Have you hired, or are considering, hiring unlicensed clinicians? What can you offer them in your practice so that they and you both benefit? How can you set up work for them so that it counts towards their hours until they are licensed?
In this podcast takeover episode, Whitney Owens speaks with Lauren Hartz on how to fill the caseloads of unlicensed clinicians at an insurance-based practice.
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Meet Lauren Hartz
Lauren is the owner of Rooted & Rising Therapy in Pittsburgh, PA. She is a wife to Jimmy and mom to two boys; Landon and Jordan, who are always her why.
In This Podcast
- Filling caseloads on the front end versus on the back end
- Educate potential clients on insurance over the phone
Filling caseloads on the front end versus on the back end
For some states, you are required to state whenever an unlicensed clinician’s name is mentioned that they are currently until clinical supervision, however you can put this information up on the website where clients can do further reading. You do not necessarily have to mention this over the phone when clients phone in.
Therefore, you can market an unlicensed clinician over the phone as you would any of your other clinicians and then place more information about them on your website.
Clinical experience does not equate to being licensed or not. Many incredibly seasoned clinicians who have specialized in their counseling may not have gotten their licenses yet, although this should not discredit their counseling abilities.
Educate potential clients on insurance over the phone
Sometimes insurance only pays for certain aspects of treatment based on the assessment they made of the client when the client took out the insurance.
Therefore, when a client comes in for therapy, it is a good idea to run over what they qualify for before starting treatment with them so that they know what they can and cannot pay for.
Things that you would assume insurance would cover sometimes [aren’t] and then you do not want that client in a situation where they find that out later. (Whitney Owens)
With unlicensed therapists, you can:
- Be upfront with them when hiring and ask them to help you in marketing themselves and their specialty. Then it is their choice to work with you.
- Offer them the chance to perhaps run a group at a reduced rate.
- Offer the current clients at your practice to join the group to increase the clinician’s working hours.
- Consider reaching out to the current insurance companies that you work with and check whether they would sponsor a therapist who is unlicensed.
- Check your state to see what a clinical hour looks like for a licensed and an unlicensed clinician.
- Bring on unlicensed clinicians as half-admin and half-clinician until they are either licensed or until they can build their caseload enough to only do counseling work.
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Meet Whitney Owens
In addition to running her practice, she offers individual and group consulting through Practice of the Practice. Whitney places a special emphasis on helping clinicians start and grow faith-based practices. She hosts a podcast to help faith-based practice owners called the Faith in Practice Podcast.
Whitney has spoken at the Licensed Professional Counselors Association of Georgia’s annual convention as well as Maryland. She has spoken the past two years at Practice of the Practice’s Killin’ It Camp Conference. She has also been interviewed about mental health issues on several media outlets including WSAV in Savannah and in the Atlanta Journal-Constitution. Whitney is a wife and mother of two beautiful girls.
Thanks For Listening!
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[JOE SANOK]: Is managing your practice stressing you out? Try Therapy Notes. It makes notes, billing, scheduling, and tele-health a whole lot easier. Check it out and you will quickly see why it’s the highest rated EHR on Trustpilot with over a thousand verified customer views and an average customer rating of 4.9 out of five stars. You’ll notice the difference from the first day you sign up for a trial. They offer live phone support seven days a week so when you have questions, you can quickly reach out to someone who can help. You are never wasting your time looking for answers. If you’re coming from another EHR, they make the transition really easy. Therapy Notes will import your clients’ demographic data free of charge during your trial so you can get going right away. Use the promo code [JOE] to get three months to try out Therapy Notes, totally free, no strings attached, including their very reliable tele-health platform. Make 2021 best year yet with Therapy Notes. Again, that’s promo code [JOE] at checkout to get three months totally free.
[WHITNEY OWENS]: The Practice of the Practice podcast, episode 558. We are currently doing a special series on how to level up in your practice and interviewing group practice owners. This is Whitney Owens, I’m one of the consultants with Practice of the Practice, and I’ll be interviewing one of the Group Practice Bosses today and doing some amazing live consulting with her. So today on this episode of Practice of the Practice I am interviewing Lauren Hartz. She is the owner of Rooted & Rising Therapy in Pittsburgh, Pennsylvania. She’s the wife to Jimmy and mom with two boys, landed in Jordan who are always her why. Thanks for coming on the show, Lauren.
[LAUREN HARTZ]: Thanks for having me, Whitney.
[WHITNEY]: So why don’t we start out with you sharing a little bit about your current stage of your practice and kind of your running a group, what’s it like, what do you all focus on, how’s the pay, how many people? Tell us about the set up.
[LAUREN]: Well, the practice started in 2016. It was a solo practice and then I decided a couple years into it to add a clinician. We shared a single office space and then I slowly started to add a few others. When the pandemic began, it really made me nervous. I had just signed a lease, a three-year lease for a new space and we had three offices and a suite and then all of a sudden we weren’t seeing anybody in person. So that kind of scared me, but we were really able to thrive. At the time it was just the one clinician and I, and then we added three more. So in the past year we’ve added, three additional clinician. So there’s five of us now, three are licensed, also I’m licensed and then we have the pre-licensed clinician. We see —
[LAUREN]: A couple of us are trained in EMDR. We have a couples therapist, we work a lot with like adjustment kinds of things and anxiety and mood disorders and diagnoses like that.
[WHITNEY]: Wonderful. And are they contractors or employees?
[LAUREN]: Right now they are contractors and we are in the middle of shifting to employees. So that’s a transition we’re making right now.
[WHITNEY]: Awesome. So go ahead and ask me your question for today.
[LAUREN]: So Pittsburgh is a mostly insurance kind of area. Most practices here primarily do work with insurance companies. So we have to have pre-licensed or excuse me, licensed clinicians. I want to begin to add pre-licensed clinicians and we do have one, but building her caseload has been kind of challenging. More recently it’s been a bit easier, but I’m hesitant to bring on more pre-licensed clinicians because I don’t know what I can promise them. And I really do want to move in that direction.
[WHITNEY]: Tell me more about why you want to move in that direction.
[LAUREN]: I really love supporting other clinicians. I’ve done some supervising for LPC hours you know, just as kind of a side part of the practice and I’ve really enjoyed it. And I want to continue doing that. Plus I know before I got licensed, I had such ambition and such, I was so excited and I really wanted to learn and I really wanted to grow and it just felt like the opportunity to do that wasn’t great. So I want to be able to provide that for clinicians that come and work with us.
[WHITNEY]: Wow. I love that. Well, let’s talk about how things are now first, and then we can kind of explore options. So your current unlicensed clinician, can you kind of tell me a little bit about the experience of filling her caseload and what has been challenging with that?
[LAUREN]: Well, I think particularly because a lot of the insurance companies, since the pandemic started has been waiving copays, waiving deductibles, which is awesome. I think it’s, I love that they’ve done that. I think it’s really important. It’s allowed people to come more often who may not have been able to come. You know, you have somebody coming weekly that was only able to do biweekly or once a month at some point. So that has been a really nice opportunity but with that, when people have insurance and have you know, a small copay or no copay or deductible to meet at all to say that, “Oh, we have this clinician who can see you, but it will cost this much,” has been a bit challenging. You know, a lot of times people would say, “Oh, you know what? I really want to use my insurance so I’m going to go look elsewhere.” And I think the other challenge that has come up is just I am somebody, I want to give everybody all the information about everything, but I think sometimes I know that a pre-licensed clinician still has a lot of experience. So I struggle with how to communicate to potential clients that yes, this person isn’t licensed yet, but that doesn’t mean they don’t have great experience and that they can’t do really great work with you. So there’s a combination of the two things.
[WHITNEY]: Yes. You’re bringing up some really good points that I think a lot of people probably experience as well with an insurance-based practice. And here are some of my thoughts here that we can kind of talk through. I do think it’s a super challenging experience to be an insurance-based practice, but then also talk to people about cash pay, just the way that we market. We market differently for a private pay practice and put our money and resources into different things in the marketing than we do with an insurance-based practice. So I do find practices that are doing both. It is hard.
[WHITNEY]: Yes. I also think that there’s some things you could probably do on the front end to encourage people to schedule with the unlicensed clinician. I know that of course, ethically, we have to make it clear and I know every state is different. Like in the state of Georgia, we have to say on any of our marketing materials, under clinical supervision beside the person’s name and of course say they’re an MSW, non LCSW, or they’re an associate and not licensed. But that’s not necessarily something that we say on the intake call. Like that’s definitely something on our website that they can read about. It’s definitely something in the informed consent and they get that paperwork in advance. We are covering so much in the intake that we will tell them about the clinician, we’ll tell them what they have experience in, but we don’t necessarily go through the, this is a pre-licensed or this is a licensed, and this is all the things. Because you even kind of mentioned it the client doesn’t really understand all that, or they don’t know that an unlicensed person still has experience. So I wonder if you’re doing yourself a disservice by saying that on the front end.
[LAUREN]: That makes a lot of sense. That really does.
[WHITNEY]: Yes, we’re not trying to trick clients. Like for example, one of my current clinicians is fantastic. She does a lot with substance abuse treatment. Now she still isn’t licensed yet, but she’s older, she’s taken a lot of time to get licensed, he’s had issues come up in her family, but she’s got 20 years experience serving in the prisons. You know, and so that talk about working with substance abuse people, so if I were to say to somebody she’s not licensed, you would discredit all this work that she has done almost. And so we kind of put ourselves in a bad situation when we do that. Like I have another clinician that’s unlicensed who is a pastor. He’s been a pastor for 20 years. Talk about getting a lot of experience. I know it’s pastoral experience, but it’s still something under his belt and he’s moved to a lot of different states. So because of that, he has struggled to get his license. It’s like every time it was time to apply, he would move, he’d have to start over and other people wouldn’t quite understand that process. And they don’t need to know all that. Clients just need to know that we’re going to meet their needs and we’re going to care well for them. And obviously all these people are under supervision as well. It’s not like we’re hurting clients in the care.
[LAUREN]: Right. That makes a lot of sense.
[WHITNEY]: Yes. Now, are there some panels that you are not on as a practice insurance wise?
[LAUREN]: Yes, there are a few we’re not on. We accept four different kind of insurance groups, although even with some of that I’ve considered just going to the two that are easiest to work with. So I’ve been thinking about making that shift lately anyway.
[WHITNEY]: And are those paying better than the other two by chance?
[LAUREN]: Yes. That’s also a perk of these two. Yes, they’re our best paying ones.
[WHITNEY]: Are your clinicians full right now?
[LAUREN]: Yes. Although I just hired somebody yesterday.
[WHITNEY]: Cool. Congratulations.
[LAUREN]: Thanks. Yes, we’re super excited about that. But yes, so I just hired somebody yesterday, but our clinicians currently seeing clients are full.
[WHITNEY]: That’s right. So now if somebody calls with the higher paying insurance, you’re having to turn them away.
[WHITNEY]: Yes. So that’s something to think about. I do encourage you to consider coming off of one of them and just see how that goes and then you can come off the other one later. And I was just talking to someone else about this in consulting, just because you change, your insurances does not mean you can’t go back if something happens. Like if you get a year or two down the road and your practice grows or you see a new need, like you can always get back on the panel.
[LAUREN]: Right. That’s a really good point. I know I kind of went into this wanting to just, I want to be able to accept every client, I want to get in with every panel. But you’re right. That’s just not where we are right now.
[WHITNEY]: I think a lot of therapists get into it for and think that, and then they start getting burned out and working hard and realizing what they want to do with their practice. And then they’re like, “Wait, I need to get more focused. I can’t do all this work.” So I can kind of talk to a little bit about how I talk to clients about insurance. This would be a little different for you in the sense of y’all do accept insurance. So some of this lingo might be like, “Wait, that wouldn’t really work,” but I’ll probably do a little bit about how we talk to them about insurance. So yes, waiving the co-pays yes, that’s a gift, but it is really hard. I can hear that for you, and that’s something that we use to talk to clients about on the front end. So if that does change in the future, which I’m assuming at some point it’s going to change, you can talk to clients about that.
New Speaker: So when they make that call and they’re on the phone with my intake specialist and they say they want to use their insurance, we’ll say, “Have you checked your benefits?” Because not every insurance has mental health benefits, unfortunately. It’s terrible. Also, have you checked your copay because you might have one insurance that has a $30 copay and another has an $80 copay. And so we’ll say, “You know what, if you have an $80 copay, here’s a therapist that is $90. Your insurance doesn’t have to know you came, there’s no record of you coming, except for the therapist who has your record. No one else will even know.” And so clients like that. Also we know that insurance dictates treatment. So depending on the company, depending on their plan, depending on their diagnostic codes that really can influence the treatment they’re getting. I am amazed that clients don’t know that.
New Speaker: So we talk to them about that in the intake call. I just want you to know these things. So for example, with children, we see children here at the practice and we let them know, “Hey, with children, if your child would have run for president one day or to become a pilot, those are times where they can get ahold of your insurance records and find out that you went to mental health treatment.” Or, I know that doctors get asked in the process of becoming a doctor, have you ever had counseling, which that’s a whole another situation as to why that’s [crosstalk].
[LAUREN]: Right. Absolutely.
[WHITNEY]: But insurance is another place where your information is stored and people know that you went to counseling and they can get that information in certain situations such as politics.
[LAUREN]: That’s a really good point.
[WHITNEY]: Yes. So we talk to them about that too, and also talking to them, “Hey, if you don’t have a severe enough diagnosis, your insurance may not cover. We won’t know that until you start treatment.” Or sometimes we see that for couples. I don’t know if you’re seeing that too, that insurance doesn’t always cover couples treatment because they don’t think it’s medically necessary.
[LAUREN]: Right, right.
[WHITNEY]: Yes. So on the front end, really educating people about how insurance works. It’s a little different than when you just go to the doctor, but well even, you know, when I take my kids to the doctor, I’m amazed at the things like my child, now I could go on a tangent, but my child has hearing aids. Insurance will not cover hearing aids. Like what? My child can’t talk and she can’t hear and now you won’t cover hearing aids? But things that you would assume insurance would cover sometimes doesn’t, and then you don’t want that client in a situation where they find that out later.
[LAUREN]: Right. I think in, you know, in Pennsylvania we’ve, we’re fortunate in a lot of ways. And I have a son who has medical needs and benefits from a secondary insurance. So we have a primary and the secondary. Pennsylvania does a really good job with insurance, I think for the most part, but , you know, that’s, we don’t want to be a sick, a reactive system. You know, we really want to be a proactive system and that’s not what health insurance is, isn’t this point. So yes, those are really good. They’re really good points.
[WHITNEY]: Yes. So I think those are all things that you can try when you’re hiring an unlicensed person and how you talk to people, especially if someone’s calling that is not in network with you, then you can kind of talk through that with them. I’ve also been hearing lately from practice owners that in some states and in some insurances, unlicensed, people are getting credentialed.
[LAUREN]: I have heard that they’re moving in that direction. I don’t know how much it’s really happening locally for us right now, but you’re right. I have I’ve heard that as a possibility.
[WHITNEY]: Yes. I was really surprised because we’ve always been really adamant that we don’t provide superbills if someone’s not licensed so like, that can make it look like something else. But now that I’ve talked to some other business owners, they’re saying, actually, this is working. And so I went into our EHR and saw what the superbills looked like. And I was like, “It’s pretty clear this person is not licensed.” And so we’ve been sending those to people and doing that and so you might be surprised. And so you could reach out to your current insurances and just ask them, would they be willing to consider someone who’s unlicensed?
[LAUREN]: That’s a good idea.
[WHITNEY]: And then there’s some other things that you can do. I know you’re saying you want to make sure you can provide enough for an unlicensed person. Couple of thoughts there, be totally upfront with them. Like, “Hey, we’re an insurance-based practice. I can’t promise you how many clients you’re going to get. You’re going to need to also do some marketing and we will market you as much as we can in your specialty but I can’t guarantee anything.” They’re the ones making that choice to work for you. And you’re being totally transparent on the front end. And then you can come up with some other creative things. Like maybe they run a group at a really reduced rate. Maybe the current clients at your practice, you find that, hey, there’s is a current thing going on with them, among these clients. And so we’re going to offer this group for kids, with parents divorcing or eating disorders or whatever the person is specializing in and whatever your current clients need, you can provide groups and then they can get some hours that way.
[LAUREN]: Yes. That’s a really good point because you’re right. If you want to do that, if you want to do groups, if you want to be kind of do some of the creative, even as far as blogging and things like that to really kind of build that reputation and this is what you’re really good at, that makes a lot of sense. It’s you are a, we are going to, you know you are, we are going to attract some people in that way. That’s a good idea. Thank you.
[WHITNEY]: Yes. Yes, and then check your state guidelines on what counts as a clinical hour towards a license and what doesn’t. When I was hiring, so anyway, that’s one point, but I’m going to give another point here. When we brought on an unlicensed person, she just graduated. I was super nervous about hiring this girl because legit, like she started working for me right after graduation, but I knew her personally and thought very highly of her. Anyway, she’s been one of my best clinicians. She is fantastic and does really good work, but she needed a lot of hours. Like she didn’t have anything else she was doing and she needed to work. That was going to take time to build her caseload. So she actually came on is half admin, half clinician. And so we built her caseload over time, but she also took calls and it was great.
New Speaker: I was really worried about that, like, oh, well, how is she going to be unbiased and not give herself half the clients? You know, and how she’s not going to get overwhelmed. But her and the intake person at the time was already getting overwhelmed with the number of calls. So they split up the time of the day and then they were back up to one another and ended up being a really fantastic situation. So if you are bringing on an unlicensed person and they just need some extra hours, you could consider some admin work that they could do on the side and then look and see if some of that can even be counted because answering calls, you’re talking to clients. Usually that can get counted towards licensure.
[LAUREN]: Right. Yes, that makes sense.
[WHITNEY]: Yes. I mean, it sounds like it’s something you’re passionate about and love. So I wouldn’t give up on hiring unlicensed people and then just kind of see where this goes, come off of that one or two panels that you’re not happy with, see how that goes, and kind of move forward from there.
[LAUREN]: I love that. I think it’s good. And a lot of it is, are things, you know just sort of a Group Practice Boss. I’ve kind of heard and considered but this is really helpful because it, I think it just kind of just reinforces in my brain, like keep moving forward. Like it’s this is, it’s coming together. It will continue to come together.
[WHITNEY]: Yes. Yes, it will. You’ve grown a ton in a short amount of time.
[LAUREN]: Yes. I’m very, I’m really, really grateful. Yes.
[WHITNEY]: Well, in all things, I always say the more time and energy you put into something, the more you’re going to get out of it. And Lauren, you are one of our all-stars in Group Practice Boss. I feel like I see you in almost all of our webinars and you know, I didn’t know you before Group Practice Boss. And now I feel like I know you at least on a professional level and that’s really special. Like I get to hang out with you almost every week.
[LAUREN]: I love it. I could have never gotten to, and that’s not to be self-critical or anything like that, but I’m passionate about the work. And that’s always been my greatest strength, but as far as some of the other stuff, like I just don’t know, and I’m really not doing this, like anybody else I know in the area. A lot of my colleagues, and I have particularly in, so we’re like out right outside of Pittsburgh. It’s called Bridgeville. And I’m close with pretty much every provider in Bridgeville. I mean, we have a really good working relationship and it’s such a gift but they’re all everybody’s doing it so differently than I am. So you and Alison and Joe have just, there’s no way I would have been able to do all of this without the support. So I’m really, really grateful for all of you. Well, I appreciate you saying that.
[WHITNEY]: And you know, I tell people all the time, I know consulting seems like a lot. It seems like a huge investment, but it really will take your practice forward so much faster and you will make so much more money. Julie Herres, who owns GreenOak Accounting, when she was on my podcast, she said after the end of the year, it was, I think, I guess it was 2019 or 2020 when they were working through private practice budgets, the practices that had consulting that year made 30% more.
[LAUREN]: I can see it. I totally believe that’s the case. And I think there’s something about the intention that comes with this. I mean, you’re doing that and I know you all have said that, like that active, just kind of weekly. And that’s why I make sure that I get to the, pretty much every week I get to the Tuesday meeting is because at least for that hour, every week, I’m being very thoughtful. I’m functioning as a CEO, rather than like getting in the weeds of clients and notes and figuring this and checking this. It gets me outside of that and I can be, I can get really easily distracted. You and I have talked about that. I’m a nine on the Enneagram and I can be very perfectionistic, which causes me to procrastinate and all of those things. So it really has given me a nice guide to follow. It’s been really, really important.
[WHITNEY]: Oh, I’m so glad. Well, nines usually are doing everything to not do the thing they need to be doing, so they become busy, but they ignore what they need to do. And you know, Lauren, even though I’m a one, sometimes I move into that nine and yes, I can really procrastinate. Yes. So, awesome. Well, I always love talking Enneagram as well. Well, thank you so much for coming on the show. I’m excited to hear about how things move forward in your business and look forward to connecting more in Group Practice Boss.
[LAUREN]: Thanks so much, Whitney. I appreciate this and I love your podcast. I love what you’re doing. It’s really cool.
[WHITNEY]: Thank you. Lauren just did an excellent job on her interview talking about moving from hiring, just not one unlicensed, but hopefully more unlicensed clinicians to her insurance-based practice and learning how to sell those clinicians to clients and help clients in their treatment. She has been rocking it out in Group Practice Boss, and we love having her in the community. If you are a group practice owner, looking for ways to make further connections with other practice owners, getting a kick in the butt in your practice, wanting to scale and grow, Group Practice Boss is just the place for you. And to tell you a little bit more about how it functions, every single month, we dive deep into different topics related to group practice ownership. This month, we’re doing money management here in the month of April, and then moving forward into may and into the summer, we’re going to really dive into different marketing techniques, like we’re going to talk about in-person marketing, social media marketing, how do you create a website that attracts your ideal client and so much more.
New Speaker: So every month our webinars are the exact same time, because this helps you as a busy practice owner to set aside in your schedule and make it important. So every Tuesday at 1:00 PM Eastern is when we have our regular meetings. We dive deep into different topics, the deep topics that I was just mentioning and then we also do a small group component within Group Practice Boss, where we connect you with other group practice owners in the same phase of business. And then we also have open office hours once a month, same time every month, where you can connect with myself or Alison and get that one-on-one time within the group setting, but put your questions out there to really get that personal feedback. So if this sounds like something that would help you, if you’re a group practice owner, it will, go over to practiceofthepractice.com\grouppracticeboss. Go ahead and join now. We used to only offer it at certain cohorts. We were finding that people wanted to join at different times. So we have an opening all time. So go ahead and go over there so that you don’t miss out on what we’re going to be covering over the summer. Thanks for listening.
[JOE]: What an awesome show. Hey, if you have not yet tried Therapy Notes, you need some help around your notes, your billing, your scheduling in now telehealth. Telehealth has never been more important than now, and it’s totally integrated within Therapy Notes. So make sure you go over to therapynotes.com, use promo code [JOE], you’re going to get three months for free. They give you three months free, and if you’re in another EHR, they will take all of that data and bring it over securely. Why not try it out? If you’re frustrated with your EHR or you just want something better, you got to check out therapynotes.com, use promo code [JOE] at checkout.
Thank you so much for letting me into your ears and into your brain. I’ll talk to you soon. Bye.
Special thanks to the band Silence is Sexy for your intro music. We really like it. And this podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. This is given with the understanding that neither the host, the publisher, or the guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.