Episode #766: Two Years of Almost — Getting Off Insurance Panels for Real This Time

Summary

Abundant Practice Podcast
Episode #766: Two Years of Almost — Getting Off Insurance Panels for Real This Time
Host: Allison Puryear
Guest: Rebecca Smith
Date: June 13, 2026

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Episode Overview

In this episode, Allison Puryear welcomes Rebecca Smith—Limitless Practice alum and private pay therapist from New Orleans—to address a prevalent question among therapists: How can you finally leave insurance panels and transition to a private pay practice without sacrificing financial stability? Drawing from both their experiences, Allison and Rebecca explore the fears, strategic considerations, and actionable steps for therapists contemplating this transition.

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Key Discussion Points & Insights

The Fear of Leaving Insurance Panels

• Listener Question: "I have been telling myself I’m going to drop my two biggest insurance panels for almost two years now, but every time I get close... I convince myself the timing isn’t right or my practice will fall apart. I have a full caseload and I know the math probably works, but the fear feels bigger than the logic. How do therapists actually make this move in a real strategic way without watching their income crater in the process?" ([01:29])

The Hope and Danger of Waiting for the "Right Time"

• Allison: "Is the timing ever right?" ([04:02])
• Rebecca: "No, I mean, I think the timing was right in 2021... In 2021, I was like, yeah, let’s rip off a Band-Aid. Let's just get off insurance... Now, I approach it very conservatively with people." ([04:02 - 04:46])

Rebecca’s Story: Full Caseload, But No Free Time

• Rebecca: "I was seeing 35 clients a week, sometimes more... My life is so much better now. I’m making way more now, seeing about 20 clients a week. It’s ridiculous how lovely that is." ([03:12])

Acknowledging the Fear and Reality

• Rebecca: "I also needed to realize that I had to lose clients. I was so scared to not see 35 a week." ([06:04])
• "Did I decrease? Probably a bit lower than I wanted to. Yes. And then I built back up. But did my practice fall apart? No, it changed and I rebuilt it in a much better way." ([07:18])

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The Myth of the "Perfect Time" and the Reality of the Leap

• Both hosts agree there isn’t a perfect time, and some discomfort or uncertainty is inevitable.

Rebecca: "There never is a right time. The timing is never going to be right." ([07:05])

Allison: "Your practice falling apart is a very broad statement." ([07:17])

The "Jump" With a Plan

• Rebecca: "They just frickin' jump." ([07:49])
• Allison: "I think you do need a plan. You need to know how to market first. A lot of people on insurance have never had to market." ([08:02])

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The Strategic Approach: Marketing, Niching, and Community Support

Build a Marketing (and Support) Plan

• "Make sure you know what you’re doing to get clients in the door so that they want to see you no matter what... You are so niched and so specific about their daily lived experience in your marketing that you are the one for them." ([08:28 - 08:57])

• Rebecca describes supportive aspects of the Limitless community: "It's like somebody’s holding your hand and pushing you off a cliff at the same time." ([06:31])

Develop a Needle-Thin Niche

• "You have to have a niche that really works for you, that is needle-thin and that other people... will be relieved to hear you say, 'Oh my god, we found her. We can send all those people to her.' So it’s a very specific niche, that calling out, 'I am your person.'" ([09:00])

• Allison: "It’s a service to be niched, truly. It makes people feel hope when they find you." ([09:31])

The Referral Network Effect

• Rebecca elaborates on how a clear niche (e.g., OCD) makes her a go-to referral for therapists who don’t provide exposure therapy, facilitating private pay transitions. ([09:44])

Real-Life Niching Examples

• Allison shares her own experience targeting business owners who are moms: "Everything on your website is exactly what I’m going through... I needed to find somebody who gets that, who’s also a mom, who’s also..." ([10:14])

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Notable Quotes & Memorable Moments

• Rebecca: "It was the best thing I’ve ever done. My life is so much better now..." ([03:13])
• Allison: "It allowed you to have an actual life and to be more the mom you want to be and be able to be, like, the friend and the partner..." ([07:35])
• Rebecca: "I took a nap yesterday, Allison. In the middle of the day." ([07:42])
• Rebecca: "It's like somebody's holding your hand and pushing you off a cliff at the same time." ([06:31])
• Allison: "It’s a service to be niched, truly... It makes people feel hope when they find you." ([09:31])

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Timestamps for Important Segments

• 01:28 – Listener question about fear of dropping insurance panels
• 03:01 – Rebecca’s personal transition off insurance panels
• 04:02 – Discussion on the reality (and myth) of "perfect timing"
• 06:31 – The emotional experience & support of making the leap
• 07:49 – The necessity of marketing and having a plan
• 08:57 – Niching and its fundamental role in a successful transition
• 10:14 – Real-world examples of effective niching and marketing
• 11:18 – Reference to free worksheet: “Things You Don’t Need for a Private Pay Practice”

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Action Steps and Takeaways

• Don’t wait for a perfect time. Progress is found in action—even if imperfect.
• Have a plan. Understand your numbers, develop a marketing strategy, and learn how to articulate your niche clearly.
• Lean on support and community. Identify mentorship and peer accountability for courage and clarity.
• Embrace discomfort and loss. Dropping panels may mean an initial dip in clients, but leads to a more aligned, abundant practice.
• Niche down. Become the obvious choice for a specific population, facilitating easier marketing and robust private pay demand.

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Resources Mentioned

• Free Worksheet: "Things You Don’t Need for a Private Pay Practice" [Link in show notes] ([11:18])
• Abundance Practice Building Programs & Community: learn more here

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For therapists feeling stuck, Allison and Rebecca’s advice is clear: get strategic, get support, and just leap. There may never be a perfect moment, but with the right preparation and a needle-thin niche, a thriving private pay practice is well within reach.

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Transcript

[A]

Foreign. Welcome to Ask Abundance. Y' all ask the questions about having a fun and thriving practice. We answer them. We have a worksheet for you today so you can bring this answer into your life. If you want support in your practice, we have you covered with on demand or one on one support. Links for the worksheet and support are in the show Notes. Can't get enough Ask Abundance? Check out our YouTube channel for the entire library. The VC backed platforms made promises and then they changed the pay, they changed the rules and they made it clear that those promises were never really about us. I built platform to private pay for therapists who were done being dependent on companies that have already shown them who they are, but who aren't ready to blow up their income to get out. You don't have to leap. I'll show you how to bring in private pay clients while you stay on the platforms for stability and then replace graduating clients with private pay clients until the math works in your favor. If you've been circling this decision, hit the link in the show Notes. Doors to this cohort close July 3rd.

[B]

Hey hey.

[A]

Welcome back to Ask Abundance. Today I'm joined by the lovely Rebecca Smith. Rebecca is a limitless practice grad who came aboard Team Abundance and she has a premium fee private pay practice in New Orleans and she is great at helping Abundance therapists imagine what's possible for them. Here is today's question. She's going to give it to us.

[B]

Thanks friend. Okay, this one says I have been telling myself I'm going to drop my two biggest insurance panels for almost two years now, but every time I get close to pulling the trigger, I convince myself the timing isn't right or my practice will fall apart. I have a full caseload and I know the math probably works, but the fear feels bigger than the logic. How do therapists actually make this move in a real strategic way without watching their income crater in the process?

[A]

Yes, and you and I both have a lot to say about this.

[B]

I do? Yes.

[A]

First, I want to thank our sponsor, Therapy Knits, though. I've talked about them for years and know their features by heart. But what really sets them apart is that they genuinely care about your experience. It's not just about troubleshooting, though. They'll do that too. They actively implement user suggested features like Therapy Search, secure Messaging and their AI notes feature, Therapy Fuel. Everyone at TherapyNotes believes in the product and wants you to love it too. Plus, they're independently owned, which means no venture capital and no pressure to prioritize investors over customers. This independence allows them to keep their prices fair, to focus on innovation, and to prioritize their customer experience. With over 100,000 therapists already on board, they've proven that you don't have to compromise success for quality. If you're ready to see for yourself, you can try TherapyNotes free for two months with the code [e-mail]. all right, well, you have the most recent experience with this personally. Should we talk about that?

[B]

Yes. But I find myself, I'm like envious of this asker, this therapist, because I was only on one panel, right? And so when I went off insurance, it was like all or nothing. There was no cute little step down process. You have to just jump. And I think that there's something cool about being able to kind of step down. But the biggest thing I will say is it's the best thing I've ever done. My life is so much better now. I was seeing 35 clients a week, sometimes even more. It was truly bananas. And I'm making way more now, seeing usually about 20 clients a week. And that's much, it's, it's ridiculous how lovely that is. And I think that the thing that I'm looking at here is, and maybe this is a question for you, is the timing ever right?

[A]

No, I mean, I think the timing was right. In 2021,

[B]

RIP. That would have been nice.

[A]

That would have been really nice for the people who are asking today. I mean, in 2021, I was like, yeah, let's rip off a span day. Let's just get off insurance. You know, like when I was advising people, it was a very different conversation than it is now, where I approach it very conservatively with people. And I do this mainly with our limitless practice folks, as you know, who are people who are. They're full and they're wanting to make a big change. And for a lot of them, that is getting off insurance panels. And so I'm coming in with like, okay, let's look at how many people are on each of the insurance panels you're on. If they're on multiple and which one's the biggest pain in the ass, which one pays?

[B]

Yes.

[A]

Which.

[B]

How will your life be better? Make your life better Faster? Yes.

[A]

And still the problem is, even if you're just on one insurance panel, it's really easy to get full just with that one insurance, if that is a large payer in your area or in your state. There was a time when Blue Cross Blue Shield had like 90% of North Carolina. It doesn't anymore. But it was like, everybody had Blue Cross Blue Shield. So if you wanted to take insurance, like, you were golden. If you didn't want to take, like, it didn't matter if you got off Cigna, because nobody had it anyway. So kind of the situation you were in, which was rocky, we should say.

[B]

Yeah, it was.

[A]

It was rocky in the moment. But you had, because you were in Limitless, built out what your marketing strategy was, and you were implementing it.

[B]

Absolutely. And I also will say that my previous plan had been, I'm excited for this person that they feel like they're ready to drop the panel, because similar was on Blue Cross Blue Shield. Everybody had Blue Cross Blue Shield. So even if I wanted to try to, like, build up my private pay side, even people who were willing to pay me a private pay rate already had Blue Cross Blue Shield. I was tied into that system anyway. Right. And so it really was the only way to take control of my practice. And it was rocky at first. I won't say it wasn't. I also needed to realize that I had to lose clients. I was so scared to not see 35 a week.

[A]

Right. Even though your goal was to see fewer.

[B]

You know, sometimes life is complicated, Alex.

[A]

I know. I remember.

[B]

It's so funny now when I talk to people who are thinking about doing Limitless. I don't know if I told you this, but the way I describe it is I was like. It's like somebody's holding your hand and pushing you off a cliff at the same time.

[A]

That's kind of how I am with everyone everywhere.

[B]

Yeah, absolutely. Because it's scary knowing that I had you and my limitless practice friends who were, like, not only going to be so supportive and so knowledgeable, but also they were going to, like, let me know if I came in the next week and didn't do the thing.

[A]

Right. Right.

[B]

Because there never is a right time. The timing is never going to be right.

[A]

Mm.

[B]

Your practice falling apart is a very broad statement.

[A]

Right.

[B]

Did I decrease? Probably a bit lower than I wanted to. Yes. And then I built back up. But did my practice fall apart? No, it changed, and I rebuilt it in a much better way. But it was not a death sentence to my practice.

[A]

Right. It allowed you to have an actual life and to be more the mom you want to be and be able to be, like, the friend and the partner and all these things.

[B]

I took a nap yesterday, Alison. I love it in the middle of the day.

[A]

Good.

[B]

I think that the final question. How do therapists Actually make this move is one part of it in a real strategic way. Without watching their income crater, how do they make this move? They just frickin jump.

[A]

I think you do need a plan.

[B]

Yes.

[A]

You need to know how to market first. A lot of people on insurance have never had to market. One of the things we talk about in Limitless is not just know how to market, but to be actually actively doing it and troubleshooting. And in Limitless, it's great because like, I can be like, okay, this is good and this is not good. Here's how to shift it. And you've got your Limitless folks saying the same thing who have, you know, varied experience as well. But this is not a. You just get off the panel. That would be freaking terrifying for anybody. It's like, make sure you know what you're doing to get clients in the door so that they want to see you no matter what. They don't care that it's private pay because they have this problem. And you are so niched and so specific about their daily lived experience in your marketing that you were the one for them.

[B]

Yeah, the niche is what I was about to bring up too. You have to have the marketing in place. You have to have a niche that really works for you, that is needle thin and that other people, not just the client, but probably other clinicians or other people who. Other referral sources will be relieved to hear you say they're, oh my God, we found her. We can send all those people to her. So it's a very specific niche that calling out, I am your person. Mm.

[A]

It's a service to be niched, truly. It makes people feel hope when they find you. So it's not just to be niche, but to also market so they can find you and feel relief and hope.

[B]

Yeah, absolutely. And I feel like that for the potential client and also for the referral sources. If your niche is like people who really like therapy. My niche is. There's a lot more to it. But one of the big parts of my niche is OCD and having so many other therapists who are like, oh God, yes, I will you do the exposures with them? I'm like, thank you. Send them my way. If you have something that other people are excited to send you, it becomes a lot easier to get off insurance.

[A]

Yeah. Yeah. I just had a call. Was it today? Actually with a potential client for my practice, working specifically with business owners, and she was like, everything on your website is exactly what I'm going through. And like most therapists, don't understand the demands of owning a business. And I needed to find somebody who gets that, who's also a mom, who's also. I think she had, like, entered a bunch of stuff into to chatgpt and ended up finding me because she's like, I want somebody who's a mom. I want somebody who's owned businesses. I want somebody, you know, like, well, all right, here I am. Well.

[B]

And I think it's funny because I feel like so much of the time this is where our conversations turn is like, this is how marketing can be really great. And this is why having a niche is so vital. Whether whether the question is dropping insurance or moving to a new town and building a new practice or raising my rates or what, it all funnels down to that principle. And I think that's really cool.

[A]

Yeah, absolutely. Awesome. Well, we do have a free worksheet today. It is things you don't need for a private pay practice because sometimes maybe you get to the point where you're like, okay, this is going to be the thing that I do. I like this idea. And then you've got your gumption up to do it, but then you're like, oh, but I've got to have a really fancy office or I've got to have a really. So these are like, this is going to set you straight. So you guys can get that free worksheet in the show notes if you're listening on the pod or in the. You can say the word sheets if you're on social media and I'll get it to you. All right, cool. I'll see you next week.

[B]

See you then.

[A]

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. I hope that helped. Please get in touch with any of your questions for Ask Abundance. 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 really want you to share this episode with a therapist friend. Let's help all our colleagues build what they want.