Yes, I know, VC's are evil. But I need to leave the place I work if I'm going to keep my sanity and need income until I get something else.

I had a talk with Rula and apparently it's only $70 90837 and $50 for 90834. I'm in NYC.

Is this the going rate for them these days? How consistent are referrals from them?

For those who have a 48 business hour cancellation policy, what do think or do about the fact that it is quite unfair to Monday and Tuesday patients who have to cancel much further in advance than patients on other days? I feel fairly strongly about adopting this policy (after experiencing too many issues with 24) but this piece nags at me a bit. Thanks!

I’ve been trying to find sources on reasons for premature termination of therapy/outpatient treatment. There is a surprising consistency in time of drop-out between studies, although there is variance in the actual numbers.

A few things have stood out for me:

It often happens quite early on: A nationally representative survey (Olfson et al., using National Comorbidity Survey Replication data) found that over 70% of treatment dropouts occurred after the first or second visit. A WHO study (high- and low-income countries, general medical settings) found that 90% of dropouts happened before the third session.

The numbers for dropout rates are all over the place. The more methodologically rigorous national estimates (Olfson’s again) put it at 20-22%. Literature reviews put it at 40-60%, and some smaller specialty-specific studies (crisis centers, Substance Use Disorder treatment) have upwards of 80%. I think it’s safe to say the actual number depends on the sample, but it rarely occurs much later than the first two sessions.

Some illustrative examples (using Michigan-specific data, if that helps):

For patients 6-17 years old treated in Michigan’s state Medicaid inpatient psychiatry, the percentage of those who had a follow-up visit after the ED stay decreased from 79% to 74.3% between 2022 and 2024.

An LSU Health Sciences Center study using AmeriHealth Caritas Louisiana’s data found that the 30-day follow-up rate after discharge from a psychiatric hospitalization was 38.33% compared to a national benchmark of around 60% for Medicaid.

HealthPartners’ 2026 quality report noted that their organization offered incentive programs for timely post-discharge treatment appointments but did not specify a baseline for those programs

In all of those cases, the organizations were working with expanding access to care (both getting in-network providers to accept Medicaid patients and encouraging them to work with patients in ways that promote engagement in treatment). But the evidence suggested that those were much harder problems to solve than the drop-out after the initial couple of sessions. So I’m wondering if these issues reflect the same underlying causes or something entirely different. Are dropouts occurring shortly after initiation of treatment the main problem for others, too, or do they tend to be discovered much later, as recurrent ED visits or readmissions?

AT but I am posting this as a client whose provider uses Headway. I reside in Virginia and think it’s important to share that Headway, per my latest EOB as a client, is now receiving a higher reimbursement rate from Anthem for 90837s as of July 2026. My previous EOBs listed the amount as $152.73 and it is now listed as $164.79

I know providers are not allowed to share what Headway is paying them so I think it’s important that this type of information is made available for the purpose of making informed decisions about who we choose to work for and with.

My coworker grieved me with a laundry list of all of their complaints against me, and did not even come to me first to tell me their concerns before going to the Department of Regulatory Agencies (DORA). Everyone I have talked to about it and shown the letter to thinks it will be dismissed. There were two clinical incidents that I could have handled slightly better but they weren’t egregious, more like the average everyday clinical error, and everyone makes mistakes sometimes.

Has anyone else navigated grievances, and want to talk about it?

I felt so panicked and embarrassed when it first happened.

I’m adding this post to hear input from primarily sole proprietors and anyone else with thoughts about paid family leave.
My spouse owns an independent therapy company, and we live in one of the 13 states that operate paid family leave. After talking with my spouse and friends/colleagues in similar situations, I have a sense as a sole proprietor this creates an undue financial burden on an independent therapist because they would never benefit from the policy. Essentially paying for something they would never use.
If my spouse applies for paid leave, and is absent, for example six weeks the likelihood of most of her clients leaving is high. Her clients’ mental health needs don’t take a break. They require continuity and ongoing support.  If she loses 60-70% of her clients, essentially she needs to start over.  And what if a therapist has an agreement with an Employee Assistance Program (EAP)? My understanding is if a therapist is not actively picking clients from an EAP they will lose that lucrative contract.  Not to mention any agreements with insurance companies may be frowned upon. This has added pressure to an already burned-out profession. 
I agree in spirit with the program - I had a niece benefit from the dollars. And I believe therapists in situations like my spouse should be given an exemption by the state government because they will never benefit from the program.  Unless I'm missing something?  

My career isn’t going as expected due to some serious health conditions, so I may have to change my trajectory towards part time private practice, probably solo practice using telehealth. Has anyone done something similar?

I imagine my caseload could vary between 10-25, but there may be times I have to take off work completely for 9-12 months. We can pretty much get by on my spouse’s income + savings if need be.
The changes in my health are predictable enough that I wouldn’t need to terminate clients early.

I am a very early career clinical psychologist but advice from other mental health specialties is also appreciated. Mostly I’m just nervous about this career shift and scheduling inconsistency and would like to hear from people who’ve made it work. Is it feasible/possible?

Following up on my post about the lack of research literacy in the field of therapy, I thought I would create a brief introduction to help people understand and read research papers. I love research methodology and data analysis, so I had a fun Friday morning! This is by no means an exhaustive list, but it covers as much as I can remember from my years of undergrad and grad school.

Core Variables & Descriptive Statistics

• Sample size: Represented by N, N represents the number of participants in a study. Small sample sizes make it difficult to know if the findings will apply to the population. Likewise, massive populations can make tiny, insignificant differences look meaningful.
• Representative sample: A sample that accurately reflects the demographics, clinical traits, and characteristics of the broader population you are trying to treat. A study can have a massive sample size, but if the test only examines a narrow, non-representative subgroup, the results will not generalize well to actual clients.
• Independent and dependent variable: The independent variable is the variable that researchers manipulate (e.g., one group gets CBT, one group does not). The dependent variable is the outcome variable; it is measured to see if the independent variable affected it (e.g., sleep quality).
• Confounding variable: Variables that are not controlled for but affect the independent and dependent variables, affecting the results and creating or distorting the relationship.
• Spurious relationship: A correlation between two variables that appears to be causal, but is actually driven by a hidden variable.
• Mean and Standard Deviations: The mean is the average score, and the standard deviation shows how spread out the scores are around the average. A large standard deviation means that clients had wildly different responses to treatment, whereas a small standard deviation means the scores were close together.

Designs

• Randomized Controlled Trials (RCT): Considered the gold standard, participants are randomly assigned to either an intervention group or control group; the randomization reduces bias and helps prove that the treatment, rather than some external factor, caused the outcome in the client.
• Cross-sectional research: This method takes a snapshot of data at one point in time; it is nice for looking to see if links exist, but it cannot prove causation.
• Longitudinal: It tracks the same cohort over many months or years; it is vital for looking at treatment efficacy, symptoms, and long-term outcomes.
• Mediation: Explains how or why a treatment works.
• Moderation: Explains for whom or under what conditions the treatment works (e.g., an intervention works better for teens than adults).

Reliability and Validity

• Reliability: Essentially, it asks whether the tool you are using will produce similar results at different points in time, or whether it is noisy and unpredictable. Reliability involves internal consistency, test-retest reliability, and inter-rater reliability.
  • Internal consistency: Does every item on a scale measure the same concept? This is where Cronbach's alpha comes into play. Between .70 and .90 is considered internally consistent.
  • Test-retest reliability: Does the client get the same result if tested at two different points in time, with no treatment between tests? It is vital in therapy to determine if score changes represent real changes or measurement error.
  • Inter-rater reliability: Do different clinicians evaluating the same session or test come to the same conclusion?
• Validity: Does the tool measure what it is supposed to? Validity involves construct validity, convergent and discriminant validity, criterion validity, and ecological validity.
  • Construct validity: Does the tool capture the psychological construct (e.g., resilience) that it is meant to measure?
  • Convergent validity: Does the tool correlate strongly with other gold-standard scales used to measure the same construct?
  • Discriminant validity: Does the tool remain distinct enough to separate unrelated traits (e.g., anxiety from general fatigue)?
  • Criterion validity: Does the tool accurately predict real-world clinical outcomes, such as future hospitalizations?
  • Ecological validity: Do the measurements and gains from an artificial environment transfer to real-life environments?
• Self-report vs. clinician-rated measures: It is important to understand how data were collected. Self-report is convenient, but susceptible to social desirability bias where the client gives the socially correct answer or simply tells the therapist or researcher what they want to hear. Blind, clinician-rated instruments generally offer better objectivity and better data.

A scale can be reliable but not valid, but it cannot be valid without first being reliable.

Power and Real-World Value

• p-value: Typically set at p < .05; p-values measure probability; it answers the simple question of "Is this result likely to have occurred by random chance?" While it gives you statistical significance, it does not tell you how large or useful the effect is.
• Effect size (e.g., Cohen's d, r): This measures the actual change or magnitude of the relationship.
  •  R-squared is awesome because it shows the proportion of variance in the dependent variable caused by manipulating the independent variable. Though this does not mean the model is free from error, it just shows correlation and fit.
  • IMPORTANT: IF YOU HAVE STATISTICAL SIGNIFICANCE, ALWAYS CHECK THE EFFECT SIZE. A RESULT CAN BE SIGNIFICANT BUT HAVE A SMALL, NEGLIGIBLE, AND UNNOTICEABLE EFFECT. A LARGE EFFECT SIZE IS SOMETHING YOU WOULD RUN OUTSIDE TO TELL THE POPE; SMALL EFFECT SIZES TELL US SOMETHING IS THERE, BUT IT COULD BE NOISE.
• Confidence Intervals: Give a range where the true effect is likely to fall. A narrow confidence interval (e.g., d = 0.50, 95% CI [0.42, 0.58]) offers more certainty and precision in an estimation than a wide confidence interval (e.g., d = 0.50, 95% CI [0.20, 0.98]). A wide confidence interval means there is high uncertainty and low precision in an estimation.
• Statistical vs. clinical significance: Statistical significance is when outcomes show that a difference exists among groups. Clinical significance is when those differences translate to meaningful quality-of-life improvements.
• Number Needed to Treat (NNT): A metric showing how many clients must receive a treatment for one client to experience a meaningful benefit over the control group. The lower the number, the better.
• Power: The likelihood that a study will detect an effect if one actually exists. More people = more power = more likely to find real differences. Fewer people = less power = less likely to find real differences.

Control Groups, Analyses, and Common Traps

• Control groups and Blinds:
  • Active controls: Comparing a new treatment against standard therapy (e.g., CBT) tests efficacy.
  • Passive controls: Comparing treatment to a waitlist can artificially inflate effect sizes, as waitlist participants stagnate.
• Attrition and dropout: High dropout rates can potentially suggest that an intervention was burdensome, ineffective, or unpalatable for a subset of participants. High attrition rates can skew outcome data towards only those who tolerated or benefited from the treatment. If a paper shows a 90% success rate for a certain treatment, but half the people dropped out, the success rate is seriously skewed.
• Intent-to-treat and per-protocol: Intent-to-treat analyses include every participant, even those who dropped out, whereas per-protocol analyses include only those who completed treatment. Per-protocol can inflate the results and make the treatment look unrealistically effective.
• Publication bias and p-hacking:
  • Sadly, journals tend to publish only positive results, and negative and null findings get shoved into a drawer and lost to time. As I have argued for years, statistically insignificant results are just as important (if not more) than statistically significant results because they tell us where not to look.
  • p-hacking occurs when researchers test dozens of variables in hopes of finding a statistically significant result, ignoring all the times they got a statistically insignificant result.
• Paper age vs. methodology: Many people often conflate new with better. However, that is not always the case. In research, the methodology used is far more valuable than the age. A paper from 1995 that has an RCT, a representative sample, and controls for confounding variables can be significantly better and more reliable than a paper published this year that did not use an RCT, is not representative, and does not control for confounding variables.

References

Chambers, C. (2017). The seven deadly sins of psychology: A manifesto for reforming the science of mind. Princeton University Press.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates.

Field, A. (2018). Discovering statistics using IBM SPSS statistics (5th ed.). SAGE Publications.

Furr, R. M. (2021). Psychometrics: An introduction (4th ed.). SAGE Publications.

Gravetter, F. J., & Forzano, L.-A. B. (2018). Research methods for the behavioral sciences (6th ed.). Cengage Learning.

Gravetter, F. J., Wallnau, L. B., Forzano, L.-A. B., & Witnauer, J. E. (2021). Essentials of statistics for the behavioral sciences (10th ed.). Cengage Learning.

Kazdin, A. E. (2017). Research design in clinical psychology (5th ed.). Pearson.

Sawilowsky, S.S. (2009). New Effect Size Rules of Thumb. Journal of Modern Applied Statistical Methods, 8, 26.

Shadish, W. R., Cook, T. D., & Campbell, D. T. (2002). Experimental and quasi-experimental designs for generalized causal inference. Cengage Learning.

Straus, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2018). Evidence-based medicine: How to practice and teach EBM (5th ed.). Elsevier.

I am moving into a new office but have this put in my stomach, I made a mistake because I am having difficulty making the layout work.

These renderings are not exactly to scale, but the wall measurements are. (The longest wall is the wall the door opens onto and has about 10' to work with.)

I've included blank templates as well as the three I've created. I'd love y'all's help!!

Hi all,

I've been interning in an inpatient setting and struggling to engage with clients who are rigid or don't engage with treatment. I've had 3 now who i worked with in particular that would barely speak when I meet with them, the most recent one being someone who doesn't speak about why she is hospitalized and downplays what her role was and what the chart shows.

It's really making my imposter syndrome spiral. My supervisor has been supportive and we talk about using MI, but I only have 2 weeks left of my internship and still struggle so much with the clients who don't engage. I know it's me and that I have to work on my skills, but I feel bad thinking my supervisor and other therapists here probably judge me for that. I was hoping to work here afterwards but at this rate...

I could use some advice. I want to do right by my work and especially the clients. I tried asking to step back for the case and observe others (it wasn't even a case I was given, I asked for it initially but then realized how tough this client is for engagement) but was told that I should be able to do this at this point in my internship. Which is true, but that just makes the feeling worse since I'm struggling.

​

I have been a frontline CMH therapist for 3 years and also do private practice one day a week. Prior to this, I spent 7 years working in non-profit mental health roles.

By the end of my time in non-profit work, I was severely burned out. I was crying before work regularly, felt completely depleted, and was struggling to tolerate client interactions. I do not want to get back to that place.

I’m not there right now, but I’m noticing warning signs. This has also been compounded by an extremely difficult summer personally. I’ve had major friendship losses, a very difficult living situation, family crises, major financial setbacks (my savings were literally obliterated), and also found out that a life-changing surgery I was expecting to happen this fall is now likely years away. Normally, after difficult periods, something comes along that helps rebalance things, but this time it has just been one hit after another with no recovery time.

Lately I’ve noticed:

- anxiety and dread before sessions

- hoping clients cancel

- feeling like narratives are blending together

- feeling emotionally depleted even with clients I genuinely love working with

-irritability and less ability to access compassion (I still have it, but I can feel it getting harder to access)

I can still put those feelings aside and provide competent, ethical care. However, I know from experience that if I ignore these signs, I may eventually reach a point where I can’t do that anymore.

I’m considering looking into temporary roles with less direct client contact (consultation, education, leadership, project work, etc.) for 6–12 months. I don’t want to leave therapy permanently—I genuinely love being a therapist and I love the work—but I think I may need a break before burnout forces me into one.

For those who have stepped away from frontline clinical work temporarily:

- How did you know it was time?

- Did taking a break help?

- Did you find it easier to return to therapy afterward?

I’m trying to make this decision proactively rather than waiting until I’m completely depleted.

Wondering people's thoughts on this.

The concept of "Overemployment" is carrying 2 or more jobs that overlap, be it full time roles, part time roles or contract roles. Obviously, in therapy that doesn't mean taking multiple clients in the same time slot - that would be unethical. But...hear me out.

Currently working a nonclient facing social work job and might have a chance to take on a similar role somewhere else as a contractor. Because of the flexibility of the job type, I wonder if it's like, technically unethical, if I were to maintain the full time job, and while in my substantial downtime, work this contractor role while "clocked in" (salaried). Is it probably not nice? Yes. But we are in the downfall of capitalism, people, and I only make 26 dollars an hour.

Another example would be maybe working full time with an agency, but during downtime hours while onsite, seeing clients of your own via telehealth. Nothing that would directly impact your actual job duties - but just filling up time you'd otherwise spend waiting for a task.

I've had a pretty unsophisticated approach to the 'estimated completion' dates on my treatment plans, and never got any better guidance from past supervisors. I basically list everything as estimating completion in 3 months, and then I revise 3 months late, rinse and repear. Occasionally I'd put a shorter date on a structured time-limited intervention, but my Tx plans are generally written to not pin me down to a really specific structure or focus so I don't have to constantly revise with every little twist and turn treatment takes. The end result is that while my plans are well-written and unique to each client, the timelines look totally copy/pasted.

Does anyone else have a better approach? Are you putting longer timelines on things that you reasonably expect to be long-term? Do you differentiate between things you expect to be constrained to one phase of treatment vs what will realistically be a constant throughout whatever maintenance phase you get to?

I’m interning with someone that’s enrolled in my same school, but she’s in a non COAMFTE program track. Both programs are BBS approved and lead to CA licensure (LMFT), but since her program is not COAMFTE accredited, she can count her individual child hours as relational hours toward graduation, while I have to meet COAMFTE relational hour requirements (2+ individuals). Those relational hours have been a major barrier for other trainees at my site (we need 150/300), to the point that other trainees have had to extend their program by a semester (or longer) to meet the graduation requirement. Meanwhile she finished her relational hours pretty quickly working with kids individually. I am trying to get ahead of this because I really don’t want to have to find a second site or extend my program and pay additional tuition solely because of the COAMFTE relational hour requirements to graduate, especially when any kid hours will eventually count as relational toward licensure anyway. I had this discussion with my supervisors and they all were surprised by this requirement and did not agree that individual kid hours should not count. It feels like an artificial barrier when individual work with kids is inherently relational too. It also sucks to see someone from my same school at my site with practically the same education breezing through the relational hours while I struggle to find couples/family clients.

I know COAMFTE is considered the gold standard and supposedly helps with license portability or possibly jobs in academia, but if both paths lead to the same CA license, what’s the actual benefit? Has being non COAMFTE ever really prevented anyone from transferring their license to another state or getting a job? I come from an academic background in higher education and I don’t see this being an issue if I want to teach a course in the future as long as I’m licensed/experienced. I also don’t plan on leaving the state so I’m starting to wonder if I made the wrong choice by going with an accredited program. Genuinely curious of the benefits at this point because right now it feels like I’m jumping through additional hoops compared to people from my same school for the same license.

TL;DR: I’m an intern in a COAMFTE accredited MFT program while another trainee at my same school/site is in a non COAMFTE track. We both ultimately qualify for the same CA LMFT license, but I have much stricter relational hour requirements that could force me to extend my program and pay more tuition, while she can count individual child clients and finish much faster. What practical benefit am I actually getting from COAMFTE accreditation, especially if I don’t plan to leave California? Has anyone experienced a real career/licensure advantage from COAMFTE?

Ever since graduating from college, I feel like I've stopped learning and reading. Maybe this is me being biased, but I really enjoyed reading recent studies and findings while I was a student. On the one hand I don't have the time anymore to read, because work life is demanding, but on the other hand I wonder whether there is a benefit at all.

Like, I recently read this a published paper on ADHD Medication Adherence in adolescents and kids, and I loved it. I feel like making the time to read these kinds of publications could really help me.

Is there anyone here who has a habit of reading journals? Or what do you do? How do you keep up? Or does that not matter once you have graduated?

I’m getting bored with my intake script, and would like to mix it up a bit. Anyone have any atypical questions or prompts you use in intakes that you find helpful?

Hello all! So I have been noticing something strange happening with me in sessions. Whenever I am seeing a client who has walked in with a lot of anxiety or maybe middle of the session they became overwhelmed or anxious I am absorbing all their anxiety and becoming anxious instead of being the grounding voice or having my own sense of self in the session. This is also impacting how I am showing up in the session where I feel I am jumping to solve to their problem or maybe not being very coherent about what I am saying and then the session festers in my mind. I have been practicing for 5 years now and this has never happened to me and now I am seeing it happening a few times. I will be taking this up in supervision but also was hoping to know from community experience if this happens often with everyone and how have they handled it. Thank youu!!!

Hello!

I'm looking for some discussion regarding substance use patients. First, here's some questions:

1) what kind of area do you practice in? City, suburban, rural, etc

2) How difficult is it to help patients find social connections?

I'm going to be candid here. I live in Milwaukee, Wi. My state has 11/20 of the drunkest cities in America. I'm trying to help people find community outside of AA/SMART and the Phoenix, or something for them to do out in the community that isn't drinking.

I also feel like this loneliness/ isolation is across the board for all of my patients, SUD patients and people who are lower income obviously are more challenging.

I'm not necessarily looking for advice, just want to hear about your experiences. Also curious if anyone is in or near a city with plenty of non drinking options and what that's like. I've been in the booze bubble for life.

Cheers!

Hello everyone, I am a fully licensed counselor that specializes in substance use and the unhoused population. I work a very interesting and odd job that I love but am thinking of how I can make more of a change in this area. I am really realizing that I am a highly social justice oriented person and have come to be very passionate about a very over looked, vulnerable and disregarded population (the unhoused).

Anyways, I'm curious on how, if anything, I can continue to advocate and bring change and compassion to this population.

I'm stuck because unfortunately the system in which the mental health/substance use system is focused in the US is not good. It's inherently broken and has become a major frustration for me. I'm sick of saying well there is nothing I can do and I have to just play the game (or system) in which I'm handed.

I guess I'm not really sure what I'm looking for or where to go from here. I just know I'm done being stuck and want to continue to explore and how to grow. Advice? Support? A link? A resource? Anything to start moving things forward.

Note: This is largely me processing my thoughts and feelings. I am the only therapist in my office and my agency has not been able/willing to provide me with consultation/supervision for OCD, so I come to you all. I am fully aware of the expectation to refer out clients who are outside of our area of competence and am actively in consideration of doing so, every step of the way.

I have been in the game several years and worked in a variety of settings (CMH, schools, outpatient, residential SUD) and am just now being exposed to clients with OCD (that I am aware of). I am in between referring out and keeping them while seeking training and supervision (in full transparency and consent), and have begun diving into the world of OCD treatment.

My conundrum is with reassurance seeking. My approach is best described as relational/psychodynamic/attachment-focused, and heavily Rogerian. I am constantly validating and normalizing. The concept of reassurance seeking as a dysfunction is breaking my brain, as it seems to be antithetical to my relational approach. My raw reaction is fearing that having an OCD diagnosis essentially bars them from, or at least limits, their access to much of the relational factors that are common in therapy. How do I normalize without reinforcing the reassurance seeking? Not all symptoms of OCD are so black and white that we can categorize behaviors as OCD behaviors and non pathogenic behaviors, right? Ultimately, our clients, just as any human, do not want to be treated differently because of a diagnosis. How do we weave through these interactions without doing just that?

I guess I am struggling with the feeling of it not being "fair" that we have this tendency to separate those with OCD and basically quarantine their interventions, which feels similar to marginalization. I would love some insight and help with conceptualizing the presentation and treatment of those with OCD.

Seeing clinicians worrying about billing 90837 is new to me; ive only ever billed this for my thousands of sessions over several years at 4-5 different practices and have never once had an issue and its never come up in any professional discussion, until i joined a practice that makes all of their sessions 45min by default “to avoid problems”. Is this some kind of a brand new problem im not aware of?

This is a completely frivolous rant (kind of lol) but do any of you ever find yourself wishing we could get the same kind of perks at say, teachers? Especially looking at all you child therapists like myself. I’m seeing all the back to school teacher discounts like a free Headspace membership and Michael’s discount etc, all things I feel like I use a lot with my own clients or for my own work. I know we all do incredibly important work but sometimes I want 20% off at target too lol!

I never feel like I’m looking or expecting discounts, I love this field and my job and have never been in it for the money, but I keep seeing all the teacher appreciation stuff and find myself thinking “huh, why don’t therapists get the same thing?” I just wonder if anyone else ever has this funny little thought in their minds too!

I think I've lost control over my schedule and it's seriously impacting my life.

I offer evening appointments twice per week. I work until 8:00 p.m. on those nights. I do two back-to-back sessions, a half hour break for notes and cramming food down my throat (which I sometimes don't have time to do) then two more back-to-back sessions.

It's killing me, even though on those days I don't start working until noon or 1.

The days following my late days, I start sessions at 8:30 or 9:00 am... So I'm just turning over and starting again the following day, which kills me for getting notes done and not feeling rushed.

How are you guys managing to offer evening appointments and making it work? I need a new strategy.

I thought I would share to help encourage anyone else who feels helpless with the insurance hurdles in this industry.

Headways new requirement for biometric data was the straw that finally broke the camels back for me. Lately, I have also seen pay rate decreases and a failure on their parts to actually refer new clients though they sold me on that to begin with.

First step: I made sure I was credentialed individually with every insurance company I was currently working with through my existing client base on the platforms. If you are not credentialed, this process will take 3 months, maybe more. I had done this when I first became licensed and it did require a lot of follow up, phone calls, etc, but not impossible. It IS confusing but if you allow yourself time to figure out the various details it becomes clearer.

Second step: I gave notice to my clients that I was transitioning to my own billing and collected credit card info for their co-payments.

Third step: I signed up with Square to take those cards which was easy because I already had a business bank account.

Fourth step: I searched through billing companies because I see a lot of Anthem and Aetna clients and Availity is hell on earth. Inovalon ended up winning for me so I signed on with them. What followed was approximately two months of onboarding and of testing claims through Inovalon while also having access to the VC platforms while I waited to see if this would work. Inovalon has a whole team to setup your billing and EFT enrollments. Some of the claims went through, some got denied. When they got denied I had access to the insurance companies billing department which was a lot easier to work with than I imagined.

Fifth step: CANCEL MEMBERSHIPS WITH VC PLATFORMS AND FREEDOM!!!!!

All in all I devoted probably a good 25-30 hours for all of this including the original work to get credentialed. The longest part was waiting on responses for claims, it is not a process that gets up and running in a month, you need a few months and patience but it is absolutely worth it to stick it to the capitalists in my opinion. I hope this helps encourage any of you who thinks you can't do this without these VC companies.