Should I Take Insurance in My Private Practice? Five Questions for Private Practice Series 2 of 5 | PoP 367

Should I take insurance in my private practice? Five Questions for Private Practice Series 2 of 5 | PoP 367

Are you unsure as to whether or not you should accept insurance in your practice? Do the benefits of insurance or private pay outweigh the cons? Would you like some tips to help you make the decision?

In this ‘Five Questions for Private Practice’ series podcast episode, Joe Sanok speaks about the differences between accepting insurance payments and private payments and shares some tips to help you make your decision.

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In This Podcast


In this podcast series, episode 2, Joe Sanok will walk you through weighing out the pros and cons of accepting insurance payments or private payments.

The Big Question

The big “taking insurance” question. What drives this question? It’s really, will I make enough money in my private practice? No one wants to fail in practice. We don’t start a practice, only to feel stressed and like we’re letting down our community.

We start a practice to make an impact.

I want to give you a mindset regarding insurance.

Taking insurance isn’t bad, you just have to know when and why you want to do it. First, it’s about where you spend time. Would you rather spend time networking and marketing yourself or working on systems and billing?

Private Pay Benefits:

  • You typically make more per hour
  • You see fewer people
  • Paperwork is easier
  • Immediate payment
  • Clients are often more dedicated and follow-through on treatment

Private Pay Cons:

  • You have to niche down more
  • Marketing is key
  • You need to understand how to articulate your value

When you have a private pay practice, more of your time is spent on networking with other people that may refer to you. Also, you’ll probably spend about twice as much time on your marketing, website, and branding. If you’re artistic, enjoy the visual side of growing a practice, and enjoy learning about new ways to get the word out, private pay might be for you. Also, you can see fewer clients at a higher rate.

Insurance Benefits:

  • You have a built-in referral network
  • People expect to use insurance
  • Doctors refer more often

Insurance Cons:

  • You don’t get paid right away
  • You need an EHR (Here’s who I recommend – use the promo code ‘Joe’ to get 2 months free), and probably a biller (Here’s who I recommend)
  • If your systems are off, you sometimes will lose money and not get paid

An insurance-based practice might be for you if you want to set up systems for automation. Maybe that’s internal systems or finding billers to help you grow your practice. You’ll have to navigate getting paneled with an insurance company, setting up an EHR, and getting paid well after you see someone. Also, overall, you’ll see more people at a lower rate, but if you scale into a group practice, it can be very lucrative.

There are pros and cons to each decision. How will you decide what you’ll do with your practice?

Here are some tips to help:

  1. Ask other clinicians what they have done.
  2. Interview billers before you decide.
  3. Meet with some local massage therapists, doctors, and yoga teachers to learn how and when they refer.
  4. Come to one of my free live events and ask me 🙂

Useful Links:

Meet Joe Sanok

private practice consultant

Joe Sanok helps counselors to create thriving practices that are the envy of other counselors. He has helped counselors to grow their businesses by 50-500% and is proud of all the private practice owners that are growing their income, influence, and impact on the world. Click here to explore consulting with Joe.

Thanks For Listening!

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Podcast Transcription

[JOE]: What’s the point of having a beautiful website that doesn’t attract the clients you want to see? As the worldwide leaders of website design for therapists, Brighter Vision sees this issue happen way too often. A nice-looking website doesn’t equate to a successful website. The truth is your current website might even be turning off potential clients. That’s where Brighter Vision comes in. Brighter Visions’ team of website designers will create you a website that is centered around attracting and retaining your ideal client so that you can have a nice-looking website as well as a successful one. For a month free, head on over to Again, that’s
This is the Practice of the Practice podcast with Joe Sanok, session number 367.
I am Joe Sanok, your host and welcome to the Practice of the Practice podcast. Hey, often I welcome the new people. If you’ve been here for a while, thanks so much for sticking around. I know that you have lots of choices with podcasts. There’s a lot of great podcasters that are out there. So, I really appreciate you taking time just to listen and be a part of this. And so many of you will email me and tell me about your success or when I do one of my keynotes at, you know, one of the counseling associations, speaking of which I’m going to be speaking at the Minnesota Counseling Association, doing their keynote leader this year. So, sign up for that if you’re going to be in the area or hey, fly in, even better. Maybe I should host a meetup for all the Practice of the Practice folks. So, we’d love to meet up with you guys. But thanks so much for listening for so long.
I know I’ve been doing this for a while. We are approaching our 400th episode and so been at it for a while. But you know, when I do these interviews and today we’re not doing interviews, I’m just kind of answering your question, but you know, it’s really interesting because I’m interviewing these people thinking, what do I wish I knew? And also, how can I pick this person’s brain so that I can do better? Honestly, like I learn so much from these interviews and I’m just like, I can’t believe I get paid for this. And it’s fun to see, you know, a lot of my mastermind people and people that are at Slow Down School be at that point where they’re just leveling up way beyond just their practice. And they’re regular people that have gone after big ideas and it’s super cool to see.
And especially when they’re in person kind of rubbing shoulders, it’s super cool to just see when they’re eating a salad at lunch, talking about stuff, or for down at the beach. So, this year I’m excited because we’re launching, you know, a few different things. You’ve probably heard me talk about Killin’It Camp, which is going to be in October in Estes Park, Colorado; where you can read more about that.
But coming up on the 23rd of April, I have a ‘How To Kill It In Private Practice’ masterclass and really, I want it to be like a masterclass where we dive super deep. You leave with tons of practical information. And then I’m also going to take some time to talk about Killin’It Camp. Killin’It Camp is an all-inclusive conference for people starting and growing a practice.
So. If you’re under $100,000 and you’re starting and growing and you want to be around experts in the field that have just been killing it in private practice, you know, unlike most conferences where there’s just a small little private practice track and you’re like, “Man, I could have learned that from a podcast,” this is the all-exclusive, all-inclusive, all-exclusive. I guess it’s not super exclusive. I mean the people that are there are there. But it’s all-inclusive.
I mean, your food, your lodging, everything’s included in that 650 bucks. But those prices do go up on the 25th of April. So, want to make sure we have some time on that masterclass and just talk about it and let you know our vision for it and why we think it’s really important, why we think it’s a great use of your time and your money, and kind of our heart behind it because we want it to be fun, we want it to be impactful. We want you to leave with a plan.
So, within those, you know, two and a half days, three days, we want you to walk away going, “Dang, I got so much done in that three days and I know exactly what to do next.” So, this isn’t a big pitch for that, but just, you know, I would love for you to hang out with us on that master class in the private practice. And if coming out to Colorado is a fit, that would be super killer. Using the word kill a lot. You know, part of it might be when I was a kid and this has absolutely nothing to do with the podcast, my mom, like we’d be playing like Mario and we’d be like, “Oh my gosh, I died.” Or you know, we’d be playing James Bond and say, “I’m going to kill you.”
And I remember like, she hated us using those terms. I mean, she’d say, “Death is a very permanent thing,” which is a good message for kids to get. But you know, when you’re like, “Oh, I died on Super Mario Brothers,” like you didn’t mean permanent death. I mean, sort of like reincarnation. And so, when I was in college, I was in this band and, my friends, Isaac, Paul, and Melanie, we just had so much fun and really didn’t make much money. We weren’t that good. But we are all playing James Bond Golden Eye. And I told my friends like if my mom gets home because we were like visiting, because we had a show in Traverse City, I said if my mom gets home we can’t say die, we can’t say death. And they’re like, “Why? You’re like 21 years old.”
Well my mom comes home, we’re playing Golden Eye and one of them yells, “I’m going to kill you.” And my mom comes in, like were fricking middle schoolers, and stands in front of the TV, and we pause the game and she goes, “Joe may not have informed you but using the words kill and death are not appropriate in this house.” So, maybe that’s why I pushed things with like Killin’It Camp. Deep down inside I’m trying to differentiate myself from my parents. I’ll let you guys sort that out.
Well, today we’re talking about the second big question that I often get and I think is one of the most important questions that we can cover. So, last week we covered ‘How much time should I spend on my practice?’ And, you know, kind of depends, but the big kind of quick rule of thumb I’d say is however many hours you eventually want to work in the practice is what you should be spending on the practice.
So, if you’re at five sessions a week right now and you want to be at 15, work those 15 hours now. Don’t just go do grocery shopping. All right. So, today we’re talking about ‘Should I take insurance for my private practice? And I’ve actually really shifted in this area. Some of my earlier episodes, I was completely bought into private pay and I think that still works, but I also think there’s a lot of things that have shifted and changed over the years.
And there’s also a number of other, just kind of ideas that I have about this. So, one thing to think about is your community and, you know, what’s the makeup of your community? Now, does that mean that you can’t do well, if you aren’t on insurance or if you are on insurance? No, I mean, I think there’s a lot of principles around private pay versus insurance, but there are some things we want to think about. [alarm goes off] Oops, there’s my reminder, I set timers all the time to remind myself to not get too into something and do what I’m supposed to do. So, in five minutes, I have a podcast interview, so I don’t want to forget to do that, but trying to squeeze out the most from this day. All right, so, kind of the big Should I take insurance questions. So, what really drives this? It’s really, I’m willing to make enough money in private practice, right? And so, no one wants to fail in private practice. We don’t want to start a practice and then feel stressed and like we’re letting down our community. So, when we start a practice we want to make an impact and we want to think through, “Well, if my practice fails, like what would that mean?” So, let’s think about a couple of mindsets regarding insurance.
So, taking insurance isn’t bad, you just have to know when and why you want to do it. So, first, it’s about where you spend your time. Would you rather do, say the marketing and networking side or would you rather work on systems? So, let’s think about the benefits of each and then we can talk through how you can decide for yourself. And so, private paid benefits, you typically make more per hour. You can keep raising your rates as you get busier. You don’t have to have a waiting list.
In fact, I’d say you shouldn’t have a waiting list. If people want to see you, you should see them. Just raise your rates to make it worth it for you. You can see fewer people. Paperwork is often much easier because you’re not, you know, sending it into insurance companies, getting pre-authorizations, all of that. You have to get immediate payment. You get payment right then and clients are often more dedicated and follow through on treatment. Now all of these are things that with your individual situation might be true, might not be true.
So, for example, you could have super dedicated insurance-based clients. So, some of the cons of private pay or you have to really kind of specialize down more than typically you would have to, marketing and networking. I mean, that’s really the key. You’ve got to make sure that people understand your value, understand you’re a specialist and people are willing to pay for what you take them through from their pain to the outcome. So, my kid keeps getting kicked out of school and we want to have a plan for better behavior at school. You know, can you do that? Like people will pay for that if you are the specialist for that area.
And another con is you need to understand how to articulate your value. That’s really hard for some people to learn, “How do I articulate my value more?” But when you’ve private, pay more of your time is spent on networking with other people and getting referrals from people that see you. So, if you have an ideal of a client that’s seeing you, they’re more likely to refer other ideal clients to see you as well.
All right. Also, you’re going to probably want to spend at least twice as much time and money on marketing your website, your branding, and if you’re artistic and enjoy that kind of thing, that’s great. But you know, if you’re not, then you may want to go the kind of insurance route. So, let’s think a little bit about some of the insurance benefits. So, taking insurance has some benefits. You have a built-in referral network.
You know, insurances have the big list of approved providers. Even when you sign up through the health care marketplace, you can put in your clinician’s name and it’ll say whether or not that specific insurance can be associated with that clinician. Things on psychology today, people have to look to see if you take that insurance. Often as people expect to use insurance now even if they have a really high deductible, it is hard for people to understand why you don’t take insurance.
So, you do have to do that extra level of work when you are private pay versus insurance. And honestly, doctors and other medical professionals will refer way more often to someone that takes insurance that will work with them, that will help them build the insurance and all of that. Well, what are some of the cons of taking insurance?
Well, you don’t get paid right away. You know, sometimes it can be, depending on the insurance plan, two weeks, you know, six weeks, you know, depending on the plan you’re going to probably want to have an, you’re not probably, you need to have an e-HR. I recommend Therapy Notes. Use promo code [JOE] and I think you get two months for free. But there are lots of e-HRs out there.
But, and you’re also going to need to have a biller. You really don’t want to spend your time learning billing. So, something like practice solutions, over, if you could just go to, that’ll redirect to them. They’re a fun group of billers, but that’s going to take 5% or so off of your billing. And I’ve seen some people that are paying nine to 11%. That’s just crazy. Work with practice solutions. They’ll help you out. They are our sponsor and you know, they’re awesome.
So, also if your systems are off, you might not get paid. Like if you didn’t get pre-auth when you were supposed to if you don’t know people’s benefits, and you don’t collect and then you’re hunting him down, so you can really end up donating a lot of your time. So, in insurance-based practice, it might be good for you if you like setting up those systems and automation, or maybe you’re good at internal systems and finding billers and growing your practice. You can also scale a lot faster oftentimes with an insurance-based practice, but you’ll have to navigate getting paneled with insurance companies, setting up the e-HR, getting paid well after someone you know, comes in, so, then you got a cash flow issue.
But overall, you’ll probably have to see more people at a lower rate. But if you scale it, it can be very lucrative. So, here’s a couple of tips, some of the pros and cons. Here are some tips that are going to help you. So, ask other clinicians locally what they’ve done. Like what have they done? Are they on insurance, are they not on insurance? Interview billers before you decide, meet with some local, say, massage therapists, doctors, Yoga teachers. See how they refer, and then we’d love for you to come to one of my live events and ask. We’ve got one coming up over at on April 23rd.
Hey, if you’re stuck like I do so many live Q&A events. Come to those and I would love to personally help you out. So, next time we’re going to be talking about how do you set rates in private practice, whether you take insurance or not? That’s really important for you to examine. So, think through all of that when you are looking at whether or not you should take insurance. And in the next episode we’re going to talk a little bit more about setting your rates because even if you take insurance, you’re going to have those people that are private pay and there’s a lot you need to think about in regards to optimizing those prices, making sure it’s fair, making sure that you know your value, and that you don’t leave money on the table.
So, special thanks to Brighter Vision. Brighter Vision is the amazing sponsor that we couldn’t do this podcast without. They really have been so loyal and we love their work and so many of our consulting clients use them. So, head on over to and get that website going today. There is no reason for you to have an ugly website. Thanks for letting me into your ears and your brain. Have a great day.
If you’re like me, you’re probably pretty skeptical of people trying to sell you things, which is why I want to get to know you. We are hosting an amazing webinar that’s going to be all about how to kill it in private practice. In that, I’m going to give you great case studies of people who have really succeeded in private practice, but we’re also going to be talking about Killin’It Camp, which is going to be the all-inclusive event of the year. The prices go up on April 25th which is why we’re doing a great event on the 23rd. Head on over to to attend this masterclass all about how to kill it in private practice and get your questions about Killin’It Camp answered. Would love to see you there. Again, that’s a
This podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. It’s given with the understanding that neither of the host, the publisher, or the guests are rendering legal, accounting, clinical, or other professional information. If you need a professional, you should find one. Also, thanks to the band Silence is Sexy for that intro music.

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