A (2:48)

Yes. So we're honored to have you all here on the podcast and honored that you're our sponsors. So Zinnime is really cool. They actually are super passion and they offer a boot camp actually once a year. So once a year you get to enter this amazing practice building boot camp where they basically talk everything private practice building, growing and retooling your practice so they meet you all along the continuum. You can enter one time a year and then they have a two week training that offers all sorts of courses and live coaching and support and resources and just an abundance tools for you guys to grow your practice.

B (3:27)

Don't forget about those amazing giveaway goodies they have. They usually have this long list of awesome free stuff and opportunities. So definitely if you are starting up, you definitely want to check out their bootcamp.

A (3:38)

Yes. And we will make sure to put the link for Zinni me and our sponsorship notes so you guys can check it there.

B (3:44)

So without further ado, ladies. Howdy, Howdy.

D (3:48)

Hello, hello.

A (3:49)

It's so exciting to have you guys here And I really want to know, how did you guys come up with the name Zinnimee? Cause Katie said there's a story about.

C (3:56)

It but I haven't heard it.

A (3:57)

And I'm sure our audience is wondering Zinni what?

D (4:01)

We wonder it too sometimes.

C (4:03)

Yeah, we do. So it's actually my fault a little bit. Actually. It was my email handle zinniahoo.com way back in the day because it was something that wasn't taken, I think actually maybe even on like aol. Like we're going that far back.

A (4:21)

Way back in the day.

C (4:22)

Way back in the day.

B (4:26)

Like that back in the day.

C (4:28)

Yeah, that kind of back in the day. And so I actually failed a licensing exam by one point and I started an online study group because I needed people to study with and nobody I'd gone to school with was in the exam process yet. And when you start things on Yahoo groups back in the day, you use your email and so. And they had like a handle or what have you. So A lot of people knew me as Zinni and this study group kind of like blew up and took off. And when we were naming the business, there were a lot of people that had known me from that study group that I chatted with and like, oh, you should use the Zinni thing.

B (5:03)

And I'm like, really?

C (5:05)

And they're like, yeah. And we're like, that sounds like fun. It's a horrible idea. It's like so weird and bizarre. And then zinni.com was taken. And so we're like, let's just do like Zinni me, like inspire me. We'll just like make up a word and it'll just be cool. And mostly it's just confusing. We don't recommend it. Like, we really don't. We usually. And now we go by mostly Kelly and Miranda. But it's a fun part of our gallery.

B (5:30)

Yeah, it's so funny. As you guys talk about that, I think of like all of our own private practice blunders and no one, no.

A (5:36)

You know, we did the.

B (5:38)

Okay, what name should I have now? Now I'll get my domain and now incorporate. Like, we didn't know anything about branding or ideal client or. So I, my incorporation is Lemieux Solutions Unlimited. Right. And then my, my website is family and couples counseling. Obviously, Lemieux Solutions Unlimited points to families and couple family and couples counseling. But I kind of think of it as like a bad tattoo. Like it just doesn't go away type of thing. Like there's nothing, I mean, you could, you could do a DBA or whatever, but you always have it. But then at some point it sticks.

C (6:05)

Right.

B (6:05)

Like people, I'm sure, refer to you guys as the Zanimi ladies or things like that. They do, yes.

A (6:11)

So thank you for sharing the story. Kelly and Miranda and the Zinnieme girls. Awesome. Yeah. So let's dive into our topic about insurance. Lots of private practitioners think that insurance is the get full quick strategy. And so a lot of times they think more short term and oh, I can fill my practice so easily. And then they find themselves like, drowning because they're seeing so many clients and having to work so much harder than self pay practices. And Katie and I built our six figure private practices and coach other practitioners to do the same. So we really don't have a lot of experience using in network insurance. And before we hit the play button or the record button here for you guys, we were talking with Kelly and Miranda and you guys don't really have much experience doing in network Insurance either. So share with us your thoughts about using insurance in your practice versus self pay.

D (7:05)

And yeah, that's what we talk about here in our boot camp alone. We have people who have straight up full insurance practices and cash pay only and hybrid where they have a mix. And I did do 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. I never wanted to add clinicians in my practice. I came from managing the largest clinic in my county. I didn't need to manage more people in the business I was creating. And so when I did the numbers, it made no sense for me to work twice as hard. Now insurance really varies, like on your licensure, the area you're in, the type of service you provide. It just takes research to really understand. And when I first started, I admittedly didn't do my research and quickly got off. And it's an uncoupling process that can be very scary for people. I had a session today with a coaching client of mine and she's making that change and you know, it filled her up but it burned her out. And so undoing it is a lot of work.

C (8:31)

I think there is this like the reason we talk about the insurance illusion, right? And this is, and this is a lot like the reason that we feel so comfortable talking about insurance, even though that's not how we build our practices, is because we've worked with hundreds of therapists from all over the country, all over the world, and we understand that it's not a black or white situation when it comes to insurance. And there is this sense of everybody should take insurance because this is what's right ethically or nobody should take insurance because this isn't right ethically or 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 and all a little bit true, but not wholly accurate. And so one of the things that we really teach people is that part of starting a private practice, it's important to realize you're starting a business, this is a business. And as you're starting a business, you come up with a plan and you get clear about what your expenses are, what your financial needs are, not just for your take home income, but for having some savings, having sick time, having your medical coverage, you know, having things together for your technology when you're an employee, your boss or your agency, your nonprofit board, whoever else, they take care of all these other moving parts. And so whatever your hourly pay is, it really starts at something totally different and then it whittles down to you. So then we look at our hourly thing go, oh, we used to, you know, I worked at an agency and I made $25 an hour. Wow. If I could make $50 a session, that's amazing. But then we don't look at like the bigger picture of this is how many hours actually have to work. This is the amount of hours it takes to run all these administrative things and tasks because I don't have a whole team of people behind me. Here are all these taxes I need to pay that I've never had to worry about before. Here are all these expenses. Here are all these things. Here's my vacation and sick time and all these things that all connect in with. So you have to start from a really clear place and know what is the average hourly that you need to be getting for each time you sit down with a client. And that has to set the stage for what you do and what kind of things that you explore. And so if an insurance plan works with that and fits with that, that might make sense for your business. And if you have the process, if this is a skill, or if you can automate that billing through a great practice management system, like simple practice or something like that, that could be fantastic. It could be a great fit for you. But if that amount that they reimburse in your county for your service is half the amount that you need hourly to sustain your business, then that means you are going to have to charge your full fee clients about twice as much to make up for every client that you take insurance. So you have to be able to do the math and realize that when you charge them full fee, you're actually supplementing that insurance plan that you're accepting over here. Now we have clients that are in certain areas of the country, like cost of living in la high, pretty high. And they are getting reimbursed half of what our clients are getting reimbursed in rural Alabama.

D (12:04)

Yes.

B (12:05)

Yeah.

A (12:05)

That's so bizarre.

B (12:06)

It's interesting. I just had a coaching consultation with someone yesterday right in the same spot. Right. She wants to stop using insurance. And so she's in the Tampa area here in Florida, which is a populated area. And she had shared that Blue Cross Blue Shield just reduced the rate. Now she's only getting $60 per cl. She's working like she told me, she had a 10, 10 hours of seeing clients on Monday. That to me, I don't, I couldn't do that. I can, I can work for 10 hours, but not seeing clients, that's just not sustainable.

C (12:36)

It's not. Yeah, there are, there was a. And this is not the only person, but there's a lot of therapists that have made the decision. They've asked for raises from their insurance plans. Insurance plans have declined it or they've reduced things and so they looked and gone. Okay, well, I've got 40 hours. What can I do? Well, you know, the insurance code is 45 to 50 minutes. If I drop it down to 45 minutes and I get rid of my 15 minutes or 10 minutes between clients and I just see people back to back, I can manage that. And I can squeeze in two more clients a day, so I can see 10 clients instead of seeing eight clients or 12 clients or 13 clients. When you go to the bathroom, how do you write your notes? How are you making sure that you're really processing what happened clinically in that session and you're really present emotionally and you're fully engaged? How are you actually, like, teaching what, like really teaching what you teach your client when you're not friggin living it?

B (13:35)

I also wonder, how do you stretch in between or how do you answer a text or a call? You don't. Exactly. It's crazy.

D (13:42)

You don't. And that's why we have more and more clinicians that are physically manifesting their stress and autoimmune disorders and all sorts of things. They don't have time to be sick. They don't take vacations. We hear the horror stories. I mean, we've been doing this for many years and we've talked to thousands, literally thousands of clinicians, and it breaks our heart. And when people join boot camp, they're often like, oh, are you gonna make me get off insurance? Well, no, we just want you to look like, really understand what you're doing to your business and to yourself. And how does that really translate clinically? Like if you aren't taking care of yourself and you're sitting here with clients back to back, that has to have some sort of therapeutic impact. I really believe that. So we just want people to open their eyes and just look at numbers and also check, like, how they feel physically and these things. Because we can get so stuck in a grind that we become immune. You know, kind of like what they say, when you put a frog in the pot and the water starts to boil, they don't know that they're boiling to death. Like that's kind of what happens to us sometimes if we aren't paying attention.

B (15:02)

And I love, I love Miranda, how you talk about, you know, not just looking at your expenses and what you want to make, but you want to also look at savings, vacation, retirement, like even emergency funds. I could go on and on about other money things and investments and things like that, but it's so essential. And we're definitely not taught that. We do look at what you said is just kind of coming in and being like, oh yeah, $50 is more than 25. Fantastic, I'll take it. But you're not considering those other things. And I remember I always say, I grew up in community mental health. I worked there for 11 years and my staff would say to me, like, well, if they're getting paid $75 an hour for me to see this one client, like, why am I getting, you know, 30 bucks? Because you don't understand all the other stuff, right? Like you said, sick vacation, medical leave act, those things are all taken in consideration and then paying administration, you know, so we have to think of those things all encompassing and not just look at what our expenses are and what we'd like to make. Because you're right. And I think, I love that, you know, if you only want to work 48 weeks and you want to take four four week vacations, four one week vacations, how do you also incorporate that into your plan?

C (16:07)

Yeah, we have, we call it, well, we have, it's called a nuts and bolts worksheet, but it's this really thorough Excel spreadsheet that our boot campers go through that has a list of here are your non negotiable expenses, and here are your negotiable expenses and going through what happens monthly and annually and how many weeks do you want to work per year and putting away for illness and all these different things. And it's such a funny process when they go through it because they start just filling out the information in these discrete formats and then it takes it all and auto calculates it and goes, okay, 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.

D (16:50)

Right?

C (16:52)

We give this general, like here's the general equation when we talk about how to set fees, but when they actually look and start to get clear and they're like, oh, this is where my money goes. This is why even though I decided to be bold and I charged $100 a session, why I'm still really struggling, and why I didn't have enough money at the end of the year to pay my taxes. This is what's happening. This is the bigger picture. This is why I don't have money in savings. This is why I don't have money in retirement. This is why I feel sick to my stomach and I end up going to work even though I'm feeling ill and I'm not fully my best for my clients. And then I feel guilt and shame because I'm not really ready to do that. I think the other illusion, beyond just this numbers part, is this illusion that insurance is going to fill your practice. There are insurance plans and EAP plans that will refer you to oblivion, and you will get tons and tons of clients. You'll get 10 clients a day. Some of them reimburse as low as $33. One of my favorite EAP tricks that I've seen multiple times is it says you'll get reimbursed $99 or $110 for up to three sessions, not each session.

B (18:11)

Up to.

C (18:12)

Up to. In other words, you get a flat rate of $100, and whether they come to see you once or three times, you'll do that. And I learned about this from another clinician when I was actually working for the county who was like, oh, yeah, when the EAP people come, I just refer them out and say, you don't need to come back because it doesn't work for. And I'm like, that's the most, like, you basically, like, make it so they don't want to come back because it makes you money, but you're still accepting these clients. Like, it made my brain hurt. But you have a lot of other insurance panels where you get on the panel, but you still have to come up with a website. You're developing your niche. You're going out on marketing, you're doing all this networking. You're out there spending all this time to build your business. Then you're getting this reduced rate that's supposed to be this reduced rate because you don't have to worry about getting clients. But you just went out and worked your business. Just like you're a private pay client or a private pay practice. You didn't really get any benefit from that whatsoever.

B (19:21)

And one of the things that I see in regards to taking insurance is a lot of times you're not always working with your ideal client, right? You're working because you're on the insurance plan and it's not the client that fulfills you. And so if you really just don't like working with depressed clients or anxious clients and you have a whole day filled with that, like, how does that impact you? How does that impact your well being? And that's really important to look at.

D (19:42)

What does that do for the client, though? 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. Have any of I've been in therapy. I know, like, you know, when someone's present, when there's the synergy, when the light bulbs are going off, when it is a good solid relationship. And you know, when your therapist is burnt out and not attuned and falling asleep in session. Like, this is a clinical issue and it's. And I think there is a part of us that we're taught, like, you're here to help people, so you help whoever comes through the door. Especially when we're trained up in nonprofits, in hospitals and all these kind of places that take the masses, you know, they take them all in, and we will help you. And people struggle with this. Well, what does it mean if I don't want to help that person? I don't think it's flipping the mentality to I'm wanting the best for that person. And I know that I am not the best for this kind of work. 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.

B (21:06)

Yes, yes, absolutely.

C (21:08)

And we learn it in grad school. Like, we are taught this in grad school. It is clear it is part of the ethical code. This is part of, like, scope of practice. This is part of the issue. And then we immediately go out to our traineeships and our internships and our externships, and then it's, oh, no, no, no, that's not how real life works. And I think this isn't just an insurance issue. I know we're kind of talking about this, but yeah, it's a desperation issue. This is a nonprofit mentality issue. This is a, you know, you got to take what you can get. This is this other issue that can happen, whether your insurance or your private pay, either any of us can be susceptible to this. And one of the Things that we ask when we have a couple of trainings where we just ask people, like, please, ethically, can you make the promise that you're never going to accept another client out of the sense of you need money, that you're gonna say no to clients that are not right for you, that you're gonna be ethically sound and refer those people out and just be your highest and best self. And if we are all doing that, you know, we can all refer to the best people. And everyone has like a really important role. And when you look at how this plays out, people have better outcomes, you get better referrals and people, you get better reviews. Like, if you go to someone and they're like, how was therapy? Oh, well, I don't know. I went for like three months. I mean, I talked, I mean, whatever. I went to therapy and it like blew my mind. Everyone should do therapy. This is fantastic, right? It's. You're not just gonna not have a great outcome. Client's not going to stay, they're going to terminate early, they're not going to give you referrals, but you're actually bringing down the referral. Like, I'm sorry, the, like the. What is this field, profession, the field.

D (23:05)

It contributes to the stigma. It's hard enough to get enough to get counseling, let alone when we prove that. It's when we, like, are not providing.

B (23:15)

Great service, you know, and it's funny and I think of like, even our own coaching, right? And so we get people asking about, like, starting up practice. And Kate and I are just like, ah, you know, and it's like, we're so grateful for you guys because it's like we can say, no, these are the ladies who want to take you start up, you know, growing to, you know, retooling your practice, where we really want to focus on marketing and other things. And it just feels good to just be able to support people for exactly what they need and say, these are the best people for you. And like you said, Marina, is that they feel grateful, right? Because they are going to the right place and it's just so important. And as you're talking, I'm just reminded of when I first started in practice. I had a colleague refer to me, a grandmother who was her adopted mother and a seven year old. And I had worked with children and families a lot, but I was transitioning way more towards teens. And it was almost painful working through the session because my mind is so abstract. Like when the kid would look at me and be like, I don't know what you're saying. And I'm like, I don't know how to connect with her. And I don't do play therapy. And it was just like. And then because they got attached to me, it was like, well, we don't want to leave you. And I'm like, but I'm not the best for you. Like, let me help you find somebody. So, you know, it almost kind of works in this interesting way, right? They build a connection with you, and you're realizing, I'm not doing good work for you. And now how do I convince you to go somewhere else? Because it's not working for me, and it's ultimately not working for you. So eventually I was able to get them to someone who did work with children, and it was a great win, win. But I could totally see exactly what you guys are saying. And like I said, Kate and I made so many mistakes, so we get that too. But it is. It's so much more rewarding to really work with your clients. And like you guys are saying is they feel that, and it's just so essential and.

C (24:51)

Well, and I think, too, like, we're not always prepared for these business aspects of private practice, right? Whether it's insurance or something else, how to have this conversation on the phone and tease out whether this is an appropriate client, prepare them for how therapy works, to talk through this conversation about payment, whether it's insurance, whether it's out of network, in network, whatever the scenario is, to really guide people through this process and give them the words and phrases. Because we don't have any of that. We're not learning that in the nonprofits that we're changing for the most part. And so when we give people scripts about how to have those conversations and how to answer questions and have conversations about how insurance works and how it doesn't, and what it looks like to do private pay, what it looks like when you're in network, out of network, it's amazing how that just settles the process. And it allows therapists to create this really safe container. Because if you don't understand your container, whatever that is, and that includes how insurance works, it's going to get in the way of the whole process.

D (25:54)

Right?

C (25:55)

And so understand that when you decide to be in network, and it can, and it's a great financial decision for you, it's also, you're kind of making a commitment to that process, to understand that process, to have that conversation, to have a biller or to really understand the billing and to get to know that process because if you don't and you're not getting reimbursed, you're not going to get paid, that's going to impact your clinical work and that's going to impact the relationship with your clients. So you need to look at that big picture and create some time and create a process for that.

B (26:29)

Awesome. Any final thoughts on your topic today?

D (26:34)

Well, I would just encourage anyone that's listening to look at your numbers. It is scary sometimes but they're more factual than the stories in your head. And when you really take the time to nurture the financial foundation of your business and these kinds of decisions that will ultimately impact the clinical outcomes in your practice, it will benefit you to do that now instead of way later and going back and having to correct. We can always correct also. So if you're like in insurance and thinking, oh my gosh, what was I thinking? Why did I do this? This isn't working for me anymore. It's alright, like we all learn and you just make a change and you can, 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 and so never feel like this. Where you're at right now is where you have to be always.

B (27:47)

And I also think what I'm kind of taking away from your guys message too today is that when you talk about the insurance illusion. So if you're coming in a practice, like Miranda said, you're coming into a business. So it doesn't mean if you sign up for insurance that you're going to have a full business. So you have to really think about that. And like you said, going back and doing your numbers, what's the quality? How many hours do you want to work? Creating a lifestyle business is that really should be the first place to really look and then you can decide from there and move forward. And like you said, if insurance, there's places in, you know where insurance is a great reimbursement and if that fits.

C (28:18)

In your plan, that's awesome.

B (28:20)

If it doesn't, that's okay too.

D (28:21)

But there are no magic wands.

A (28:23)

No, no magic wands. It's all an illusion. It's an illusion. Yeah. So looking at the numbers, that's awesome. Doing the research, being informed and then for those who are paneled with insurances and they decide that hey this is not working for me, that's probably a whole Other podcast where we could talk about how to get unpaneled from the insurances and create a strategy. You can really build up your practice to the way that you need it to be so that you can really live the lifestyle that you want.

C (28:53)

Yeah. About a third of the clients, at least, that enroll in boot camp, that's what they're working towards, is breaking up with insurance panels that don't longer serve them. Some of them are going to full cash pay and some of them are going to a hybrid. And then they're kind of ultimately, I think this is the other piece they really talk about. I want to have work life balance. I want to do great clinical work and I want to have a profitable practice that's sustainable for my life. I don't want to be a paycheck to paycheck therapist where if I break my leg and have to like be off for a month, that I'm going to not be able to pay my mortgage and that I'm going to be in this funky space and be in debt. Like, this doesn't make sense to do this. And a lot of therapists are living in debt, which is sad.

A (29:45)

Yeah, it's really unfortunate.

B (29:46)

So, Kelly, I know you gave us your kind of final thoughts. Miranda, what are your final thoughts on this topic?

C (29:51)

My final thought is to really look at the process of what you're doing with insurance and make sure you have a process that really makes sense for you and that you're looking at that big picture about how you have conversations, how you say yes and how you say no. Look at all of these different pieces to make sure that your business is really running in a way that is sustainable and good and that works for your clients. Because you don't want to be coming into sessions feeling like, just feeling frustrated, feeling like, wow, every time I see this client, I sort of love the work, but I just feel sad realizing that I'm getting reimbursed 30 days or $65 when I know what it takes now to keep the lights on. So look at the process and realize that cleaning all this stuff up is going to lead to better clinical outcomes. And that should be our focus. It's taking care of us so we can take really good care of clients.

B (30:52)

Awesome.

C (30:52)

I love that.

B (30:53)

And I know you guys have a giveaway for Startup Nation. What is that?

C (30:58)

We have over 10 hours of free training that you can grab and I'm sure the link will be there, but you can also go to zinnime.com events and over 10 hours of free training, how to set your team, how to develop your niche. Private Practice Planning, Marketing 101. We want to make sure that it's accessible, where you can just go and get the information you need. And we've had hundreds of therapists that are like, I built my practice off of your free trainings. This is amazing. Like, I have the practice that I want and my dreams, and this feels so good. And we love to hear that. Truly.

A (31:37)

That's awesome.

B (31:38)

That's the best, right?

C (31:39)

It is.

B (31:40)

We have one of our coaching clients, he constantly is, like, emailing us or messaging us, and he's like, and so I just completed the training today, and I just got this and I got that and I got more clients. And it's just like, it's so exciting, especially when you have a virtual business, because you don't always get that direct feedback. You know, your stuff is out there in the world, but it's not like a live training where people can give you that feedback.

C (32:01)

Yeah. Like in our bootcamp, like, we see it, we know and we know every time they're like, oh, my God, I scheduled three.

D (32:06)

Three new private pay clients this week.

C (32:07)

Or I just got my first private pay client. I used the consultation script. Like, we get that, like, immediate feedback. But for people who are just doing the free trainings, like, sometimes we don't look at the numbers and realize, like, oh, my gosh, like, this many thousands of people just went through that training and we don't know what happens with that. So when we do get to hear back, like, it's such an exciting thing.

B (32:28)

Yeah, awesome. And so for those of you who are listening to this and you are in that startup phase and really just want some boot camp support, like, get a up, roll your sleeves, get dirty, do the work. We're going to put that link on the show notes page. So we wanted to thank you lovely ladies for hanging out with us today, sharing your expertise. It was a great conversation. I know we could probably sit here and talk longer, but next week you guys want to listen because we are speaking with Roy Huggins from Censored Tech. They know Roy too.

C (32:56)

We love Roy.

B (32:58)

Awesome. So actually, we did a part one and part two with him on hipaa. Peace of mind. Because earlier. No, we're already in earlier in the year. For a few months, I thought I was doing stuff wrong with hipaa and I came across Roy's podcast on Joe Sanock's podcast, and we decided to have him on. So we did part one and part two all about hipaa technology what it means Security. Don't forget to listen to that one next week. So we wanted to say thank you so much for joining us today. Startup Nation. Don't forget to check out the Show Notes page with all the tips, resources, giveaways from today's show. We look forward to continuing to inspire you from Startup to mastery.

A (33:37)

See you next time. Thanks for joining us on the Private practice startup. Visit theprivatepracticestartup.com for awesome resources, free trainings, attorney approved private practice paperwork, and so much more.

C (34:04)

Sam.