
It is very hard to say I'm stepping out of that bullshit.
I'm stepping out of the system that actually doesn't care about me, and I'm gonna make my own way.
I'm gonna set up a business that prioritizes my and my family's financial security.
I'm gonna set up a business where I can show up clinically.
In a way that really serves my clients, I'm going to set up a business that gives me health and well-being emotionally, physically and psychologically.
That is hard to do and you're not gonna get a cookie for it.
You, I'll give you a cookie, but most of your colleagues are gonna tell you.
Making the wrong choice.
maybe even your spouse is gonna say, are you sure that's what you wanna do?
Your patients or clients certainly are gonna give you some pushback, most likely.
And then if 3 months down the road or 6 months down the road, it looks like things aren't working, you're gonna have all kinds of people look at you and say I told you so.
I told you so, ha, right?
You should have stayed over here with us.
It takes a courageous person, a courageous therapist to say I'm not fucking doing it anymore, and maybe I'm gonna fail, maybe it's not gonna work, but I know that this path I'm on, this insurance low fee burnout path, I know that's not working.
It's not working for me and truth is it's not working for anybody, so I'm gonna have the courage to take a different path.
That's what I've been helping therapists do for 8 years.
I've been helping therapists carve out a different path.
Is it always successful?
Yes, and here's what I mean by that.
I can't guarantee you're gonna be able to see 12 to 15 clients a week and make $200,000 a year.
We have many, many examples of the therapists on our podcast, this one, the money sessions, who have done very well for themselves financially, who have increased their time, increased their freedom, increased their clinical confidence, increased their fee and their ability to show up and do the work they want to do, many, many examples of that.
Do they do it in 3 months?
Not all of them, 6 months, maybe a year, sometimes 4 years, most definitely if they stay on the course, right?
So while people are naysaying you, while you're like, is this really gonna work while you're having doubts if you stay on the course and if you say I'm not going back to those insurance companies, I'm gonna fucking figure it out.
I might fall off the the wagon.
I might face pitfalls I didn't understand.
I might even backslide the.
Little bit, but I'm learning and growing.
I'm surrounding myself with people who are doing it differently.
I'm surrounding myself with therapists who are committed to charging $300 per session.
I'm surrounding myself with clinicians who are committed to keeping their case load low.
I'm committed to, I'm I'm committed to surrounding myself with people who are playing a different game, and I'm gonna be by their side and they're gonna be by my side as we do things differently because we're not gonna be slaves to the system.
If you're in America, you're a woman, a minority, someone from the queer community, even someone who's come from a working-class background.
You have been a slave to the system for many, many years.
For those of you who are saying, even if the road is hard, even if it's insecure, even if I don't know what the outcome is gonna be, I know I'm the kind of person who's gonna be proud of myself for learning, growing, challenging myself to do something different.
Then I say you cannot fail.
It's the process, it's the game, it's the puzzle, it's the community, it's the striving, it's the freeing oneself, the emancipating oneself.
That is a success for me.
And I think if you're listening to this point, that is also what success is to you showing your kids a different way.
Right?
Stepping out of something and refusing to continue compromising.
Refusing to continue doing shitty work because you're burnt out and overwhelmed and saying I'm gonna do it differently.
Imagine what kind of clinician you're gonna be when you step out and do something differently.
Even when it feels like the odds are against you, even when when all your friends and maybe even your spouse or family members say, are you sure you wanna do that?
Insurance is no longer taking care of you.
In fact it was, the fact is it never was, but at least it gave you something.
Now we're seeing it's gonna pull the rug out from under you and pull and pull and pull and squeeze and squeeze and squeeze because that's its job.
It's job is to take care of it, its shareholders, itself, it's wider client base, right?
You have all kinds of people on insurance who need help.
The more they cut costs, the more they can deliver healthcare, whatever they need to do.
Your job.
Your job is to take care of you.
Do you know who else is gonna do it?
Nobody.
Do you know who's gonna prioritize your financial well-being?
, nobody.
So if you're not doing it, nobody else is.
If you want to do something different, if you want to step out of this paradigm that was never built for you and create your own.
Dream, your own sustainable practice, liberate and emancipate yourself.
I invite you to.
Come on over.
Just send me an email that says emancipation.
Send me an email, Tiffany at leanin make bank and just say emancipate.
Emancipate, and I will give you your first next step to stepping out of a system that doesn't give a shit about you.
Nor should it, right?
I'm going to, I, I, I want therapists who, who make a decision, who recognize nobody is ever gonna care for me.
As much as I care for me.
If you don't advocate for yourself, nobody is.
Now, I will advocate for you.
I will advocate for you, but I cannot do anything on your behalf.
I cannot put my, my, my legs into your pants.
And walk around for you.
I can show you a path.
I can bring you a community.
I can have your back, but you're the one who has to take the first step.
Send me an email, Tiffany at lean in make bank with the word emancipate, and I'll follow up.
Also share this with a friend.
If you're like I'm scared.
I don't know if this is possible.
What if this is all crazy?
What's happening in the world?
I don't want to be alone.
Send it to a friend.
A colleague you trust, who is also recognizing that the system is not working for them anymore.
Send this to them.
Listen to it together, sit down, have coffee, discuss.
And then email me together, you and your buddy, we'll go from there.
You don't have to do it alone, and you don't have to stay stuck.
There are other possibilities and we only have this one life to live.
Are you living?