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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 Therapists whose practices are full Is this actually the practice you want? If you're secretly stuck, you're cramming in evening sessions, glued to insurance panels, unable to raise rates. Limitless practice is your way out. Over 12 weeks, you'll make the changes you've been thinking about making for months so that you can work fewer hours while making more money. You'll design a schedule that actually fits your life and you'll say yes to only the clients you love. Together, we'll release you from your golden handcuffs. We're capping the cohort at 10 people because I'm personally running every individual, every group call, and every accountability check in. People on the wait list will get first dibs on those spots and then the opportunity to sign up will go out to the rest of my audience. So join the wait list now. I'm going to put the link in the show notes and I look forward to helping you get your practice exactly where you want it. Welcome back to the Abundant Practice Podcast. I'm your host, Allison Parir, founder of Abundance Practice Building. I am here with Sanjana Satya, founder, the founder of Thrisr. And we're going to be talking about out of network benefits. It's a really interesting time to be talking about private pay practices out of network benefits. I'm going to go into some of why I find it so fascinating right now because things are different now than they've been the other 10 years. I've been helping people with their practice. So yeah, I'm psyched to have this conversation. Thanks for being here.
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A
Yeah, no, thank you so much for having me. And I feel like there is such an evolution in this space, so I'm excited to kind of dig into it with you.
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Well, let's start with why helping people with out of network benefits, it's kind of a random niche, right? Given all the things you can do with your life. So why is this something you care about?
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A
Yeah. Yeah. I love that you asked that question. So I have been a long time therapy goer myself. So I've been doing this for almost like the past, you know, eight, eight years or so. And so I always found myself in healthcare. So I was working with like Genentech, consulting for them on pricing and contracting stuff. And then I did a short stint away from healthcare and I was like, oh God no, I need to go back into healthcare. And then I came to one medical and I was doing, you know, primary care there. Kind of along the same time I felt like my mental health was getting worse. And I remember going to my therapist for the first time was around Covid and she diagnosed you with generalized anxiety disorder. And I was like, oh my God, my life makes so much more sense now. So since then, you know, I have always seen an out of network provider myself because I just felt like I found a good fit and I wanted to see her. And I struggled with super bills and it was one of those things that I would send into the abyss and never hear back. And I was like, okay, well, you know, for the longest time I didn't even know what out of network benefits were. Kind of along the same time I met Ronak, who's the founder actually of Thrisr. He was kind of working on this. He also had been in and out of therapy so many times dealing with out of network benefits. And so he founded the company in 22. I met him as a friend and ended up kind of being like, wow, this is, this is kind of, you know, I would love to be a part of this. Mental health has been such a personal, you know, passion of mine and especially therapy has been such a huge part of my own life that I was like, wow, this would be kind of a dream come true to bring my like, health care background, but specifically my mental health passion together. So that's how I ended up here. And I've been here for about, you know, Pfizer was founded in February of 2022, so we're celebr starting our four year anniversary this month. And I joined in 2024. So I've been here for about two years. Fun fact. Ronick and I got married recently. We got married. Yeah, we haven't been like, we just, we just got married. So it's like now we're kind of going around being like, oh, hey, by the way, we're married. But we weren't like, oh, we were dating or we were engaged this whole time. We didn't do any of that. And so, yeah, so it's kind of like our baby. It's like our passion project. It's like our livelihood. Right. And it's something that we both deeply care about and it bonds us. And mental health has always been such a huge emphasis and focus for our relationship too. And to be able to like do this together with him is just like kind of really exciting. And so that's a little bit, a little bit about that. And then side note, I just got diagnosed with ADHD like two weeks ago and I was like blown, you know, I was like, wait, what? Like, you know, so now I feel like I have this whole other journey to be on. So it just kind of like mental health keeps coming back into my life personally, professionally, of course, while I've seen out of nowhere provider still. Right. Both psychiatrists and a therapist. And it's very expensive. So it just feels like the perfect use of my time in this, in this world to be like, wow, let's, let's do this. So, yeah, it's a little bit long winded story about myself.
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B
I love it. I love it. And I mean therapists love it. Right? So we want to know people. Yeah. Okay, let's talk some about getting reimbursed when you're out of network in general. I think a lot of people who take insurance don't really understand how it works to be out of network. I think sometimes people who have cash pay practices are kind of afraid to get in bed with insurance at all. And they're afraid that that means getting in bed with them to some extent. Let's kind of walk through. I can talk about it from a therapist perspective. You can talk about it from a client perspective. I can talk about it both, actually.
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A
Sure.
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B
So let's talk about, you know, you had these super bills that your therapist was giving you. What was your understanding of those? Granted, you worked in healthcare, so you probably had a better idea than most, but what was your understanding of what a super was and did as a client?
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That's a great question. Honestly, the first time I heard about a super bill, I never tied it without a network benefits. Like that connection wasn't made. It was just like, hey, here's an invoice. It's called a super bill. Submit it to your insurance. And I was like, okay, great. And I kind of was like, I have the Super Bowl, I don't know what to do with it. It was kind of around the time that I met Ronick that he coached me on, hey, auto network benefits. And that's what this is related to. And I was like, wait, wait, like I. My therapist doesn't accept insurance. So are you saying that I can still get reimbursement from my insurance plan even if she doesn't accept insurance? And he's like, that's literally what what Pfizer does. Right. So it was definitely a journey for me to be like, okay, so there are these out of network benefits in my insurance plan. The way I access them is a super bill. Right. And here's the process of doing so, like submitting it to insurance and then you have to actually wait for a reimbursement check back. So that's thing came full circle. Submitted it and didn't unfortunately, didn't have any luck with it. Unfortunately. But yeah, that was kind of the first time that I was like, oh, there is an avenue for me to get reimbursed via my insurance benefits even if my therapist doesn't accept insurance.
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B
Yeah. And I can say as a therapist, when I first started understanding super bills, I was like, oh, this is cool.
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Yeah.
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Like this makes it a lot more cost effective for the client than just paying my fee.
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Yeah.
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As a client myself with super bills, I have never been good at submitting them. Like, I would get them and be like, oh, yeah, I'll do that later. But I personally didn't have a system in place to actually do that later. So I never did. And thus left a lot of money on the table. As a therapist, if you are providing super bills to your clients, and that's what I have always typically done, there are some therapists who will go after the reimbursement themselves as an out of network provider. But I always gave it to my clients so that they could navigate that system and it wasn't more of an administrative load on me.
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A
Sure.
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But I would try to tell clients how to do it. And most of them were like me, where they're like, oh yeah. And you know, some of them would have to go less frequently because of the financial burden.
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Exactly.
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B
I mentioned earlier that it's really different in the last year than it's been in the past. And for me, as somebody helping people build their practice, because in the last year, I would say is the first time I've seen it be slightly easier for private pay practices than insurance based practices. And my hypothesis there is that like you as a client, you're searching for that fit and you have the resources to make whoever the fit is work. There are a lot of people who are just looking at their insurance list or they're looking on Big Therapy Tech. And as a result they're not. They're just like thousands and thousands and thousands more therapists that seem like they'd be just as good because they're not looking for somebody so specialized.
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A
Yeah.
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B
And so I think there's, I've always preached like, saturation's not a thing in there. Like, if there's a lot of therapists in your area, it's because there's a lot of clients in your area. But now with Big Therapy tech coming in, taking over Psychology Today profiles those kinds of things, there is more saturation in the market of people who are like, I don't know, I just, something's wrong and I need to see a therapist versus that maybe more specific. I don't know if this sounds snotty, I don't mean it to, but maybe more discerning client who's like, I have this problem and it is really messing with my life and I need help for this one problem. We all know there's like 30 problems under it, but for them it feels very specific.
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Yep. Yeah.
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And the private pay therapists who are speaking really well to that one problem are staying full and getting full in a way that seems harder for people who are taking any insurance. Any private insurance.
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A
Yep, yep. No, I hear you. I think it's I kind of saw this shift start to happen around Covid times, right? Because I think that's where people who hadn't paid attention to their mental health started to pay attention to their mental health because they were in isolation, they felt lonely. Like, I feel like that was kind of the perfect world circumstance to be like, oh, let's slow down and figure out what the heck is happening in my brain. Right? And that was interesting because the demand for therapy went up, right? But then the supply of in network therapists did not go up. And the reason it didn't go up is because historically, right, insurance companies don't take care of mental health practitioners. Really low reimbursement rates, a lot of admin work, a lot of, you know, therapists are in private practice and smaller private practice, right? How are they going to carve out time to deal with insurance while they're also wanting to support clients? And so I think that difference, that shift happened where there was so much demand and then it felt natural to be like, hey, like, I'm not going to wait six months to find an in network therapist. Like, I need therapy right now. Like, I really would like that for my, for my life. So I think that's where like more people, like clients started looking for therapy services. But I think it was also when I feel like maybe a lot of therapists were like, hey, like, I do want to meet that demand and I'm going to find other ways to make it happen. And that was kind of around the same time that we started talking about out of network benefits. Right? It should never feel being in network is the only way for a therapist to make their services accessible, nor is it on them to take on the burden of a system that just doesn't work. Right. It's totally not on therapists to do that. And so I think that's where I, at least I felt like more people were talking about therapy and super bills, at least in my friend circles and stuff. And I was like, like, I like that we're talking about this, right? So it's almost like the whole world kind of collided for this moment. It's very, it's kind of like cool that you felt that too. Like, in the past year, there's been kind of this rise in private pay therapy. I think this is a huge opportunity for private pay therapists, right? It's an opportunity for you to be able to say, hey, I'm going to take on the caseload that I want, the people that I want. I'm going to take care of myself so that I can show up the best I can for my clients. And insurance isn't the only way that I can be a quote unquote, accessible, ethical provider. Right. It's not. And so I love that we're as an industry talking more about this. I think you're absolutely right that in the past couple years there has been this evolution. Yes.
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B
And it's interesting because it's like the demand continues to grow, like unprecedented year over year of people seeking therapy services. And the supply also has grown significantly through some of these large companies, these tech companies. Yeah. And in some ways that's making it harder for independent solo practitioners who are trying to compete with them. If you step out of that competition, if you differentiate yourself, if you are very clear with a niche and your marketing is solid and you're speaking to that one ideal client, it helps people who can and will afford you make it this easy choice to choose you. Correct. And then if you're providing out of network benefits for them, like your super bill or things like that, then it makes it even easier for them to say yes.
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A
Yeah.
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B
I feel like the way that y' all do this at Thricer is really different from a lot of other companies and the way that they help manage out of network benefits. Can you describe that for people?
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A
Yeah, yeah, absolutely. So I know we talked about kind of in a non thricer world or norm, kind of normal super bills. Right. Let's say that, you know, the, the provider charges $200 for that session. Right. And so the way that would work for, for a client would be, I'm going to pay the $200 to my therapist for providing the service. He's going to give me a super bill that I have to then figure out where to send it to. Right. And that's actually a pretty hard thing like figuring out, okay, do I email it, do I fax it, do I do it on my portal, how do I even access my portal? No one actually uses insurance portals in most of their lives. Right. Okay. And so that's step one. They have to figure out how to submit it. Unfortunately, there isn't a way to track the claim after you send it out. So it's kind of just sends into an abyss and you're like, okay, I hope it reaches the right person. It probably will be about four to six weeks till you hear back, if you hear back. But hopefully you will. And then you will be like, okay, great. Reimbursement check for, let's say 150 is on its way. So that's how a normal super bill process looks. As you can imagine, there's so many friction points at every step of the way. Right. The first one is the actual claim submission. To your point, a lot of people are like, is this way too intimidating? I'm not even going to submit it or I forget to submit it. Right. So that's friction point number one. Two is even after you submit it, you have absolutely no transparency in what is happening with your claim. And then three is fine. Let's say I feel okay and I'm not overwhelmed by the process. I've made it this far. But still, you're gonna have to wait six weeks or more to get that reimbursement check back. And you fronted $200. Maybe if you go to weekly therapy, you fronted $800 that month. Right. And you haven't received anything back in reimbursement. And that can be very financially burdening for a lot of clients. Right. So we have at Thrisr tried to fix kind of those three main friction points that we've seen. And the way that we do it is we are first and foremost a clinician tool. So we wanted to go straight to the people who are providing care because they have access to their clients. Rather than going and trying to marketing out a network benefits to clients who don't know what the heck that is. We said, hey, clinician, Pfizer is a payment platform. So you can think of us similar to a stripe or a square. Essentially, you would use Thrizer to charge your clients for your sessions and collect your full fees. Right. So that works exactly like a payment platform for you. The benefit of doing so through Thrisr is that an out of network claim is automatically submitted to insurance every time you charge a client. So there's no more back and forth on super bills. You charge them for the session, it automatically goes to insurance. Typically, a client will have a deductible that they have to meet. I'm happy to kind of talk more about that later. But you know, deductible, your sessions would be applied towards the deductible first. And then we actually provide full kind of claim submission and management support. Right. So you're never left in the dark. You can go onto your portal anytime. You can reach out to our support team. It's been four weeks, six weeks. You're getting kind of anxious. What's happening with my claim? You can always reach out to us. We'll call your insurance to verify what's happening and then give you that status update. So that kind of is the this part two of that, part three, which is, I think what differentiates the most from other companies who are trying to do this is we have this thing call Thricer Pay. And what that is is that once a client meets their deductible, they actually have the option to pay a reduced fee upfront. We call it a copay, we call it coinsurance. Essentially we let you know what that out of pocket responsibility is for you as a client. We cover the rest of the fees for your clinicians so that they're still made whole upfront. And then essentially instead of the client needing to wait for that reimbursement back, driver waits for it back. And so we will take care of submitting the claim, managing the claim. We're kind of on hook. We assume the risk of getting that insurance reimbursement back. Once we do, we keep that reimbursement. And then, you know, the clients only paid a portion of their fee. Like in this example, let's say that, you know, $200 was the clinician rate, 150 was the reimbursement amount. Then they only paid $50 out of pocket, plus a 5% fee that we charge. And so they paid $60, which kind of feels like an in network copay. It's definitely more, but it feels like a lower amount that they can pocket and be able to put out like every week. Right. Clinician is still made whole at the 200. We only take a 3% credit card transaction fee from it. No other fees for the clinician. And that's pretty much it. And so we try to make the process super simple. Like it shouldn't feel like you're using this like clunky tool. Can I have to go out of my way to like incorporate this within my workflow? Which is why we were very intentional of like everyone charges their clients. Let's just automate it from that step. Right. And so, yeah, that's kind of how it works for us. We also actually recently came out with a free benefits calculator that you can put on your website. So there are other companies, I think, who charge for it. But that's step one, just having an out of network benefits calculator on your website. So it's super clear that our clients can go to your website and be like, okay, this provider isn't in network with my insurance, but oh, there's out of network benefits. Let me just quickly check if I have out of network benefits. Using this instant calculator gives you that it'll also give you, hey, here's what your reduced fee would be after you meet your deductible. So, yeah, that's usually step one. And then you kind of onboard them onto Thrizer. So, yeah, that was kind of the full journey of how it works being a Thrizer therapist.
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B
Yeah. And I mean, it's interesting because a huge differentiator is that y' all take on that financial risk.
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A
Yeah.
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The therapist gets paid their fee and y' all make sure that you recoup the money from the insurance. Y' all are the ones calling. You're not. That that burden isn't on the therapist and it's also not on the client. And I think that's a great differentiator that takes a lot of the frustration and risk out of it for. For the therapist.
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A
Absolutely. Yeah. And a question we get asked often that I'd love to address is, okay, what if the claim gets denied? Right. Because yes, that that can happen. What we do is that we. We feel pretty confident when we do provide that insurance estimate upfront that the client has out of network benefits. Right. So the question often doesn't become, is the claim going to get denied or accepted? It's more that, hey, how much are they going to get back in insurance reimbursement? And that it's still an estimate because we don't know exactly until we hear back on the first claim. But for whatever reason, let's say the claim gets denied. Usually we're able to fix it. It's just a billing error or something like that. We change the code. Like everything kind of works out. But if for whatever reason the claim isn't accepted even after resubmission, we actually absorb the difference for that for that session. So we won't go back to the client or the clinician and back charge them for that for that session or the number of sessions before we got that first claim denial. That's a strict policy we have. So we will let the client know, though, hey. That your past X number of sessions did get denied. We're trying our best, but if this continues to happen, you will be responsible for your. For your clinician's full rate. And you can, you know, we'll give you as much as we know from your insurance company. Please contact them directly. Right. But, you know, usually we're able to work it out. The denial rate is very low. And so. Yeah, that's usually so. You're absolutely right. We are assuming the risk of it, but we're able to do that because we've kind of figured out how to work with insurance companies. Right. And we don't get slapped with huge denials. If not, we obviously wouldn't be in business. And so, yeah, that's. That's kind of how we manage claim denials. Got it.
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B
Amazing. Well, how can people learn more about Thrizer if they're interested?
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A
Yeah. So I will make sure to actually send you a link, Allison, if people want to try it out for free, you can maybe include it in your show notes or wherever they can access a free trial with that. So they can actually try us out completely for free. They'll get waived credit card fees for, like, their first 2,500 in charges. Right. So they can totally tie us out. Try us out for free. If you're like, oh, I want to get started right now, just go to thrizer.com t h r I z-e r.com and yeah, you'll kind of be able to learn everything about us there. Definitely check out that free widget. You don't have to use Thrizer as your billing platform to have access to that widget. So if you're like, hey, I'm going to take my time to evaluate Thrizer, but I definitely do want to get the out of network widget onto my website so I can start helping clients right now. You can absolutely do that too. So, yeah, that's kind of how they can hear from us.
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B
Yeah, we'll put that link in the show notes to make it easy for folks. And yeah, thanks so much for your time today.
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A
Yeah, of course.
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B
I hope it empowers some people who maybe want to offer out of network benefits, but don't want the responsibility of, like, figuring that out with or for their clients. Make it an easier process for everybody.
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Absolutely.
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B
Yay. Well, thanks so much. Take care.
- [25:49]
A
Cool. Thank you for having me. Bye.
- [25:54]
B
If you're ready for a much easier practice, TherapyNotes 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 newbie, grab our free checklist using the link in the show notes. I'd love for you to follow rate and review, but I really want you to share this episode with a therapist friend. Let's help all our colleagues build what they want.