How to bill out of network benefits with Christine Li (and exactly what to say when someone asks “Do you take my insurance?”) | POP 908

Share this content

Are you a cash-pay therapist? Do you want to bridge the gap between clients needing therapy without you taking insurance and losing money? How can you tap into the out-of-network benefits and still be cash-paid?

In this podcast episode, Joe Sanok speaks about how to bill out-of-network benefits with Christine Li (and exactly what to say when someone asks “Do you take my insurance?”!)

Podcast Sponsor: Therapy Notes

An image of Therapy Notes is captured as the sponsor on the Practice of the Practice Podcast, a therapist podcast. Therapy Notes is the most trusted EHR for Behavioral Health.

As a therapist, I can tell you from experience that having the right EHR is an absolute lifeline. I recommend using TherapyNotes. They make billing, scheduling, notetaking, telehealth, and E-prescribe incredibly easy. Best of all, they offer live telephone support that’s available 7 days a week.

You don’t have to take my word for it – Do your own research and see for yourself – TherapyNotes is the #1 highest-rated EHR system available today, with 4.9 out of 5 stars on and on Google.

All you have to do is click the link below, or type promo code JOE on their website, and receive a special 2-month trial, absolutely free.

If you’re coming from another EHR, TherapyNotes will import your demographic data quickly and easily at no cost, so you can get started right away.

Trust me, don’t waste any more of your time, and try TherapyNotes.

Meet Christine Li

A photo of Christine Li is captured. She is the founder and CEO of Mentaya. Christine is featured on the Practice of the Practice, a therapist podcast.

Christine Li is the founder and CEO of Mentaya. Their mission is to increase access to high-quality mental health care in a sustainable way. At Mentaya they believe that the solution to greater mental health access has to include helping therapists put their oxygen masks on first.

Christine was a former product manager at Google and has a degree in computer science from Princeton.

Visit Mentaya, and connect with Christine on Twitter and LinkedIn.

FREEBIE: Sign up to Mentaya with the code JOE to try the Instant Benefits Calculator for free for a month!

In this Podcast

  • Why out-of-network benefits?
  • The problems with insurance
  • Are you a private pay therapist?
  • What to say to a client
  • Christine’s advice to private practitioners

Why out-of-network benefits?

Christine’s passion to start a business came from her desire to make high-quality mental health care more accessible. Her company was initially focused on out-of-network benefits because they wanted to ensure that they were taking both the client and the perspective into account.

I know that this is a field in which mental health workers and therapists are oftentimes or are not as focused on [since] it’s a lot on the client … We wanted to do it in a way that would not only help the client but also help the therapist as well. (Christine Li)

Working with out-of-network benefits is then a great way to help the therapists get their full hourly rate while allowing clients to be reimbursed for up to 80% of the cost of that therapy.

The problems with insurance

With insurance, a lot depends on the contract and the practice’s physical geographic location because for some locations insurance companies will pay more than others. This can become tricky if the cost of living in an area is especially high, which could end up costing a therapist more money than they are able to make by working with a certain insurance company.

A lot of therapists find it unsustainable to only take insurance clients and so most therapists are either entirely out of network or have a big chunk of their practice that is out of [insurance] network. (Christine Li)

If a therapist is considering taking on insurance, they will have to consider whether they have time to handle the billing that comes with being in network, consider the practice’s accessibility to clients, and how much they would be paid at the end of the day.

Are you a private pay therapist?

Most clients might not realize that they have out-of-network benefits, and if they see you even as a private pay client, they can still get reimbursed from their insurance company for their therapy with you.

You don’t have to specifically be credentialed, but you might need to be registered as an out-of-network provider with the insurance company.

What to say to a client

I think one of the most difficult things about going cash pay or being out of network is saying to clients, “Hey, this is the fee. Sorry, we don’t take insurance. Here’s a superbill, good luck submitting!” … There are other ways to do that, and to have that conversation. (Christine Li)

With a platform like Mentaya and its benefits calculator, you could be a cash-pay therapist but then say on the phone to a client query:

  • “My fee is $200 cash pay and I don’t take insurance, but give me your insurance card and I can just check and run your benefits through the system to tell you immediately whether you have these out-of-network benefits, and how much you could get reimbursed per session, and we can help you file the claim!”

Having this conversation can help clients who might be on the fence about taking sessions with you when you aren’t fully on their insurance. Not everyone can pay their full fee, so these systems can help clients get to the therapists that they want to see without paying out of their budget or the therapist having to lose money to see the client.

Christine’s advice to private practitioners

Being in private practice is admirable! The fact that your business serves the community and you weren’t taught about business in school is brilliant, but feel safe to reach out for help. Organizations like Mentaya are here for you!

Sponsors Mentioned in this episode:

Useful links mentioned in this episode:

Check out these additional resources:

Meet Joe Sanok

A photo of Joe Sanok is displayed. Joe, private practice consultant, offers helpful advice for group practice owners to grow their private practice. His therapist podcast, Practice of the Practice, offers this advice.

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.

Thanks For Listening!

Feel free to leave a comment below or share the social media below!