Abundant Practice Podcast: Episode #670 – Insurance vs Private Pay

Host: Allison Puryear
Guest: Laura
Release Date: July 23, 2025
Duration: Approximately 26 minutes

Introduction

In Episode #670 of the Abundant Practice Podcast, host Allison Puryear engages in a candid conversation with Laura, a therapist navigating the complexities of running a private practice. The episode delves deep into the dilemmas therapists face when deciding between insurance-based billing and private pay, exploring the emotional and practical implications of each choice.

Laura’s Journey and Current Challenges

Starting the Practice: Laura began her private practice eight years ago while still employed at an agency. Over time, significant life events, including the pandemic and the birth of her two children, influenced her professional trajectory. This period allowed her the flexibility to be present with her young family but also led to a slower-growing practice primarily sustained through word-of-mouth referrals.

Feelings of Conflict: Laura expresses a profound internal conflict regarding the idea of accepting insurance. She shares:

Laura [02:27]: "I just feel like a failure if I take insurance. It feels like I've... I didn't make it... I wasn't enough on my own."

This sentiment underscores a common struggle among therapists who prefer maintaining autonomy and quality of client care over the perceived compromises of insurance involvement.

Exploring Insurance as an Option

Potential Benefits: A psych nurse practitioner in Laura’s network offers to fill her caseload with vetted clients if she opts to take insurance, presenting a tempting solution to her slow practice growth.

Allison’s Reframing: Allison addresses Laura’s feelings of failure by reframing the decision as an active choice rather than a fallback or a measure of success:

Allison [04:43]: "You're not failing. You're making an active choice, period."

This perspective helps Laura see the option of taking insurance not as a personal shortcoming but as a strategic business decision.

Practical Considerations: Allison provides practical advice on navigating insurance complexities:

• Credentialing Process: It typically takes about three months to get credentialed.

Allison [07:25]: "A lot of insurance companies won't tell you what you're going to be paid until you've already signed a contract."

• Clawbacks: While relatively rare, clawbacks are a concern and require meticulous documentation and adherence to insurance requirements.

Overcoming Bureaucratic Hurdles

Navigating Big Companies: Laura expresses skepticism about large insurance companies like Alma, citing negative experiences and concerns about their intentions.

Allison [11:13]: "I don’t believe any of these companies have our best interest at heart... it's a weird, mean, bad loophole."

Alternative Strategies: Allison suggests:

• Hiring Assistance: Employing someone to handle credentialing and paperwork.
• Utilizing TherapyNotes: Leveraging platforms that simplify insurance-related tasks.

Preparedness: Allison recommends having credentialing information ready in CAQH to streamline the process when needed.

Reframing Financial Conversations

Changing Money Mindsets: The discussion shifts to the uncomfortable nature of discussing money within therapy practices. Laura shares her anxiety over raising rates and communicating these changes to clients.

Laura [22:34]: "In eight years I've successfully raised my rates one time by $10. I raised them again recently so I was like, this is a ridiculously low rate."

Allison’s Encouragement: Allison encourages Laura to confidently adjust her rates, emphasizing that increasing fees is a valid and necessary step for sustaining her practice and personal well-being.

Allison [22:58]: "You could have a really small practice at a premium rate and take care of your family."

Practical Steps:

• Incremental Increases: Gradually raising rates for new clients to test comfort levels.
• Communication Practices: Practicing phone calls and discussions about rate changes in therapy to build confidence.

Defining the Ideal Client

Shifting Niches: Laura reflects on her evolving ideal client, transitioning from working with teens and young adults to focusing more on new mothers. Allison validates this natural shift:

Allison [17:57]: "It almost always is... it's okay that that shifts."

Flexibility in Practice: Emphasizing that niches can evolve over time, Allison reassures Laura that adapting to new client demographics does not compromise her practice’s integrity or success.

Key Takeaways and Insights

1. Active Choice vs. Failure: Deciding to take insurance should be viewed as a strategic business decision rather than a personal failure.

2. Practical Preparedness: Streamlining credentialing processes and utilizing supportive platforms can mitigate the administrative burdens of insurance billing.

3. Reframing Money Conversations: Therapists need to overcome discomfort around financial discussions to ensure their practices are sustainable and fulfilling.

4. Evolving Niches: It's natural for a therapist’s ideal client profile to change over time, reflecting personal growth and shifting interests.

5. Support Systems: Leveraging professional networks and seeking external support can provide the necessary guidance and confidence to implement significant changes.

Notable Quotes

• Laura [02:27]: "I just feel like a failure if I take insurance. It feels like I've... I didn't make it... I wasn't enough on my own."

• Allison [04:43]: "You're not failing. You're making an active choice, period."

• Allison [11:13]: "I don’t believe any of these companies have our best interest at heart... it's a weird, mean, bad loophole."

• Allison [22:58]: "You could have a really small practice at a premium rate and take care of your family."

• Allison [17:57]: "It almost always is... it's okay that that shifts."

Conclusion

Episode #670 of the Abundant Practice Podcast offers a heartfelt exploration of the internal and external factors influencing a therapist’s decision to accept insurance. Through empathetic dialogue and practical advice, Allison Puryear helps listeners navigate the often complex landscape of private practice management, emphasizing the importance of making choices that align with personal values and professional goals. This episode serves as a valuable resource for therapists seeking to balance financial sustainability with the desire to provide meaningful, quality care to their clients.

Resources Mentioned:

• Abundance Practice Building: abundancepracticebuilding.com
• Alma: Alma Platform
• TherapyNotes Offer: Use promo code Abundant at therapynotes.com for two months free.

Join the Conversation:
If you're grappling with similar challenges in your practice, consider reaching out to the Abundance Practice Building team for personalized support at help@abundancepracticebuilding.com.

This summary encapsulates the key discussions and insights from Episode #670, providing a comprehensive overview for those who have yet to listen.