Building an “Out-Of-Network” Practice with Melissa Schneider | GP 207

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Is there a difference between cash-pay and out-of-network services? How can offering out-of-network payments help to pay your therapists more? Is this something that you would want to try in your business, and if so, how can you get started with what you already have?

In this podcast episode, LaToya Smith speaks about building an “out-of-network” practice with Melissa Schneider.

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Meet Melissa Schneider

A photo of Melissa Schneider, LCSW is captured. She is a therapist, writer, and speaker specializing in couples therapy and support for entrepreneurs. Melissa is featured on the Practice of the Practice, a therapist podcast.
Melissa Schneider, LCSW is a therapist, writer, and speaker specializing in couples therapy and support for entrepreneurs.  In 2019, she founded Resolution Counseling Center in Jersey City.  In 2023, she launched Cultivate Therapy to bring more specialized services to her community.  Melissa earned her masters in Social Work from Columbia University in 2006 and lives in Jersey City with her husband and twin first graders.
Visit Cultivate Therapy, Resolution Counseling, and connect with Melissa on LinkedIn.

In this Podcast

  • The difference between “out of network” and cash-pay
  • What’s the benefit for the therapist?
  • What to say to the insurance companies
  • Building the out-of-network team

The difference between “out-of-network” and cash-pay

Many people may use the phrases out-of-network and cash-pay interchangeably, but Melissa recommends using them differently because they mean different things.

Melissa runs two practices; one is in network and the other is out of network, so she’s had experience with the two. The main difference is for the clients.

If a client goes to a cash-pay practice, they’re paying the same thing out of pocket and they may not be reimbursed at all, whereas out-of-network practices allow for clients to get partially reimbursed from their insurance companies.

[Clients] may not know that it’s a different deductible … We’re able to catch those details and really explain it to a client and we send claims to their insurance, so it’s not cash-pay, it’s like [you] pay upfront, we send the billing for you, and then you get reimbursed. (Melissa Schneider)

What’s the benefit for the therapist?

It can be tough to retain great therapists who are fully licensed and supervised. Offering out-of-network payment options can help retention issues because therapists can be paid more!

For me, my big value is that I want a happy, long-term professional home for my staff … For me, that’s the key to both practices being great [is] that our people stick around. (Melissa Schneider)

At Resolution Counseling, Melissa and her team use the profit-first approach to handling their finances. However, at Cultivate Therapy, the therapists on staff are offered a higher fee-for-service rate. 

Because now [therapists might think], “I could go with somebody else and jump over … Maybe I came in as a grad student and I’m working with you … I could stay with you and make double off-the-top and continue to grow with you”, to me it’s a no-brainer why they would want to stay. (LaToya Smith)

What to say to the insurance companies

With insurance companies, you have to speak their language.

Understanding the right questions to ask and the right words to use is important since if you outright ask for something, the chances are high that they’ll just say no.

You have to use the loopholes here and there in how you phrase things to get to some of the benefits for your clients.

Building the out-of-network team

That was the beautiful part, right. Like, we already had wonderful therapists so we picked four of them … And then on the back-end, we didn’t need anybody. It’s me and our billing manager. (Melissa Schneider)

Cultivate Therapy is Melissa’s out-of-network practice that exists as a sister practice to Resolution Counseling, and even though it has the same staff, it’s a separate business.

It has a unique tax code and separate registration.

Because this was a risk, Melissa and her team were very conservative with their therapists about their expectations. However, so far it’s going well and they are cash-flow positive.

For the next cohort, Melissa and her team are bringing in more therapists since the response has been successful.

Useful links mentioned in this episode:

Check out these additional resources:

Respect Your Craft. Own Your Greatness. With Audrey Augustave | GP 206

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Meet Joe Sanok

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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 who are growing their income, influence, and impact on the world. Click here to explore consulting with Joe.

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