
member Hagger and I dig into what it really takes to move off insurance panels—and how to do it without blowing up your caseload or your nervous system. We walk through the numbers to help you feel confident the math can work in your favor, even...
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Hi, welcome to the Abundant Practice Podcast. I'm Alison 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 and paid support. Go to abundance practice building.com Links all right, onto the show. So I've talked about therapy notes on here for years. I could talk about the features and the benefits in my sleep. But there are a couple things I want you to know about therapy notes that doesn't typically make it into an ad script. First is that they actually care if you like their platform. They don't only make themselves available on the phone to troubleshoot so you don't pull your hair out when you get stuck. They also take member suggestions and implement those that there's client demand for. Like Therapy Search, an included listing service that helps clients find you internal and external secure messaging. Clinical outcome measures to keep an eye on how your clients are progressing. A super smooth, super bill process. Real time eligibility to check on your client's insurance. In my conversations with the employees there at all levels, they all really believe in their product and they want you to love it too. Second, they are proudly independently owned. Why should you care about that? Because as soon as venture capital becomes involved, the focus shifts from making customers happy to making investors happy. Prices go way up. Innovation plateaus. Making more money with as little output as possible becomes the number one focus. With over 100,000 therapists using their platform, they've been able to stay incredibly successful and they don't have to sacrifice your experience to stay there. You can try two months free@therapynotes.com with the coupon code Abundant. How you doing, Hager? Good, how are you? I'm doing well. What would be helpful today?
A
Oh my gosh. Okay. So much. But thank you so much for setting up this time. Like I'm so happy I was able to get in this month. So thank you so much. I really appreciate it. Yeah, I think today what I would like to talk about is the classic moving off insurance panels and trying to just. It's been something that's been floating in my head for the last couple of months of dropping a specific panel that I'm on. Like so much fear. So yeah, that's the one thing I would say. That's the main thing.
B
Yeah. Okay. So I want to contextualize everything of like this is A weird year. Right. Like, two years ago, I'd be like, just hop off, whatever. No big deal, you know?
A
Yeah.
B
So I want to understand how much of your practice is currently, like, being paid for by that insurance company. Like, how many? What percentage of your clientele you could.
A
Say from that specific company? I would say nine. Nine of my clients.
B
Nine out of how many? Yeah.
A
Fifteen. Okay, 15. So I keep a small caseload because I can't see that many people. Love it.
B
Good.
A
But, you know, so I would say, like, yeah, maybe like nine, 10 people. I would say they're the biggest payer, so I'll definitely give it that. They're the ones that bring in the most people. Then I have three from a different panel. Oh. And then three private pay. So there's quite a mix there. Yeah.
B
Okay, got it. And a certain percentage of these nine people are going to stay on with you and pay out of pocket is. Yeah, everybody worries about that. They're like, well, you don't know my clients, Allison. Yeah, I'm like, I don't know your clients, but I can say with a, like, strong amount of assuredness that some of them, slash, maybe all of them will stay on with you. So we are seeing people spreading out more than we used to. So, you know, like I said two years ago, if you were like, I want to go off insurance panels, I'd be like, sweet. Like, let's make sure that your marketing is tight so you can continue to get private pay people in, and then let's just go off. And most of your clients will probably stay with you. Like, we were looking at, usually about 90% of people's caseload would stay on with them. We're still seeing a lot of people staying on.
A
Yeah.
B
But they are spreading out. So, like, instead of weekly, they might go to every other week. So that can feel like, let's say three quarters of your people stay with you, but a certain percentage of them go to every other week. It can feel like you lost half of that caseload. So then we got to do math, which is therapist we don't always love, but this is the math I like.
A
Yes.
B
How much is that insurance company reimbursing for your typical session?
A
127. Okay.
B
And what is the fee that they will be paying out of pocket?
A
So my out of pocket fee is 225.
B
Okay. So you're in a good position where if it feels like half of those sessions per week end up going away with that kind of elite, you're in a much better Position. Yeah, it's more like, oh, gosh, now I've got to do math because I don't want to be like, it's more like this number. So let's say, let's use all nine at 127. So that's $1,143 per week. And at 225, that same number is 2025. So, I mean, we know from 127 to 225, like, it's nearly double but not quite there.
A
So.
B
Yeah, well, just like, I think you'll be in a good position. You'll be either making more money or not losing much. Yes. And kind of typical amount of people stay on.
A
Stay on. Yeah. Well, that breakdown actually is quite helpful because, you know, I think sometimes I think of, like, you know, some of my clients are paying, like, $0 per session because their insurance is covering all of it. Some are paying, you know, 20. Like, it's just like, such, like, you know, and I think it brings up a lot of, like, definitely, like, the. Am I good enough for the full fee for people to be like, oh, like. Because I've had some clients drop due to insurance changes. And it's like, for such things a little bit. But ultimately people do what's best for them. So it's always, like, kind of like in the back of my head, you know, I think I'm very much so this is my first year in private practice, driven by, like, that. That fear. Like, this is scary, but I know it's something I want to do because I fundamentally. Just like insurance companies, you know, I think that, you know, over the past year, rates have gotten reduced, like, you know, just, like, different. I think that 127 used to be, like, almost 140 at some point, and then it just got reduced, like, it. So it just doesn't feel lucrative as much, you know. And I think that even, just like, having that breakdown of doing the math is. Is helpful. So thank you.
B
Yeah, absolutely. And I mean, ultimately, like, you've got private pay clients, so you know how to bring people in. Yeah, there are people who can't, who you're currently working with, who will not be able to pay out of pocket, potentially.
A
Yeah.
B
There might be some of them, and they need to go according to their insurance to somebody else, and then there are people who can't afford it. It's been nice for them to be able to use their insurance, but they feel like their relationship with you is strong enough. They don't want to start over. They, like the work y' all are doing together. And so they'll make it work.
A
Yeah.
B
And a lot of this is in how it's framed. I've seen some people lose, like, their whole caseload because they come at it from this perspective of, I'm getting off your insurance so I can give you referrals to other people. Like, they just make the assumption nobody's going to stay with them. And I want you to make the assumption that everybody's going to stay with you while also having good referral sources to send people to when they say, I can't make that work financially. It's kind of like the people who assume when you get your first phone call from a client that they want to make an appointment. Those people fill up so much more from phone calls than the people who are like, well, yeah, think about it and give me a call back when you want to schedule. If you frame it in your own head, like it's a mindset.
A
Yeah, yeah.
B
And it is also how you present it to them so that you. I keep going back to that first phone call because it feels so similar to me. If you say, you know, my fee is 225 and you don't even give them a chance to respond. And you say, but I can slide down to, you know, 75 if you need.
A
I've run into that before.
B
Yeah. It's so human. Right. Like, so many of us do that.
A
Yeah.
B
And I've been on the receiving end of that as a client and wanted. Had to, like, hold myself back from coaching someone. But there's a certain amount of, like, confidence going into that conversation and saying, we've got scripts for it in the party of basically, like, I would love to continue working together after this change. Is that something you can make work? And if they say no, then, you know, be like, I totally get that. And I'm going to find some really great referrals for you that I think will be a good fit clinically and personality wise. So well cared for.
A
Yeah.
B
And ultimately, I would not underestimate the impact of your relationship.
A
Yeah.
B
And if someone can, they probably will.
A
Yeah, that's true. That's true. Because I've done it with my own therapist and, you know, personally, it's, you know, and of course, like, we can't speak for everyone. Like you said, like, there's some people that really might need to go through their insurance because finances are tight or like, they. They just need to. Right. Yeah. Some people might not. And it's. Or might want to choose to pay or choose to kind of, like, you know, I think it's within me as a clinician, as a human. It's that fear of change. Or, like, I think we overestimate, like, the negative what ifs happening. Yes. Versus, like, I really, really love what you said about making the assumption everyone will stay. It doesn't mean that everybody will. But at least going into it with that mindset, and it really. It really is all about mindset. So I do, you know, agree with that, because even just like, saying that out loud, I'm like, wait, you know, that feels good. Yeah.
B
And the anticipation of these kinds of changes is so much worse than the actual conversations. 99% of the time, every now and then, I'll have a conversation with the therapist who was like, it was all. And then I told this one client, she got so mad at me, and she called me selfish and greedy. But that's like one out of a hundred therapists that I work with who all have a caseload full of people they're talking to. So probably it's going to go over well.
A
Yeah.
B
I hear more therapists say, yeah, I had a client say, it's about time or good for you or worth every penny or whatever. Like, my. I go to a concierge doctor here, and they recently sent out an email about how they were having to raise rates for what we. It's like a monthly payment that we do. And I wrote back because I know how it is. And I was like, it's worth every penny.
A
And she was like, oh, my God.
B
This to the top. We all needed to see this today because I don't think this is going to be what we hear from most people. So.
A
Oh, my God.
B
It's just knowing that, like, what you were doing with people matters and they're getting the benefit of therapy with you.
A
Yeah.
B
And if they leave, it's not because they're not getting benefit. It's because, like, their financial situation doesn't allow it.
A
Yeah. Yeah, absolutely. You know, it's interesting that you said that about the, you know, you saying that to your doctors, the doctor's office, because I had a client this past week, interestingly enough, she's on that panel, but she was like, hey, do you have any other times available this week? And I was like, no, I'm all full. I don't have anything else. You know, she wanted to reschedule. She was like, oh, it sucks that we make. Can't make something work. But I'm so happy to hear that you're Full like, way to go. I was like, wait. That's so sweet. Thank you.
B
Absolutely.
A
So I think you know, to kind of just like our point earlier of like anticipating the negatives happening or people. Because I'm anticipating people be like, you're such a selfish, you know, B word. Right. You, you know, like you're greedy or this or that. Like it just, it feels like that's what's gonna happen. Like that people. And you know what, there might be a person. I don't know. Right. Well.
B
And that's your own stuff, right? Like that's just you projecting.
A
Yeah.
B
And so like there's some, some juicy stuff to work out there.
A
I know, I know so much juicy stuff because it's, it's like, you know, like, like I feel like I'm anticipating them being mad at me or just you know, but it's like not, it's like so not about them.
B
Right. And it's probably like if you thought about each individual client, like you gave each client some thought and you thought would they call me a selfish? You'd probably be like, of course they wouldn't.
A
I work with like some of the sweetest people. Yeah, they're just such kind humans. So I don't think so. I think it's just like I'm anticipating the, the, the backlash that probably doesn't exist. You know, I did have a question kind of on that tail end. So I have my website, I have like all these like a shit ton direct of directories that I'm a part of. What else to do to market. Like it's just like not something that was taught like marketing. Putting myself out there, especially social media, it feels very intimidating and so scary. Yeah.
B
Have you done the marketing fundamentals course yet?
A
No, I know I'm part of like the abundance practice that hold the party right up until I think December. So I don't know if that's on there, if this is a separate thing.
B
Yeah, it's on there. It's on there. So it's Marketing Fundamentals one and two. One is primarily focused on the two things everybody needs to be doing. So networking and making sure your website is like super niched and well messaged. And then Marketing Fundamentals 2 is like all the other options. So you can choose up to three of those, including one of which is online listings and making sure that the way that your listings are written are very like really grab your ideal client. They feel very seen so they immediately choose you. So you can, if you, when you go through that, all of the different marketing strategy options. There's a is it for me at the beginning of each one.
A
Okay.
B
Don't dive into, like, how to do each one. Just look at the. Is it for me for each one to like, not waste your time on something that, you know isn't for you.
A
Okay.
B
And then when you're like, maybe this is for me, I think, you know, I think maybe video or I think maybe social media would be good. Then go into the best practices video and learn how to do it.
A
Okay.
B
That way you're not wasting.
A
It's not overwhelming. Yeah, yeah.
B
And you don't need to know how to do, you know, public speaking if you don't want to public speak.
A
Yeah, yeah. You know, I like that, I guess. You know, I think part of what's been overwhelming for me is like, I feel like I'm holding myself to the standard to like, do something that's not, that I know isn't exactly me. Like, social media maybe right here, right now is not some. Is not a path that I want to go down because they're, you know, not saying I will always be in that boat. But, you know, I like that there's like options for different things. Yeah.
B
You never ever have to do social media.
A
Yeah.
B
I've not done social media for my private practice.
A
Yeah.
B
It's just not necessary. It's, it's a route. If you loved it, if you loved content creation, then I'd be like, yeah, let's talk about it.
A
But overthink everything. And you know, people in the comments are mean.
B
They can be so like, yeah, you can just skip that, do something else.
A
Maybe right here, right now. It's, it's not the thing for me, but, you know, I think just like exploring other options might, might be helpful as well. Yeah. There's a lot of fear. There's a lot of projection stuff to work through. What do you think is, like, the best route of, like, working through it as clinicians, as business owners? Like, what's important to prioritize because there's so much. And all this stuff brings up so much.
B
Yeah. So, I mean, I like, I like looking at data. I think data really saves us because our emotions as therapists, we tend to be feely types. Right.
A
Yeah.
B
And it's really easy to spin out and assume something's going to go a particular way. So I like data and I like information. So if I know how, like what I'm going to do, what my next steps are, how to do them right, then I feel a lot safer. Than if I'm like, if I don't have that clarity.
A
Yeah.
B
So, like, doing the math, for instance, once you've done the math and you're like, okay, well, I could actually lose six of these clients.
A
Yeah.
B
But I'll be making the same amount of money. I don't think that number's right. You need to do the actual math. But, like, you know, a certain number of these clients and I'll be fine financially and can build from there. Then, like, there's relief in it.
A
Yeah.
B
Instead of just being like, oh, gosh, I'm going to lose clients and it's going to be awful, how am I going to make ends meet? Am I going to be able to build it back up? You. You do the math. You figure out what the margins are. So, like, you'll make the same amount if you lose X number of clients. You will make less, but still be able to pay your bills without concern if you lose Y number of clients.
A
Yeah.
B
And, like, things are too tight and bad if you lose Z number of clients.
A
Yeah.
B
And so you have that data so that if you're somewhere in between X and Y, you know, you're still fine. It's not exactly where you want to be, but it's not Z. Yeah, yeah, we can hop to Z really quickly.
A
Yeah. We can assume that Z is the only option. Yeah. Just kind of like, build our reality off of that. But yeah, no, the looking at the data and kind of like grounding ourselves in it and the information that's available, I think. Yeah, I think that's absolutely helpful. Do you. And I don't know if this is a question I can ask. I'm going to ask it, and you tell me. Yeah, you know, assuming that you've worked with a lot of clinicians who are hoping to get off of panels and, you know, all these things, what is an appropriate notice to give clients? Because I'm thinking, like, six months, Right. I just want to prepare. I'm like, oh, my God, like, six months. I want to tell them in September that I'll be going off in, like, January, February, just to prepare them. Like, I'm like, very much, like, centering their own. Their experience, which is. I think it makes me an effective clinician. But at the same time, it's like, is that too much? Like. But I also don't want to give, like, two weeks either. So I don't know. Yeah, yeah.
B
So I usually recommend six to eight weeks. Okay, so.
A
So six to eight weeks.
B
Yeah, that. That gives them plenty of time.
A
Yeah.
B
Most people are going to be just fine, you know, because of staying.
A
Okay.
B
And that gives you adequate time to be able to arrange a handoff to another therapist if somebody is leaving while also wrapping up some of the work you're doing.
A
Yeah. Six weeks. Okay. So definitely not six months. No, no.
B
I appreciate you wanting to take good care.
A
Like, I feel like. But sometimes it's like it comes at my own detriment because it's like, wait six months. Like that's a lot of time. A lot of time. You know, and, and, and it's like, I'm sure clients would appreciate it, but it felt like too much at the same time. So I'm just like, okay, so glad to know there's like a golden standard of like this six to eight week period. And, and just kind of. Yeah. Eight weeks is like two months. So that makes sense. Yeah. Yeah.
B
And we've got like scripts for things in the abundance party. We have the course. Oh, I saw getting off insurance without going broke and selling out. So that one has some scripts and some of the same scripts I believe are in the scripts and templates course.
A
Yeah.
B
So you've got like the words to use. If you're like. But I don't even know what to say. You can literally just paste them into your notes app and you've got it right there anytime you need to call someone or send an email or however you're going to do it.
A
Yeah, yeah. Can I ask, this is more of a personal question. Do you see clients one on one or do you like primarily do coaching.
B
And so, yeah, I primarily do Abundance, but I do still see clients. Yeah.
A
Very nice. Okay.
B
I can't give it up. I love therapy. Like, I'll probably never not do therapy.
A
So. Yeah. How do you feel? Like a. How did you. I know we don't have that much time, but I'm just for my own curiosity and then just like getting to know you a little bit. What led you to start Abundance?
B
Oh, so I had been in agencies for a while.
A
Yeah.
B
And was like the employee always getting like, exceeds expectations. Like just like, you know, like just a little worker bee who wanted to make everybody happy and still wasn't really getting raises and still like wasn't able to take the annual leave I had earned at the time I wanted to take it and things like that. And I would. I'd had a small private practice on the side for like five years and was like, screw this. And I, I decided screw this at a really inopportune time. I Decided when my husband and I were moving across the country to a city where we didn't know anyone. So I was like, well, I'll start a private practice in a city where I don't know anyone. That's a great idea. And when I did, once it really got rolling, I was like, oh, my gosh. I'm working so much less, and I'm making so much more, and I have, like, spaciousness, and no one is, like, breathing down my neck while making me feel like I'm doing a great job without doing it well enough.
A
Yeah. Yeah.
B
And I just fell so in love with it. I started kind of bullying my friends into private practice. I just, like. I was like, no, you don't understand. I only worked this many hours this week, and this is how much I need. And so I started helping my friends. And then we moved back across the country to the southeast, to Asheville, and I. It just came out of my mouth one day at a networking event that I liked, helping people with their private practices. And I got kind of, like, mobbed right afterwards with all these people who were like, I've been wanting to go into private practice, or I'm in private practice, but I'm not getting clients. And so I started my first group then, like, 11 years ago, almost.
A
Oh, my gosh.
B
Actually, that event was August 20th. It was on my birthday, so it was August 20th. And I, like, started a group and helped those folks get full and then took it very quickly from, like, local to national to international. And it just, like, it's fun.
A
Yeah.
B
The skill set that therapists don't realize, they're so perfectly positioned to have. Like, the hardest part of marketing for other industries is understanding what their prospects are, thinking and feeling. And, like, they tell us, yeah, we know. We know how to connect with them.
A
Yeah.
B
And when we're good at that, people get the care they need because they're not still looking, trying to find the right fit.
A
Yeah. Yeah, absolutely. Absolutely. I mean, thank you so much for sharing a little bit about, like, your story and your journey. And, you know, it's interesting how, like, it's those things that happen along the way that, like, set our path, like, just. Just, like, create a different path for us.
B
Yeah.
A
You know, like, you've not been in that networking event. You know, it's like, so that's, like, really. I mean, that's just so inspirational. So thank you so much for shar sharing it. And also, like, your passion does come across in your videos and, like, everything that you share, like, you Know, it really, really does come across.
B
Oh, good, good.
A
Yeah. So it's, you know, it's. It's definitely really like, on the receiving end. You know, it feels like there's support even though, like, I mean, now we're having the one on one conversation, but, you know, you know, it feels like just like kind of like from consuming, you know, what you put out there and stuff like that. It's Feels really good to be on the receiving end.
B
I'm so glad. Good.
A
All right. I think those were all the questions for today.
B
Sounds good.
A
Those were all the things that I wanted to talk through and just kind of like seek your feedback or input on. Yeah, yeah.
B
And post in the Facebook group if you like.
A
Let us.
B
Let me know how it's going.
A
Okay.
B
And so many people in there have gotten off insurance. So you're, like, in good company if you're like, I just got really scared out of nowhere. Even though, like, I know on some level it's gonna be fine. I got scared and I just need. I just need someone else to tell me it's going to be good.
A
Yeah.
B
So, you know, the folks in there are so sweet, so they will.
A
Yeah. I actually have to create a professional Facebook because I'm off Facebook, but I think creating a professional one might be helpful, so I might do that.
B
I wouldn't worry about it. I mean, maybe just to get in that group if you wanted to, but, like, you don't need to post as social for your practice, so. Yeah, okay.
A
Do whatever. Okay. Sounds good. Thank you so much, Allison. I really appreciate your time today. Have a lovely rest of your day.
B
You too. Take care.
A
Bye. Bye.
B
If you're ready for a much easier practice, therapy notes is the way to go. Go to therapynotes.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. I'd love for you to follow rate and review, but I. I really want you to share this episode with a therapist friend. Let's help all our colleagues build what they want.
Host: Allison Puryear
Guest/Caller: (A – therapist in first private practice year)
Date: October 22, 2025
In this episode, Allison Puryear coaches a therapist navigating the fear of dropping an insurance panel—one that currently covers the majority of her caseload. The conversation dives into the real worries, math, practical steps, mindset shifts, and marketing strategies that come with moving off insurance in private practice. Allison provides empathetic, data-driven reassurance and shares her own journey and best practices from supporting thousands of therapists.
[02:04–03:26]
[04:16–06:54]
“You’ll be either making more money or not losing much.” (Allison, 05:33)
[07:24–10:25]
“If you frame it in your own head, like it’s a mindset…and it is also how you present it to them.” (Allison, 08:18)
“She was like, ‘Oh, it sucks we can’t make something work. But I’m so happy to hear you’re full—way to go.’” (12:00)
[12:04–13:29]
“That’s your own stuff, right? That’s just you projecting…there’s some juicy stuff to work out there.” (Allison, 12:26)
"I work with some of the sweetest people... I think I'm anticipating backlash that probably doesn't exist." (12:56)
[13:29–15:33]
“You never ever have to do social media. … I’ve not done social media for my private practice.” (Allison, 15:14)
[16:02–17:24]
“Doing the math, you figure out what the margins are...there’s relief in it.” (Allison, 16:40)
[17:37–19:27]
“Six to eight weeks…that gives them plenty of time…to arrange a handoff or wrap up work.” (Allison, 18:34)
[20:10–22:58]
“I was like, screw this…I’m working so much less, making so much more, and I have spaciousness…no one is breathing down my neck.” (Allison, 21:08)
“The anticipation of these kinds of changes is so much worse than the actual conversations. 99% of the time.” (Allison, 10:25)
“I would not underestimate the impact of your relationship…if someone can, they probably will [stay].” (Allison, 09:30)
“Assume everyone will stay…it really is all about mindset.” (Guest, 10:08)
“You never ever have to do social media. I’ve not done social media for my private practice.” (Allison, 15:14)
“Do the math…figure out what the margins are. There’s relief in it.” (Allison, 16:40)
Warm, vulnerable, and pragmatic—Allison creates a judgment-free space that blends “feelings talk” with business logic, empowering therapists to act with confidence and compassion during potentially scary transitions. Both host and guest balance emotional transparency with humor and encouragement.
TL;DR:
Allison Puryear coaches a therapist through the real, often uncomfortable, financial and emotional process of leaving insurance panels. Instead of fear-based decisions, she advocates for math-driven clarity, authentic marketing, mindset shifts, and leaning into the strength of the therapeutic relationship. The message: most therapists are more ready than they believe, and there’s abundant support available for the journey off insurance.