Podcast Summary: Private Practice Startup Podcast

Episode 75: The Insurance Illusion – Real Talk About Private Practice & Insurance

Hosts: Dr. Kate Campbell & Katie Lemieux
Guests: Miranda Palmer, LMFT & Kelly Higdon, LMFT (Co-founders of ZynnyMe)
Release Date: March 3, 2018

Episode Overview

This episode tackles the "insurance illusion" — the common belief among private practice therapists that accepting insurance is the easiest and surest way to fill a caseload and build a practice. The hosts and their guests, Miranda Palmer and Kelly Higdon of ZynnyMe, debunk misconceptions about insurance panels, discuss business mindset in private practice, share insights on financial planning, and stress the importance of building a sustainable, fulfilling business — whether insurance, cash pay, or a mix.

The episode is packed with hard truths, practical advice, and engaging stories from therapists who have crafted six-figure practices and supported thousands of clinicians navigating these decisions.

Key Discussion Points & Insights

1. Origin Story of "ZynnyMe" (04:01–06:11)

• Fun backstory: The brand name “ZynnyMe” originated from Kelly’s old AOL email handle, “zinniahoo,” which became “ZynnyMe” when the domain "zinni.com" wasn’t available. The hosts and guests laugh about how business names can feel like “a bad tattoo” from early mistakes but eventually stick as your brand grows.

  "We don't recommend it – we usually say, just go by our names, but it's part of our story!" – Kelly Higdon (05:30)

2. The Insurance Illusion Explained (06:12–08:31)

• Prevalence of false beliefs: Many new therapists see insurance as a "get full quick" strategy, assuming that panels will guarantee a steady stream of clients and income.

• Burnout warning: In reality, accepting insurance often results in overwork, lower pay, administrative hassle, and eventual burnout.

  "I did insurance for a month, and then I realized I don't want to do this billing, I don't want to wait for a payment, all of that. It didn't fit with me being a solo practitioner." – Kelly Higdon (07:13)

• Varied experiences: Outcomes with insurance depend on licensure, location, and niche; research is essential to avoid traps.

3. Private Practice as a Business – Numbers Matter (08:32–16:50)

• Business mindset: Therapists must remember that private practice is a business. Success requires understanding expenses, income needs, and planning for savings, sick time, retirement, and taxes – not just comparing paychecks to past agency jobs.

• Do the math: Calculate your true hourly needs based on your goals (vacation, emergency fund, working weeks). Insurance reimbursement sometimes forces you to work much harder for the same income or raises ethical challenges around supplementing insurance with full-fee clients.

  "You have to start from a really clear place and know what is the average hourly that you need to be getting... If an insurance plan works with that, that might make sense for your business." – Miranda Palmer (09:43)

• Real-world example: Some clinicians face drastic rate cuts (e.g., $60 per session from Blue Cross Blue Shield in a populated area), requiring unsustainably high client loads (e.g., 10 clients in a day).

4. The Physical and Ethical Cost of Overworking for Insurance (12:36–15:02)

• Administrative realities and health consequences: Seeing clients back-to-back to make up for low reimbursement leads to administrative overload, missed breaks, stress, and health issues.

• Impact on clients: Therapist burnout harms client care and can be clinically and ethically problematic.

  "We have more and more clinicians that are physically manifesting their stress and autoimmune disorders... If you aren't taking care of yourself and you're seeing clients back to back, that has to have some sort of therapeutic impact." – Kelly Higdon (13:42)

5. Financial Clarity Tools & Eye-Opening Truths (16:07–18:11)

• Practical tools: ZynnyMe offers a "nuts and bolts" worksheet for bootcampers to calculate true hourly needs, incorporating “non-negotiable” and “negotiable” expenses and planning for time off.

• Aha moments: Therapists are often shocked by how underpriced their services are and why they struggle despite “charging enough.”

  "It's such a funny process... then it takes it all and auto calculates it and goes, okay, here's the average hourly that you need... and they're like, oh my gosh, I had no idea." – Miranda Palmer (16:50)

6. The Truth About Insurance Panel Referrals and Ideal Clients (18:12–23:05)

• Not all panels send clients: Some EAP (Employee Assistance Programs) and insurance plans offer misleading reimbursement structures (e.g., flat rate for up to three sessions) or require self-marketing anyway.

• Ideal client work: Insurance often means therapists see whoever comes along, not necessarily their ideal clients — leading to dissatisfaction for both client and clinician.

  "You know when your therapist is burnt out and not attuned and falling asleep in session. Like, this is a clinical issue..." – Kelly Higdon (20:11)

7. The Ethical Commitment and Real-Life Examples (21:06–25:54)

• Refer with integrity: Therapists are urged to refer out clients they can’t best serve, both for client outcome and systemic field reputation.
• Scripts and preparation: Kelly and Miranda stress the importance of scripts, processes, and confidence around discussing payment, insurance, and whether a case is a fit.

8. Building a Business That Sustains YOU (26:29–30:52)

• Numbers don't lie: Looking honestly at your finances, workload, and fulfillment is crucial. You aren’t stuck with panels you dislike — you can unpanel and pivot toward your ideal practice.

• Work-life balance is central: Therapists deserve a business that supports life goals, health, and financial well-being, rather than paycheck-to-paycheck survival.

  "Never feel like this – where you're at right now is where you have to be always." – Kelly Higdon (27:47) "You don't want to be coming into sessions... feeling sad realizing that I'm getting reimbursed $65 when I know what it takes to keep the lights on." – Miranda Palmer (29:51)

Notable Quotes & Moments

• On The Insurance Trap:
  "Insurance is great and it will sustain your family and you can make good money or oh, you can't make crap on insurance. And maybe all of those things are sort of right... but not wholly accurate." – Miranda Palmer (08:31)

• On Burnout:
  "I did insurance for a month and then I realized I don't want to do this billing, I don't want to wait for a payment, all of that." – Kelly Higdon (07:13)

• On Ethics and Clients:
  "How is it for me as a client to sit with someone who really doesn't want to be with me? And if you think that, like, they don't know. They know." – Kelly Higdon (19:42)

• On Financial Clarity:
  "It's such a funny process when they go through it because... here's the average hourly that you need to be taking home to reach these goals. And they're like, oh my gosh, I had no idea." – Miranda Palmer (16:50)

• On Referring Out:
  "I am my best clinically when I work with this kind of client, it's actually in the best interest of the client for you to refer out. It's not just about you. And like, I want to be picky. It's also about, like, having people get the right help with the right people." – Kelly Higdon (20:11)

• On Change:
  "You were never stuck. Right? 'I made a commitment to Blue Cross, Blue Shield.' It's okay, you can break up with them, it's okay. Like things change, you grew up out, I don't need you anymore, Blue Cross, you know, like you move on..." – Kelly Higdon (27:47)

Timestamps for Important Segments

• 04:01–06:11: ZynnyMe naming origin
• 06:12–08:31: The insurance illusion in private practice
• 08:32–16:50: The business side: financial planning and real costs of running a practice
• 12:36–15:02: The clinical and physical impact of insurance-driven burnout
• 18:12–23:05: Getting referrals from panels and the issue with ideal clients
• 21:06–25:54: Ethical commitments, saying no, and the stigma of poor fit
• 26:29–30:52: Final thoughts – numbers, change, building a sustainable practice

Resources & Free Trainings

• Over 10 hours of free practice-building training offered by ZynnyMe: zynnime.com/events (31:00)
  • Topics include fee setting, niche development, marketing basics, and strategic planning.

Tone & Style

Friendly, direct, humor-infused, and supportive. The conversation is open, honest, and rooted in real-world experience, blending practical advice with empathy and encouragement.

For Listeners: Core Takeaways

• Don’t assume insurance is an easy ticket to a sustainable private practice; crunch your numbers and weigh the hidden costs.
• You have options — you’re not stuck with panels or situations that don’t serve you, your clients, or your business.
• Build a business that fits your life and values, focusing on the clients and work you do best.
• Approach all decisions (insurance, fees, niche) from a holistic business mindset, not just a clinical one.
• It’s never too late to change course, and support/training is available for every stage of your practice journey.