Why I don’t take insurance

daughter counseling private practice advice

daughter counseling private practice advice


Someone just asked me: “I saw your comment on LinkedIn about how you no longer take insurance. I’m curious about that. What made you decide? How do you keep your clients? What do you charge?” I thought I would share my responses with you. I know that I get this question often, so here’s what I responded:

My journey was a bit unexpected. I worked in Kalamazoo for 3 years as an associate with a counseling practice. Here is a blog post I wrote about it that you might like: https://www.practiceofthepractice.com/privatepa/ I took insurance at that practice. Then in 2009 my wife and I moved to Traverse City, MI. Traverse City is flooded with counselors, mostly because we have a university that has a counseling program aimed at locals, so we have 30-40 new counselors entering the area area year.

At first, I did not take insurance because the panels were really difficult to get on. I read through the book Guerrilla Marketing  and started to use many of the approaches, such as getting onto a local radio show, evaluating my website to make it look different than other counselors (www.mentalwellnesscounseling.com) and finding people that could refer to me.

I then realized that I was spending a lot more time doing counseling and not sitting on the phone to try and get paid. For example, my typical Medicaid client would no show about 25-33% of the time, time I could not bill for. As well I got paid $53 per session from Medicaid. I then had to sit on the phone for at least an hour every 3 sessions, fighting with insurance. So if I sat on the phone for an hour, sat around due to a no show and did three sessions, I was getting $159 for 5 hours of work, or $31.80 pre-tax. If I wanted to do the same without the hassle, I could charge $32 per session. Also, I had a lot more time with my family, especially my cute daughter (see photo above).

Instead, I did a market analysis of the area and saw that the going rate was $80 per session. I decided to start at $70. Over the next year I raised my rates to $100, and now I am at $150 per session. As my expertise, exposure, and the client’s perception of value increased, I have raised my rates. I am now almost twice the going rate for private pay and still get 3-4 new referrals per week.

I think what any clinician needs to do is to somehow set their practice apart from others in their community. That can be through the website, participating in the community through radio, events, or writing, and having great customer service.

Regarding keeping clients, my goal is never to keep them past when I think treatment is necessary. I often ask them, “Why are you still in counseling?” or “Why are we still doing counseling weekly?” They then are on the defense and have to justify to me and to themselves as to why they keep coming. It keeps us goal-oriented and focused, thus using less sessions and saving them money.

As well, since I usually come recommended from people they trust, they usually want to see me. So, if they can only afford one session a month, we discuss how I will give them homework to make the most of that one session.

A few things that may help you as you prepare to launch your private practice:

I have an e-book that outlines more of what I have learned, www.practiceofthepractice.com/ebook
My newsletter usually has tips that help to make your practice more awesome
I also reference a number of books that have really helped me at www.practiceofthepractice.com/resources

Also, if you have any other questions, feel free to email me (joe@practiceofthepractice.com).

I’m also looking at planning a weekend retreat next summer specifically for counselors to learn about growing their practice. It is going to be a Fri-Sun and it will be limited to 8 people. Also, we’re going to go sailing, it’s in my hometown of Traverse City, MI, named one of the most beautiful places in America. Let me know if you are interested.

Please don’t feel you need to buy anything, I want to be a resource to help you out. I just wanted to let you know what might help you grow. Thanks!!!




counseling private practice advice

Joseph R. Sanok, MA, LLP, LPC, NCC loves helping counselors to make their private practices more awesome. He gets really geeked about seeing people reach their goals and also can’t wait to start offering more focused help through sailing retreats with counselors.

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