1 00:00:00,000 --> 00:00:01,000 Tiffany(00:02): 2 00:00:01,000 --> 00:00:02,000 Alright, folks, as promised, I am here with Anna Deto. I'm so excited to have you. You all know why we're here, so we're gonna jump straight in. And I wanna ask you, how did you even just talk to us about how you got started in private practice in the first place? 3 00:00:02,000 --> 00:00:03,000 Anna(00:19): 4 00:00:03,000 --> 00:00:04,000 Right. Private practice started around 2012. It was like 20 11, 20 12. I was working for a company and I had to be a contractor, which meant that you basically have your own company and you're working for someone else, and they, they give you patience. And in that process, I, I started to realize that I liked that, that that aspect of just being able to create my own hours and, and just being, being my own person. Right. being your one man bandstand, if you will. And through that, again, I was working with another company. I, they, they were kind of decreasing their hours and I said, oh, maybe this is a sign for me, to, you know, laterally kind of move into my own. And as I was decreasing their hours, I stopped, stopped accepting new ones, even though they were giving me some and started building my own. And then I, you know, that kind of got a seesaw and then I obviously put that other job and then just stayed in private practices. 5 00:00:04,000 --> 00:00:05,000 Tiffany(01:17): 6 00:00:05,000 --> 00:00:06,000 So you went out on your own in private practice. And actually, let me even back up. For folks listening, why don't you start by telling us even a little bit about now. Tell us a little bit about where you're currently practicing, who you see, what does your practice look like today? 7 00:00:06,000 --> 00:00:07,000 Anna(01:33): 8 00:00:07,000 --> 00:00:08,000 Today, a little bit different than before. Today I work heavily with individuals that are neurodiverse, neurodivergent populations intellectually, developmentally delayed individuals as well. And I work across the lifespan. So I see as young as one and a half all the way. My oldest patient's been about 80. And I just work across that spectrum with just varying just differences. And I kind of have a split within that. I do clinical work, which is I do treat, but I most heavily assess and diagnose. And then the other part is forensic, where I'm interfacing with the courts, some kind of legal aspect, legal situation that a patient has been within. And however long that's, that's been going on. And sometimes that involves a school district, sometimes it involves going through a divorce or something happened, you know, some kind of situation in an accident. And I'm helping support whatever, whatever's going on in that realm. So that's kind of where I'm at. 9 00:00:08,000 --> 00:00:09,000 Tiffany(02:37): 10 00:00:09,000 --> 00:00:10,000 Thank you. That's wonderful. So you have like these two aspects of what you're currently doing, kind of keeping yourself fresh and engaged in your work. Yes. Very cool. Yes. Okay. Exactly. That's now, so let's take us back to 2012. You're working for this other company. You start building up your practice on the side mm-hmm . You start slowly leaving that practice, decreasing your client hours over there. At some point you have the idea of starting your own group practice. Can you talk about what made you decide like, all right, I'm gonna go from doing individual, my own private practice to like having a group talk to us about why you did that. 11 00:00:10,000 --> 00:00:11,000 Anna(03:11): 12 00:00:11,000 --> 00:00:12,000 Yeah. The, so the, the backstory there, and, and this is, this is kind of a heated topic right now in, in the field, I worked with an a, BA applied behavior analysis therapy. And this is back way back. I started out in, in 2003 in that field. So fast forward right to 2012, I was still in that field and very much enjoying that work. And I would go to people's homes, I would work with these patients, I would work at the family system, the schools, and I loved it. Right? So that never really stopped. And when I went into private practice, it was just me and I was working with other individuals that I would have to give the treatment plan to and say, okay, this is the program we're working on. We're building this skill, we're helping this patient become fluent in this task. 13 00:00:12,000 --> 00:00:13,000 Anna(03:57): 14 00:00:13,000 --> 00:00:14,000 And, you know, I, I need a team of different people to work under me to kind of deliver the skills. At the time they were all working with another company and I was just still giving the information. And that's just how the system worked. And slowly, actually, I, I was working with insurance. The insurance started to create these rules that you had to then employ these people. And I was like, well, okay, , I started to employ people. And, and that's just how it worked. And that just started to kind of snowball into developing a bigger practice. And I'm not sure how much you want me to expand on that and kind of how it started to build into this big, big company, which leads to the ProPublica kind of article as well. But it did get, it got big. 15 00:00:14,000 --> 00:00:15,000 Tiffany(04:42): 16 00:00:15,000 --> 00:00:16,000 I'll take it step by step. So first you mentioned, you know, there's some controversy in the field with something having to do with a BA, I don't know anything about that. So for, for us listeners who are like, what do you mean controversy? Can you say a little bit more about what's controversial about that history? 17 00:00:16,000 --> 00:00:17,000 Anna(04:56): 18 00:00:17,000 --> 00:00:18,000 Yeah. Applied behavior analysis, when you go back to when it was created, there was, there was a lot of individuals that were doing this form of therapy and not doing it in very respectful ways. And a lot of the work was very abusive, to be kind, honest. It was not very nice to the patients. And it was hurtful and harmful and there was a lot of damage that was done. And when we go throughout time, it has evolved. It has changed, but a lot of those individuals have come out from it, you know, 20, 15, 20 years later now they're able to speak out about what happened. And now the field should be taking that very seriously and should be understanding and appreciating what happened because they didn't have a voice, right? And you were having these individuals that weren't autistic, did not have any understanding of really what that was in telling these patients, do this, do that. 19 00:00:18,000 --> 00:00:19,000 Anna(05:50): 20 00:00:19,000 --> 00:00:20,000 Look at me in the face, do, you know, sit down, listen. And very, it was very I dunno how else to say it, but it, it wasn't very nice is how I'll kind of wrap that up. And so again, the, there's, there's that information that's coming out now and the field is very aware of it. And the field hopefully is responding to that and shifting and changing to that mindset of what it was and making it more person centered. And there's a lot of different offshoots of a BA therapy that are much more positive, neuro reaffirming and, and just very respectful and client centered. And those are just different fields of work. Again, that coming out in response to that. 21 00:00:20,000 --> 00:00:21,000 Tiffany(06:32): 22 00:00:21,000 --> 00:00:22,000 Thank you for that background. That's very helpful to have that context. Mm-Hmm . So we're gonna talk a little bit about kind of this situation where you are doing your private practice, you're collaborating with folks, then there's a law that says you have to employ these folks. So just talk to me about some of the challenges that, that you faced when going from working for yourself, collaborating with people to building like a big company. How big did it get? What was hard about getting to that point? 23 00:00:22,000 --> 00:00:23,000 Anna(07:01): 24 00:00:23,000 --> 00:00:24,000 I don't, I don't think I can put that in one bullet point. take it all. I think there's a lot. Yeah. As I was growing, you know, I growed slow. I tried my best to grow slow. How it grew fast was when I collaborated with two other people. But when I was growing slow, it was one employee, then it was two and it was, you know, over the course of a year, two years, right. And it just kept growing. And then once you had an employee that you trusted, that person would help then train other people. So it wasn't just always falling on me, right? And so you kind of build these step stools and kind of scaffold it like a building, right? You kind of branch it out. And that's how that process worked. Now, to, to answer your question about some of the difficulties, the difficulties was managing expectations. 25 00:00:24,000 --> 00:00:25,000 Anna(07:49): 26 00:00:25,000 --> 00:00:26,000 And when someone comes in as an employee, I think one of the biggest things that, that I felt pressure, and I'm not sure how how many other people experience this, but when you get, when you bill insurance, you, you always bill a little bit higher. So if, if an insurance will pay you $120 an hour, you always bill one 30 because if you bill one 20, they're gonna give you one 15. Like they're gonna give you lower. And so you always bill the high and you figure out what their max is, and you have to across the board then bill every single insurance company at that same, because there's laws around that. But anyway, where I'm going with this is that when you bill that one 30 an hour and an employee sees, well you're billing me for one 30, but you're paying me, you know, $50 an hour or something, I want the rest of that, that, that, that becomes a big challenge. 27 00:00:26,000 --> 00:00:27,000 Anna(08:38): 28 00:00:27,000 --> 00:00:28,000 And then there's pushback to that. Well, I want that full thing. It's like, well, but when you're an employee, I'm paying your liability. I'm paying your tax and paying the roof over your head. I'm paying for your gas mileage. I'm paying for all the toys that you're using and the EHR that you, and like the list goes on. And I think seeing that you kind of fantasize about what could be, and then those people would leave. And the high turnover rate was difficult. I think managing the different personalities, the conflicts that come with that, having to balance getting along with staff, but also having to put my foot down, having to deal with my own stuff too. Because it's visa. We're all humans and I have kids and I have a life. And sometimes it's hard to drop that off at the door when you come in and dealing with having to stay up to date on all the HIPAA laws and the various rules that are always changing and politics and keeping up with that and having your staff be informed and hearing, hearing what their needs are. But balancing, I, I have to pay your paycheck, so I hear you that you want that extra laptop 'cause it's got a nice touchscreen, but it's just not in the budget, you know? So yeah, all of those things kind of create a confluence of, of stress and strain. And when you have good business partners, when you have good colleagues that are working as part of your team, it makes the situation far more easier to navigate. 29 00:00:28,000 --> 00:00:29,000 Tiffany(10:01): 30 00:00:29,000 --> 00:00:30,000 Yeah. This sounds so intense, . I'm thinking when you, it can be, well, I can imagine when you started this route, it, it, it, it doesn't sound like you were the person who's like, I'm gonna have a group practice and I'm gonna work. You just kind of fell into it and then kept going and kept going as it grew. And you had to learn these lessons as you got there. I did. 31 00:00:30,000 --> 00:00:31,000 Anna(10:19): 32 00:00:31,000 --> 00:00:32,000 I did. I, I learned a lot. 33 00:00:32,000 --> 00:00:33,000 Tiffany(10:21): 34 00:00:33,000 --> 00:00:34,000 I wanna give you one more moment to speak from a place of the the difficulty of being a group practice owner who, let me back up. Here's why I work with individual therapists who have their one-to-one private practice wanna have premium fees. Often these people come from groups and they're like, I'm not getting paid enough. And, and sometimes they're like, I'm not getting paid enough and I wanna go try it on my own. Sometimes they're frustrated with a group practice owner, so I understand why they wanna leave, but I wanna give you a little more of a platform to be like, as a group practice owner, here's what you all don't understand about what's hard. And so I would love to hear, just as you think about all that you had to hold as a group practice owner, and you had your individual therapist who were just seeing the discrepancy, like, I'm making 50 and you're making one 30. What do you wish they understood or what, what could they not see about how hard that was for you? 35 00:00:34,000 --> 00:00:35,000 Anna(11:21): 36 00:00:35,000 --> 00:00:36,000 I think, I think that's a really good question and I, it's one of those things where you, you can try your best to give, hey, you know, you should really understand this, but it's, it's very similar to when you're raising a child and you're like, you'll understand one day when you have your own kids. It's really like you have to be in those shoes to understand it. So I wanna preface it with that. That said, to try to give some some flavor to that answer. I would say the amount of liability risk that we really gate keep and not like we protect you from is significant. The amount of disgruntled patients that say, I don't wanna work with Susie because they're, they just got outta school and they're, I don't trust them. I'm, you know, that that isn't going to be shared as rawly as Right. 37 00:00:36,000 --> 00:00:37,000 Anna(12:18): 38 00:00:37,000 --> 00:00:38,000 I'm gonna hear that. I'm gonna listen to that and see if I can put that, that flame out, right. And, and protect my staff from hearing those things. There's so much of that that comes and there's so, so many complaints and we have to face that and we have to face very frustrated patients that do not wanna pay their bill. And I'm still paying you out of my own paycheck because I'm, I have to, I'm legally and obligated. And that's part of what happened with ProPublica, right? Is I paid out of my own paycheck and, and paid my staff and they didn't know, right? And they, they were just seeing the other side of like, well, this is stressful. We have to fork over our notes. It's like, but you just have to fork over your notes. , I'm the one reading it. I'm right. So there's, there's all this stuff, but really you, you have to separate yourself from that. And, and I think it's difficult because I have to listen, I have to hear that and I have to hear your frustrations and I can't take that personally. And, and there's a lot of stress and strain into putting on a smile and taking it for the team every single day when it breaks you down and it wears you out and it burnout is very real. So those are just some of the top things that I can think of that are a little bit different than what I said before. 39 00:00:38,000 --> 00:00:39,000 Tiffany(13:35): 40 00:00:39,000 --> 00:00:40,000 Yeah. Thank you. I appreciate it. And the, the the analogy to having young children is so on point, you can't say to them, you, you, they're not supposed to get it. That's not their job. Right. And so it is, I do understand that the difficulty of this position, so thank you for sharing that. Mm-Hmm 41 00:00:40,000 --> 00:00:41,000 Anna(13:50): 42 00:00:41,000 --> 00:00:42,000 . 43 00:00:42,000 --> 00:00:43,000 Tiffany(13:51): 44 00:00:43,000 --> 00:00:44,000 So let's get to the point in your practice where, where, this is where the ProPublica journalist came to and talked to you about this. At the height of your practice, you talked about working with some business owners. What was your structure? What did your, your business look like? How many folks were working for you? What'd it look like? 45 00:00:44,000 --> 00:00:45,000 Anna(14:09): 46 00:00:45,000 --> 00:00:46,000 We had three companies originally and then one of our business partners wanted to leave and, and it was stressful. And, and so they left. And then that left that technically left three companies and it, it left my company, my other business partner. And then we had sandbox therapy. And what we were starting to do, our plan was to basically fold our companies into sandbox over time. But to do that as a slow role because there were, there were certain kind of benefits that, you know, there were, there were like I'll just say benefits to being, to being part of the other company. Just longevity, right? And loyalty. And so we did that role very slow and we informed the, the, the different employees from each respective company. And that, like I said, that took us several years. And so that's, that's kind of what that looked like. Hmm. 47 00:00:46,000 --> 00:00:47,000 Tiffany(15:06): 48 00:00:47,000 --> 00:00:48,000 And what happened when, with, you were taking insurance this whole time. At what point did you realize this is untenable? I can no longer have an insurance based business. We have to get outta here. What, what led up to that? 49 00:00:48,000 --> 00:00:49,000 Anna(15:20): 50 00:00:49,000 --> 00:00:50,000 That happened after my business partner left. Mm-Hmm . So that happened 3 20, 23 51 00:00:50,000 --> 00:00:51,000 Tiffany(15:30): 52 00:00:51,000 --> 00:00:52,000 Recent. This is all recent. Pretty recent. 53 00:00:52,000 --> 00:00:53,000 Anna(15:33): 54 00:00:53,000 --> 00:00:54,000 Yeah. It's not that long ago. 55 00:00:54,000 --> 00:00:55,000 Tiffany(15:34): 56 00:00:55,000 --> 00:00:56,000 Okay. So for folks who did not, hopefully everybody will have read this article, hopefully everybo all of you in the audience. Hopefully you read this article, but if you haven't, walk us through what happened that got you to the point of saying, I'm leaving these insurance panels. 57 00:00:56,000 --> 00:00:57,000 Anna(15:48): 58 00:00:57,000 --> 00:00:58,000 Oh my goodness. It wasn't one thing, it was just a, it was a lot . So the, there's, there's everything that happened with the ProPublica article and them coming after us and, and they're still coming after me. I got a letter that police 59 00:00:58,000 --> 00:00:59,000 Tiffany(16:07): 60 00:00:59,000 --> 00:01:00,000 Coming after you. 61 00:01:00,000 --> 00:01:01,000 Anna(16:09): 62 00:01:01,000 --> 00:01:02,000 Yeah. Premera sent me a letter, I believe last week still asking me for money. And I, and I literally closed my company. I have the, you know, I have Sandbox, I closed my other company. The one that that was under, it was doing, it was called DBA doing business as sandbox therapy. , you close my, you ran us to the ground. Whatcha doing? Anyway, so to answer your question, oh my goodness, it's just a long laundry list of why it's, it's a safe, it's a, it's a false census security when, when you're in, in network with insurance, and this is my experience, I understand that everyone's is different, but when I was with insurance every year they would claw back money. And to me, the trend when I looked back, 'cause I was working with ProPublica, they obviously didn't mention my whole entire timeline, right? 63 00:01:02,000 --> 00:01:03,000 Anna(17:05): 64 00:01:03,000 --> 00:01:04,000 But part of what I did, and I documented all of it, I said, every year, look, every year they squeeze just a little bit more out of me every single year. And you don't, you don't really realize like, oh, it's just a thousand, oh, it's just another thousand. Like, you know, I'll just work an extra 15 hours and make that up. Like, that's kind of my mentality. 'cause It's like, but they're giving me patience. I have to accept it. Right? And it's just such a unhealthy dynamic. And, and there's a sunk cost fallacy to it as well where you've invested so much time that you're like, I can't give up now. Like I just can't give it up. What am I gonna do? I'm so dependent on them. And all the clawbacks, all the different kinds of patients where I would put in all the prior authorizations. 65 00:01:04,000 --> 00:01:05,000 Anna(17:56): 66 00:01:05,000 --> 00:01:06,000 As a psychologist, it's very common to send in almost like a preport for prior authorization, especially for Medicare, Medicaid. If you're doing an evaluation of some kind, you have to prove to them that this patient is in a position where they need a neuropsychological evaluation and you write down their history. You write down what test you're gonna give and what diagnoses and yada yada, yada. And it's this, this preport mind you, you don't get paid a penny until they approve it. So you technically are working for free and then they say, I'm just gonna approve two hours. It's like two hours, but I can barely give an IQ test and one other test during that time, what And you wonder who's on the other side of this. So all of those stressors, right, of the unknowns of when am I gonna get slammed with a, a prepayment plan or a clawback. 67 00:01:06,000 --> 00:01:07,000 Anna(18:46): 68 00:01:07,000 --> 00:01:08,000 And, and the client is always right. So whenever we would have a patient complain because they didn't wanna pay their copays to us, we couldn't charge them and we couldn't argue with them because that's in our contractual obligation. We also can't talk with other providers about what are you getting paid? Like, and it, it varies from county to county. There's all these laws about all of it. And, and it's just, it's like, but I can put it on my website if I'm private pay, but , like, I can't talk to you to see if another county, maybe it makes sense for me to move my office literally two miles away and get paid $15 more or something. Right. All of those things come together and it's so incredibly frustrating. 69 00:01:08,000 --> 00:01:09,000 Tiffany(19:30): 70 00:01:09,000 --> 00:01:10,000 This is wild to hear. So, and thank you for laying it out. I'm thinking about you, your, your mom. How old were your kids around this part? 2020. 2022. How old are your kids? 71 00:01:10,000 --> 00:01:11,000 Anna(19:41): 72 00:01:11,000 --> 00:01:12,000 Oh, so my kids are seven and nine right now. Oh, 73 00:01:12,000 --> 00:01:13,000 Tiffany(19:44): 74 00:01:13,000 --> 00:01:14,000 So little you had little kids at the time, or, or not? Yeah, barely. Okay. so you're having this pile up. Money's being taken out doing this free labor aware if aware of like the secrecy, you can't be asking people. And and you were, you were doing this for years and years, so at what point did you start having a, a gut sense of like, this is no longer tenable. And and I'm asking this because there are so many therapists out there who are on insurance for all the reasons you're describing. It's just what we do. I'm getting referrals. It's the right thing to do to help my patients, you know, all the reasons. But they're having these little cuts, cuts, cuts that are just, they're just tolerating. So for you, at what point were you like, I cannot tolerate this anymore. This has to stop? What was it 75 00:01:14,000 --> 00:01:15,000 Anna(20:30): 76 00:01:15,000 --> 00:01:16,000 I had, I had had that though. The prob so to answer that it's kind of two part is I had had that pretty much before the audit had happened. I had wanted to, but when you're in a business, it's almost like a marriage, right? Like you're in this business with someone else and you can't just like rip off a bandaid. It's, it's 50 50, you have to talk. So to be respectful, I was like, okay, well I need to be supportive. This is what we're doing. This is a giant company, right? I have to be, I have to just be a team player. And so that, that's what we did. And it wasn't until my business partner had left the company that I had the freedom. And I am not kidding, I'm not making this up. This is a document. And quite literally, when this person signed off on the papers to be done, it was that day that I put in for all of the insurance companies I was off. It was that day like that I, like, I, I knew I wanted to do it, but I had to, I had to be respectful to have that parting of, of the business and, and let that part go to be able to, to do that. And so once that happened, then I was done. You 77 00:01:16,000 --> 00:01:17,000 Tiffany(21:38): 78 00:01:17,000 --> 00:01:18,000 Were out. What this is in the ProPublica article, but tell tell listeners, when you look back at all of the money that you were owed by insurance and never paid, what was the total? 79 00:01:18,000 --> 00:01:19,000 Anna(21:48): 80 00:01:19,000 --> 00:01:20,000 It was a little over 1.5 million. Yeah. 81 00:01:20,000 --> 00:01:21,000 Tiffany(21:54): 82 00:01:21,000 --> 00:01:22,000 When you said, when I, I think I read that and then when you emailed me, I don't know if I asked you again. I like, do you mean million one over $1.5 million that you were not paid? Yep. Mm-Hmm . How do you understand that? 83 00:01:22,000 --> 00:01:23,000 Anna(22:16): 84 00:01:23,000 --> 00:01:24,000 I mean there's a lot of layers to that question. That's, it's, it's a giant number. It's, it is and it's, it's not a number that primero whatever, say that that's what they owe me because I was the problem. 85 00:01:24,000 --> 00:01:25,000 Anna(22:33): 86 00:01:25,000 --> 00:01:26,000 And so it, it, it, I don't know. I I have done what I can to move past that and and see it as, as opportunities like this to be a platform to be able to really encourage people that are terrified of insurance to see they'll stop at nothing. And to be quite honest, so they own me money, they will never admit to that. There's a lot of documentation 'cause ProPublica does their homework. They're very good at it. So they wouldn't put that in writing unless they could prove it. Right? And so, so that's the first thing. The second thing is that with this information, being able to support therapists and say it's totally possible, you can go private pay and you can still support your patients. And I have low bono or very or pro bono supports for patients who cannot afford my services. So my services are not 100%, you're paying 100% my hourly. 87 00:01:26,000 --> 00:01:27,000 Anna(23:36): 88 00:01:27,000 --> 00:01:28,000 No. I'm able to take like basically see not Seesaw but level it out to whatever the patient is able to pay because I don't have to worry because I have patients that are able to afford services and I'm able to, to use that to be able to balance out patients that aren't and then still be able to provide completely free services to patients who can't or very, very low support. You know, maybe $20, $5, $10 something and whatever they're able to afford. So while I hear people saying, I really wanna support, you know, people who can't afford and gain that access. I, my, my comeback is, well, have you looked at what their insurance will pay? Because a lot of times when I work with patients and they say, I I can't afford this, you know, and they're open to the dial. I'm like, well what if you call your insurance, see what out of network would pay? 89 00:01:28,000 --> 00:01:29,000 Anna(24:30): 90 00:01:29,000 --> 00:01:30,000 And they're like, okay, my insurance will pay a hundred dollars an hour. Okay then you know what I'm gonna bill, I'm gonna bill this for a hundred. You will get paid a hundred percent, we're good to go. Yeah. And they're like, oh, that easy. I'm like, yeah, you, you actually don't pay for anything. Like it's a hundred percent paid because we found out that you get a hundred dollars for the session. I'm okay with that. You're okay with that? 'cause You're not gonna have to pay your insurance will. Yes, you'll have to wait three weeks. But that like, you know, it's, at the end of the day, it's still paid for. So, and we work that out, right? And I say, okay, well then you submit it and then you pay me when you get paid. And assuming we have that trust built in, then it's fine. 91 00:01:30,000 --> 00:01:31,000 Anna(25:09): 92 00:01:31,000 --> 00:01:32,000 So I, I don't, I don't think that there is this aspect of thinking outside the box and being creative and having those difficult discussions. And yes, it is more footwork, the passive approach would be to accept insurance, but you're gonna get slapped repeatedly in the face and sometimes stabbed . Like you, there's so much that will happen down the path of insurance, in my opinion. And I saw it repeatedly. So like, no, I've seen what happens. But private pay, yes, you have to be creative, you have to be very comfortable with having those difficult discussions and you have to work a little bit more to, to have that level of encouragement for the patient to understand like, yes, this can happen. It is, and it depends, right? Because some patients just aren't gonna wanna hear it and they wanna go to someone else. But more and more the trend is moving away from, from the insurance and going private pay. So I think these discussions really need to happen and having support for therapists who don't know what to do or how to do it. 93 00:01:32,000 --> 00:01:33,000 Tiffany(26:10): 94 00:01:33,000 --> 00:01:34,000 Yes. Thank you for sharing that. So I I I love your just laying bare. Yes, referrals come easier with insurance, but there are a lot of difficulties with insurance, private pay. There are, there are difficulties with private pay as well. Just choose your difficulty. One, are you gonna get slapped over and over and over again? The other one you have to learn and grow. How do I have these difficult conversations? How do I find the clients who are willing and eager to pay me my fee and have the resources to do so? How do I set up a structure that works for me where some people are paying my full fee and other people are getting a low bone or a pro. Like you have to make those decisions, which is a little hard and requires growth, but for you it's so much better, it sounds like, than this alternative of having this insurance company who's you over, frankly. 95 00:01:34,000 --> 00:01:35,000 Anna(26:55): 96 00:01:35,000 --> 00:01:36,000 Yeah. And they, they will do it repeatedly. 97 00:01:36,000 --> 00:01:37,000 Tiffany(26:57): 98 00:01:37,000 --> 00:01:38,000 Well, tell me a little bit about, now that you're in your own practice doing your thing, doing the forensics, seeing clients how are you feeling in your day to day that's different than back when you were running this big company under the insurance system? 99 00:01:38,000 --> 00:01:39,000 Anna(27:16): 100 00:01:39,000 --> 00:01:40,000 I know, I know that I feel like people that are listening, I can't say I know, but I feel like people that are listening and be like, you are just like, you're saying this 'cause this is a platform to say I'm and I'm not. And I, I really hope that that listeners understand that I'm being as truthful as possible. That less truly is more. And I feel so much less stressed. I am a better mom. a better business owner. I'm a better psychologist because I'm taking on less patience and I'm, I'm able to pay my bills so much better and I'm able to spend time with my patients so much more deeply and passionately. And I am overall far less stressed . And, and it's because the less is more like that aspect of work smarter, not harder. I was working so hard to try to make insurance work because you're, you're just kind of running in a hamster wheel and you're not going anywhere and you start to feel insane because you are being led to be insane that process. 101 00:01:40,000 --> 00:01:41,000 Anna(28:34): 102 00:01:41,000 --> 00:01:42,000 I think that's the biggest thing is there's so much weight lifted and in my practice day to day that I just don't have to fill every single hour to try and make up for the money that's being taken away because it is not taken away. It is paid and patients are paying on time and the ones that have payment plans are happy and so thankful that they have a payment plan. And money is actually talked about from the beginning day one with insurance. It's this weird, like, I kind of have to give you a copay, but wait, you're double insured and you didn't tell me so now I can't, like now I actually owe you money six months down the line. I'm confused. And I think I broke a law in there like , like it's so, there's so much webbing involved in insurance and, and I don't have to deal with any of that. So I, I just walk in, do my work and I walk out and I get paid and that's it. I collect payment right up front. There's a credit card on file. There's no weirdness about it and it's so much nicer, smoother. 103 00:01:42,000 --> 00:01:43,000 Tiffany(29:40): 104 00:01:43,000 --> 00:01:44,000 I think our people believe you. I think you're very believable. trust. Yeah. Our, our folks, I think they, I think they, under the, the folks who are listening who are on insurance, they know what you're talking about with the clawback and the paperwork and did I make a mistake and is this money gonna come? They know that feeling and so they also know that stepping out of that, you just bill the patient and the patient pays you the money and goes like, of course it's simpler. Of course it's more useful. It frees up so much time and headspace. 105 00:01:44,000 --> 00:01:45,000 Anna(30:09): 106 00:01:45,000 --> 00:01:46,000 It does. Yeah. 107 00:01:46,000 --> 00:01:47,000 Tiffany(30:11): 108 00:01:47,000 --> 00:01:48,000 I'd like to take a few minutes just to talk about you and your background. So our folks have been listening to you this whole time. Let's, they might be thinking, okay, maybe Anna could do that or that's, that's easy for her, but for me it's harder for the, you know, we all have our, our reasons that it's harder for us in the world. So let's talk about your identities. How did you grow up? What are some of your important identities? Let's start there. 109 00:01:48,000 --> 00:01:49,000 Anna(30:34): 110 00:01:49,000 --> 00:01:50,000 I one of the things there, there's a couple things. One of the things is that I grew up in first generation immigrant home family, right? And I grew up very poor and money was earned to pay off debts and to pay your family members and to send it overseas. And, and that was a big thing, thing and everything we had was secondhand. And you had to be really, really, really thankful if you had soda twice a year. Like it was, it was a, it was a treat, right? Like we it was just, we didn't grow up with a lot and growing up we were really taught me to value it ahead and to treat others with love, generosity, pay it forward and put my talents to use the best I can because that is what I was given. Those are my god-given talents and gifts. 111 00:01:50,000 --> 00:01:51,000 Anna(31:27): 112 00:01:51,000 --> 00:01:52,000 And that has been repeated over the cycle of just my career, my education, my life, right? And so that's a really big part of it and that's why paying it forward's really important to me. And that's why I love, I love talking with therapists, especially in this kind of platform. When they ask me like, how did you do it? How'd you get off insurance? How did you do it? I, I am like, it's possible, especially if you're thinking about it. It's there. Let's water it, let's plant, let's we'll see it grow, it will happen. So I think that's really important and that's why I'm really honored and thankful that you have me on here today. Because when I read that email I was like, oh my goodness, lemme like reach out to this person because right. So, so that's really important to me. Just my history of my family and seeing how hard they worked and what that meant for them and to better my life and you know, continue that with my kids. 113 00:01:52,000 --> 00:01:53,000 Anna(32:17): 114 00:01:53,000 --> 00:01:54,000 The other thing is I myself am also neurodiverse. I work with that population and I really get them and understand them. 'cause A lot of times my brain thinks very similarly to that population and my brain works very different. I found out pretty early on than a lot of other people. And that's another part of who I am. And I love it. And I think that, again, if I can kind of give an elevator pitch of how I've done what I've done, then I love being able to do that to kind of package that up and give people hope and inspire them to go on and go into private practice or go on and start their own business, however that may look for them or just keep, take that leap of whatever it is that, that they're a little scared to do, but they still wanna do it. 115 00:01:54,000 --> 00:01:55,000 Tiffany(33:09): 116 00:01:55,000 --> 00:01:56,000 I love it. Thank you for sharing. I, I think I know there are individual practitioners who listen to the show who are on insurance and will wanna get off and so they're listening to like, okay, this is possible. I also know there are group practice owners who have set themselves up, kind of gotten, gotten ahead of themselves and now they have these big group practices, insurance-based and they're drowning and they feel like these golden handcuffs, but not even that golden 'cause they're not really making, you know, they're not really making as much as they hope. They're paying everyone else and just struggling. So to those folks who are listening, oh, I'm drowning. I don't, I'm, I don't know how to get out of this. I'm stuck. What's one, what's one word of wisdom or just what, what do you say to her right now who's listening? 117 00:01:56,000 --> 00:01:57,000 Anna(33:56): 118 00:01:57,000 --> 00:01:58,000 I would say create a plan that I think while I say I ripped off the bandaid and I did, there was still a huge plan behind that because with that plan I had researched that every single insurance panel, some of them had 90 days that I was gonna be off. Some of them had 120 days and some of them had quite literally a year and a half. And I knew, okay, I have three months to get my act in order and like to get out there and market my butt off and coordinate care and get out there, talk to the psychiatrist, talk to dentists, where are all my patients living? Let's go. Right? So I created that plan and I had 90 days and I had planned it before I did that. So I had 90 days for some of them. And those were kind of my low end paying ones. 119 00:01:58,000 --> 00:01:59,000 Anna(34:48): 120 00:01:59,000 --> 00:02:00,000 So I was like, gonna be totally fine 'cause my higher paying ones, higher paying ones, , I put that in quotes, still clogg me back. They were maxed out for 120 months or a year and a half, right? So that's, that's what I would say is plan it all out. If you have a map and you can kind of meter where everything's gonna be falling, then you know, okay, schools are where the vast majority of my patients are. You know well substance use treatment centers are where they are, you know inpatient treat, whatever your populations are, you're gonna have to market yourself and have business cards, give free presentations. So you're gonna have to, you know, lighten your load a little bit to start marketing and kind of massage those relationships, follow up with them and Right squeaky wheel does get the grease and that, that's the biggest, it's all part of the plan. 121 00:02:00,000 --> 00:02:01,000 Anna(35:41): 122 00:02:01,000 --> 00:02:02,000 So I wouldn't say haphazardly impulsively do it. While it may sound like I did that, believe me, I, I don't work that way. I , if you ask my kids, I'll even say there's, I always have a plan. Like I, I do create plans and so planning is the biggest piece I think of it because that's going to give you space to just breathe and know I'm not doing this on a whim. I have, I have laid out what I'm hoping to have happen and I know plan A is my ideal. Plan B is my, okay, I, it's not the greatest, but it still works. Plan C is okay, right? And so you have that all out and you have it, you have it there and I wouldn't do it alone either. So if planning and have support, 123 00:02:02,000 --> 00:02:03,000 Tiffany(36:24): 124 00:02:03,000 --> 00:02:04,000 This is beautiful. 125 00:02:04,000 --> 00:02:05,000 Anna(36:25): 126 00:02:05,000 --> 00:02:06,000 I think the two things. Yeah, 127 00:02:06,000 --> 00:02:07,000 Tiffany(36:27): 128 00:02:07,000 --> 00:02:08,000 Yeah, very, you, you sound through the whole interview, you come off as very methodical, very thoughtful. And so I can see like you ripping the bandaid off is what that was like the final like I've made all the plans, now I just have to just do it. Versus like making all the plans and staying in plans for 10 years, you're not gonna do that and you're gonna make the plans and then you're gonna leap. Which it sounds like is what you did. 129 00:02:08,000 --> 00:02:09,000 Anna(36:47): 130 00:02:09,000 --> 00:02:10,000 Yeah, no, but I had my life vest on and I knew that there was water below, so like it was all planned out. It just, it was just excitement to do that and be like, oh yes, I can breathe. You know? 'cause I sent them all in. And the hard part is, again, part of that plan I've told therapists is you have to find out how many days you're gonna be in network with them. You're gonna have to inform all your patients, write the letters and then have an Excel spreadsheet. 'cause If people are in network with every single insurance under the sun have have a due date of like, okay, I reached out, I sent this into like Molina, I haven't heard back from them. Let me follow up, let me follow. Because regions Blue Cross Blue Shield lost our letter like three times. 131 00:02:10,000 --> 00:02:11,000 Anna(37:29): 132 00:02:11,000 --> 00:02:12,000 Wow. I'm like, is it in a paper shredder? How does it get lost ? And so I'm like, do you want me to hand deliver it? Where's this address? And we were finally able to do it. You know, I had to go to USPS and like do this extra money to like have the sand signature. And I was like, listen, I followed this, we're done. Like we're no. And then we finally made it, but it took three tries. So you have to just because you cast the net, you are in charge of reeling it in each time you do it. So I think that's part of that planning of, you have to be organized and like you've said, methodical in the process. 133 00:02:12,000 --> 00:02:13,000 Tiffany(38:02): 134 00:02:13,000 --> 00:02:14,000 Beautiful. and I know people are gonna want to talk with you. They're gonna wanna reach out or learn more about your experience. How can people connect to you or get to know you better? Where's the best place for them to go? 135 00:02:14,000 --> 00:02:15,000 Anna(38:14): 136 00:02:15,000 --> 00:02:16,000 Yeah, my website, sandbox therapy.com and my specific email is anna a na@sandboxtherapy.com. Those are the two best ways. If you go onto my website, sandbox therapy.com and you just scroll to the, the contact us, you know section, contact me area, then you can get ahold of us and then it will funnel into my inbox and then happy to chat. 137 00:02:16,000 --> 00:02:17,000 Tiffany(38:37): 138 00:02:17,000 --> 00:02:18,000 You'll get it. And where are you located? 139 00:02:18,000 --> 00:02:19,000 Anna(38:40): 140 00:02:19,000 --> 00:02:20,000 I'm in Mun Monroe, Washington. Most people are like, well where is that? Yeah, well it, it's about 45 minutes east of Seattle. Yes. It's in, it's closer to the mountains, kind of the foothills closer to the Cascades. 141 00:02:20,000 --> 00:02:21,000 Tiffany(38:54): 142 00:02:21,000 --> 00:02:22,000 Okay. You know, do you know from Bremerton, did you know that the other way? Oh no. Yeah, I grew up in Bremerton. 143 00:02:22,000 --> 00:02:23,000 Anna(38:59): 144 00:02:23,000 --> 00:02:24,000 No, I didn't know that. Yeah. Yeah, no idea. 145 00:02:24,000 --> 00:02:25,000 Tiffany(39:02): 146 00:02:25,000 --> 00:02:26,000 Thank you so much. This has been enlightening, thoughtful. You've been very transparent. I really appreciate you taking the time and using your experience, just like you said, to inform therapists and help them know there is a better way, there is a way out. It's very generous. And I suspect by the way that were you still trapped into this insurance maze with all these companies, you probably wouldn't have the time or space to come on and share this kind of thing. You seem much freer. Oh 147 00:02:26,000 --> 00:02:27,000 Anna(39:28): 148 00:02:27,000 --> 00:02:28,000 No, you mean you're working so much. You're working from the second you wake up to the second you go to bed and I swear in your sleep like, 'cause you're just trying to make a buck. 'cause They take it all away. Yeah. It's stressful. Yeah. Thank you madam. But yes, you're welcome and thank you for having me and I look forward to hearing if anyone else has questions or comments or anything. Yeah, 149 00:02:28,000 --> 00:02:29,000 Tiffany(39:50): 150 00:02:29,000 --> 00:02:30,000 Anytime. And folks listening, I'm gonna say if you reach out to, to Anna, you are paying her for her co her time. This is not a free consultation. I'm all about business consulting. So Anna, make sure you're charging folks for this hard one knowledge. 151 00:02:30,000 --> 00:02:31,000 Anna(40:05): 152 00:02:31,000 --> 00:02:32,000 Thanks for that . Reminder .