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In this episode, Joe Sanok speaks with Perry Rosenbloom, from Brighter Vision, in a reverse podcast about how to go private pay.
Confused by all the advice on starting a private practice? I’d love to help. I put together a checklist of the top 28 things to do to launch a private practice.
In This Podcast
I chat to Perry Rosenbloom, from Brighter Vision, about going private pay in private practice. This includes my experience with insurance panels and my decision to go private pay. I also speak about how to chat to clients about this as well as how to market your private pay private practice.
Issues With Insurance
My issues with insurance panels was as follows:
- Spending time acquiring clients only to find you don’t work with their insurance
- Deciding which insurance panels to sign up with in your area
- Amount of time spent dealing with insurance panels / doing the paperwork etc.
Benefits Of Private Pay
You can use the fact that your private practice is ‘over the top’ confidential as a selling point. The information cannot get hacked because it is safeguarded as paperwork in a cabinet.
When selling your private practice, you need to believe in your work. Speak to why your expertise are different. Your passion will come out when marketing your practice.
How To Market Your Private Pay Private Practice
- Create a business avator
- Identify pains of that avatar as well as outcomes
- Who is your avatar connected to?
- Webinars about how to start a practice, fill a practice, add insurance, etc.
- World Changers Challenge: write an e-book in a month
- September: Michigan Home Based Family Services Association
- October: Brew Your Practice
- November: Alabama Counseling Association
Meet Joe Sanok
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!
Feel free to leave a comment below or share this podcast on social media by clicking on one of the social media links below! Alternatively, leave a review on iTunes and subscribe!
File: POP 237 – Perry Rosenbloom – To go Private Pay
Joe Sanok: This is the Practice of the Practice Podcast with Joe Sanok, session number 237.[MUSIC] [WELCOME TO THE PODCAST] Joe Sanok: If you are starting, growing or scaling a private practice, you are absolutely in the right spot. Massage, therapists, counselors, therapists, marriage and family therapists, chiropractors – you are all welcome and you are here with the right people. We’re talking every single week or more. Sometimes I do multiple episodes in a week all about how to grow your practice. What you do to start it? How do you scale it? How do you outsource all these things? I interview people. I get people to interview me or I just talk. So if you are brand new here, welcome. I am so glad you are here. Make sure you rate and review us and I am feeling kind of nervous right now. About an hour from now, I have one of my first… actually it’s the first Practice Essentials Webinar and we tried to launch it last week with How To Fill Up Your Practice with Allison Puryear and Jane Carter, and I totally screwed up. I didn’t realize that the host, me, had to be plugged into Ethernet and that doing over Wi-Fi base screwed everything up. So we had 80 people that came to this webinar and they couldn’t see it. And we ended up having to use Zoom instead. So like I am in my office. I am connected to the Ethernet, but part of me is like, “I don’t want to screw this up again.” But if you want to be a part of all of these webinars that are coming up, we have so many different and amazing guests and topics we are going to be covering… they are live, Q and A, have great resources for you to take advantage of. Head then over to www.practiceofthepractice.com/practiceessentials to sign up for that. Also in September, we are going to be doing another challenge, write an e-book in a month. So you are going to have to focus in on, you know, what you want to kind of tell your potential clients or to tell your community. You can sign up for that over www.practiceofthepractice.com/challenge. It’s a 100 percent free. It’s my way of saying, let’s do something together. We did the World Changers Challenge back in June, and we are doing another World Changers Challenge around writing an e-book in a month. So again, that’s www.practiceofthepractice.com/challenge. Get tons of things coming up this fall. In September, I am going to be speaking at a Michigan home-based family services association down in Franklin with Michigan doing their keynote. So if you are in the Midwest, come on up to that. In October, we have Brew Your Practice down in Asheville, North Carolina. Two days hanging out, working on your practice. Head on over to www.brewyourpractice.com for that. I am going to work with Jane Carter and Allison Puryear on that. And then in November, I am going to be down doing the opening keynote for the Alabama Counseling Association, like 2000 counselors. It’s the biggest keynote I have done to date and I am crazy excited for it. So if you want to hang out in person, I would love that. It’s always so much fun and I just got these brand new the Practice of the Practice stickers, similar to like the match stickers, but it’s the Practice of the Practice chair. So I will be giving those out to people there, our podcast listeners. So find me in one of those conferences and I will give you a sticker. And maybe we will see if you get a Practice of the Practice trucker hat. Those are something that I have been… I gave out at Slow Down School and they were big hit.
So today Perry Rosenbloom who is the CEO of Brighter Vision… Brighter Vision has been a huge sponsor, partner with Practice of the Practice and so many of my consulting clients have used them for their websites… Perry invited me to talk about private pay practices for his podcast, and the content that he was able to pull out of me, I just not have to do another reverse podcast interview. And so without any further ado, we have Perry Rosenbloom from Brighter Vision interviewing me, Joe Sanok.[MUSIC] [THE PODCAST – INTRODUCTION, BACKGROUND, AND ABOUT BUSINESS] Perry Rosenbloom: Hi everyone, welcome to episode two of The Therapist Experience Mini-Series on becoming a private pay private practice where we interview industry experts on their experience, guidance, and advice on transitioning to a fully cash-based practice. To listen to previous episodes in this Mini-Series, please head on over to www.brightervision.com/privatepay. Today’s guest I am so excited for, he is the number one podcaster in our industry and a major voice and does so many great things. Joe Sanok. Joe how are you today, Sir?
Joe Sanok: I am doing great Perry. I am so excited to be here. Thanks for having me on.
Perry Rosenbloom: My pleasure, and as I said to you before here, I am a little antsy here. I am a little, little intimidated being on the other side of microphone from you. So we are going to have a lot of fun though. You have so much advice and expertise to share and thank you so much for coming on today.
Joe Sanok: Oh, yeah. Any time. I love the work you are doing.
Perry Rosenbloom: So for those not familiar with Joe, let me give a little introduction to him. Joe Sanok is a speaker, mental health counselor, business consultant, and podcaster. Joe has the number one podcast for counselors, the Practice of the Practice podcast with interviews with Pat Flynn, John Lee Dumas, Chris Ducker, Rob Bell, Glennon Doyle Melton and Lewis Howes. Joe is a rising star in the speaking world. Joe is a writer for Psych Central and has been featured on the Huffington Post, Readers Digest, Buzzle, and Yahoo News. He is a keynote speaker, author of five books, and is a top consultant in the therapy industry. Joe, thank you so much for being here man.
Joe Sanok: Yeah, this is going to be awesome.
Perry Rosenbloom: Yeah, so Joe, why don’t you tell our audience a little more about your background, how long you have been in private practice, what you focus on, and a little bit about your business?
Joe Sanok: Yeah, so I have a business called Mental Wellness Counseling in Traverse City, Michigan, and this year we are up to 10 clinicians, and then we actually thinned that out a bit, so we have five really active clinicians now. And it’s an entirely cash-based private practice here in Traverse City, and then the other side of what I do is Practice of the Practice where I help people to plan, start and grow private practices.
Perry Rosenbloom: Wow! So you were up to 10 clinicians and thinned out to just 5. Why is that?
Joe Sanok: Yeah, you know what’s interesting is we were up to 10 and I was thinking I have got some people that are kind of moonlighting, doing like 10 sessions a week or fewer inside. I was like, I would rather have less people there doing more sessions, just because from a management standpoint. So it’s like if someone was doing five sessions a week, it is nice to have their money come in, but then everybody feels like they have an equal say in things. But really in my mind, they didn’t like the person that is doing 30 sessions a week. To me, that person is really invested, whereas someone who has a full time job and is just kind of part time here… it was kind of annoying, honestly, from a management standpoint. What happened was I didn’t have to let anybody go, it just like naturally thinned itself. One lady moved to Tucson and other lady moved to Detroit. Someone else just decided that want to downsize, and other lady got married and said, “I just want to take like 8 months off as sabbatical.” They just like be married and just kind of see how that is, and it just worked itself out in a way that I didn’t have to be the bad guy.
Perry Rosenbloom: (laugh) That’s a nice way of working out for you. That’s great.
Joe Sanok: Yeah.
Perry Rosenbloom: And so you have five full time clinicians working for you and you are entirely cash-based.
Joe Sanok: Correct, yeah. So in 2009, when I moved back to Traverse City from Kalamazoo, I tried to get onto insurance panels and luckily they were all fallen. Nobody wanted me. And I wanted to start a part-time private practice in addition to my full-time job, just to pay off student loan debt. And I got it going, got my website up and said I am going to just open my doors and slowly got a handful of people. At that time, my goal literally was just to pay off student loan debt. It wasn’t to build some empire of private practice, that was something that was on my radar, but I didn’t necessarily have that as an immediate goal. And then things just kept taking off. We can talk about how I structured pay and how I talk about that, but then I added a clinician after about a year. While I was still on my full-time job, I had three clinicians working for me. So I was making more outside of my full-time job, you know, working 10 hours a week. Then I was in my 40-hour week job and that’s why I clearly had to say what am I doing here.[ISSUES WITH INSURANCE] Perry Rosenbloom: (chuckle) So did you ever try again to get back on insurance panels or you just sort of put that in the rear view mirror and never looked back?
Joe Sanok: Yeah, so I have been on insurance panels when I was down in Kalamazoo working as a 1099 contractor and I can talk about what that experience was like, but by the time the insurance panels opened up, it was probably 6 months or a year after I had opened the practice. I was just full as I wanted to be, was raising my rates on a regular basis, was getting paid more than what the insurance panels were paying and I just decided I am not even going to apply. They actually reached out to me and I’m like sorry, I am not going to do it.
Perry Rosenbloom: (chuckle) That must have been so gratifying after having to deal with insurance panels in Kalamazoo and just to say oop, nope, sorry, don’t need you guys.
Joe Sanok: Yeah, I mean, there was a certain sense of…not going to lie, there was some pride there, for sure.
Perry Rosenbloom: So what was the experience like being a 1099 on insurance panels in Kalamazoo? Did you enjoy the experience or… tell our audience about that.
Joe Sanok: Yeah, so I worked for Dr. Larry Beer, who has one of the largest practices in the nation. He often speaks at the American Psychological Association about supersized private practices and it’s just an incredible practice… and did I lose you?
Perry Rosenbloom: Nope. I am sorry.
Joe Sanok: Oh, sorry. I heard a click and then it was silent. So he is amazing. He has an insurance-based practice there and he coached me the best that he could. But what I found really tough, especially earlier in my career was I had a market to find new clients, but then often as people would call and I wasn’t yet on a certain insurance panel. So then I have to refer them outside. So all this time getting the clients only to say sorry I don’t take your insurance. Or on the other side, I would spend all this time getting onto insurance panels only to be like where are these people in our town. Like, should I do it with the big ones, just the big two or three? Should I try to get on all the little ones, go through CAQH and all that stuff. And for me the amount of time that I spent dealing with insurance wasn’t worth it. I remember one insurance in particular. I got $53 per session, which… as someone couple of years out of grad school with the business taking a percentage of that was still, you know, a decent hourly for me. But they would only authorize three sessions. So a $159 for those three sessions. I would spend at least an hour sending in paper work and working for those authorizations, getting paid for something that I had already done. I would then have to wait 30 to 45 days for the check. Then usually that client would not show one of those three sessions which wasn’t billable. So now you have five hours in for 160 bucks or so. So I could then keep that model or I could just charge a 160 bucks and give four sessions away and come out exactly the same.
Perry Rosenbloom: So there is a lot interesting stuff there. So the $160 [Inaudible 00:11:32.00] dealing with the insurance panels and all the paper work and all the headache and all the hassle. But then they only approve three sessions. So then that means that every new patient is only worth a $160, their entire lifetime value. Is that correct?
Joe Sanok: Well, so they would only approve three at the beginning and then you have to come back and kind of say why do I want five more. And so then would do it in blocks of five, but every time there was someone that wasn’t a clinician that was saying, well, why does this person still need therapy, and I’m like you barely have an associate’s degree, you are just reading off of a script and you are trying to find ways to not give people coverage. So like this is not what I went to school for when it comes to helping people.[PRIVATE PAY PRACTICE – SOME ISSUES] Perry Rosenbloom: Yeah, and so then you move from Kalamazoo to Traverse City, and you said, all right, I am not going to be on these insurance panels. They don’t have room for me. Let’s just open a practice and let’s just be cash-based. And you said that you started filling up very quickly. What rate did you start at?
Joe Sanok: Yeah, so what I did is I looked at what the market rate was for our area for a private pay and at that time it was $80 per session. So I thought, well, I’ll just go $10 a session underneath which actually I wouldn’t recommend right now. I think that from my level of experience at that time, if I was consulting with 2009 Joe Sanok, I would say, you’re fully licensed. You have a bunch of experience. You have been featured in a lot of different things. I would say actually go above the market rate, so you build your value, especially if you have a full-time job for people that are doing kind of a part-time practice, you really want to make it worth it, for you to go and to do the practice. So I would say I should have started probably around $120. But I started at 70 bucks a session.
Perry Rosenbloom: So you started 70 bucks a session, started filling your practice pretty rapidly. Do you think that people who started seeing you were… do you think that you were able to build your practice so quickly in part because you started with a lower rate?
Joe Sanok: I think that definitely was part of it for some of my clients, but when you think about the type of person that can pay out of pocket, typically they have the money, no matter what you charge. I mean of course there is an upper level to that, but I do think that the people that are going to choose private pay, they are going to choose it for a few different reasons. They don’t want their insurance to know that they are in counseling. They don’t want a formal mental health diagnosis. They don’t want [Inaudible 00:13:54.08] mental health diagnosis. They maybe in a career where that could really affect their career if for some reason there is a HIPPA violation in that somebody found out about their diagnosis. Also, they just want to be in charge of their records. They want to be a 100 percent in charge of it. So they may use an HSA or flexible spending account to pay for that, and for a lot of people that’s really important especially with… I mean if the DNC can get hacked, a lot of things out there can get hacked. Nothing against all of the great providers out there that provide HIPPA management systems or EMRs. But for me having a private pay practice, the paperwork is literally locked in a cabinet and not online, was actually something I used as a selling point to say we are over the top confidential, let me tell you why.
Perry Rosenbloom: (chuckle) Do you think that in your consultant work you see the selling point of being over-the-top confidential as being an asset across the country to help sell your services.
Joe Sanok: I think being over the top confidential can be an asset of what that looks like to each person or each clinician, and clinic is going to look a little bit different. So if it’s that you want electronic medical record, you want electronic scheduling or those sorts of things, making sure that you have the top products that are out there, that are both user friendly and also HIPPA compliant. So that can be something like simple practice and looking at what people like Roy Huggins are writing about HIPPA. Making sure that you are up-to-date on all the ways that people can get hacked is really important. And then use that as a selling point to say you are over-the-top confidential what differentiates you from just a regular clinician, that the insurance says, sure you can go see these 10 people.[MARKETING PRIVATE PAY PRACTICE] Perry Rosenbloom: So you have a taste for selling. You understand it and you know whether that can be acquired overtime as a skill or was innate in you. I don’t know 2009 Joe, but a lot of people, a lot of therapists find selling really hard, and that’s got to be the most challenging part about being a cash-based private practice because you do need to sell yourself more. You don’t… you know, you are not on insurance panel, you are not getting the referrals from the insurance network. You have to tell someone, hey, you know, you have to pay me cash for my services. Would you recommend to people who are transitioning to a private pay, private practice? Would you recommend to them in terms of advising guidance, on learning how to sell yourself.
Joe Sanok: Yeah, so definitely is not innate to me. The summer… it was my senior year of high school, the summer going into college. I sold Kirby vacuum cleaners door to door. And so I literally would carry a vacuum cleaner up to someone’s door and try to get in there to demonstrate it for them to sell them this $2000 vacuum cleaner. I sold two and half, I sold one…
Perry Rosenbloom: … and half? (laugh)
Joe Sanok: Yes. So I sold one to my parents. My parent’s friends wanted a demonstration and bought one, and then I got so bored with going door to door by myself, I got a friend of mine to go with me and I said, literally I just want the company. I will give you half of the profits if you come and that was one that we actually sold. We sold one to this couple that really needed it. But for me marketing a $2000 vacuum cleaner door to door was the worst thing in the world for me. The product was good, but I didn’t believe in it. It wasn’t a life passion. And so, that’s where I think a lot of us feel when it comes to our private practices. But the big difference is… in selling your private practice is you have to believe in your work. I believe that we have some of the best clinicians in Traverse City, that we are the premier practice for premier people here in Traverse City. And so when I can speak to why expertise is different… you know, I went through Gottman’s level 1 training recently. And so I am incorporating that in my [Inaudible 00:17:51.29] work. As well I have Steve Greenman, who… he writes the best substance abuse assessments in the [Inaudible 00:17:59.18] County area. The judges, the attorneys, the people that get the substance abuse assessments, they say that to us. And so if you are doing really, really good work, it’s a lot easier to market yourself because you just want to talk about the impact it’s having on people. The bottom line is we have fast outcomes in our work here. We help people quicker. We help people make changes and we get to see people’s lives change really quickly because we have great clinicians here. And so when that’s the case, that passion comes out versus selling a Kirby vacuum cleaner door to door.
Perry Rosenbloom: So [Inaudible 00:18:35.02] I had no idea you guys have five, previously ten clinicians, working at your practice. That’s so impressive and so amazing to see, and you know the work that you are doing, like you said, it’s great work. You’ve seen the outcomes. You have the premier private practice in Traverse City. But what about to a therapist who has been on insurance panels for four/five years and it’s getting sick of doing all the paperwork and essentially being an employee of Blue Cross Blue Shield and United Healthcare. What do you… how do they begin understanding how to sell themselves and begin that transition and make that transition a success.
Joe Sanok: I think the very first step is to identify who are the clients that you have enjoyed working with the most. So was it that one couple that… you know, they were dealing a miscarriage and you’re like that was amazing. I felt so good about that work. They felt so good about that work. Like create a business avatar who you really enjoyed working with. Just yesterday, in our mastermind group, I helped this one lady. As a group, we helped her figure out who is her specialty and who does she love working with. You can find these unifying features. It doesn’t have to just be, I am going to work with people dealing with an eating disorder. I am going to just help people that are dealing with divorce. Look at those clients that you have really enjoyed working with and you had strong outcomes with, and see what unifying features they are. Maybe they are all people that really value change and self-improvement, and then they also… maybe they are highly educated. Maybe they are type A people. What is the unifying feature. So I start there with creating a business avatar. From there, really looking at how do you articulate the pain that that business avatar comes to you with in your practice and then the outcome. So I help kids or I help parents who are getting too many phone calls from the principal to be able to have a clear plan for helping the student be more successful in school. So, what’s that pain? I am getting way too many phone calls from the principal. What’s the outcome? We are going to have a plan for the behavior, so that you can have more peace in your house. So you really want to say what’s that pain and then what’s the outcome you get from that. And then third, you want to think about once you have sketched out that business avatar, who is connected to that person. So say we have that couple, that there they have a middle school boy who the principal calls at least once a week because of some behavioral issue. Who is that mom or who is that dad going to vent to about that? Like are they going to have a beer with somebody? Are they going to talk to their pastor? Are they going to go to a Facebook group and vent to other moms or dads? Like where are they going to go vent? And if you can discover that, that’s the list of people you need to be networking with, that when someone is venting to them they say, oh, my gosh! I know this guy in Traverse City, Michigan, who works with angry teenagers – named Joe Sanok. He is the best. He has got all these blog posts about it. Yeah, if you google angry teenager, it’s going to show up top. And that’s where the process of knowing who you enjoy working with and get the best outcomes. How do you quickly articulate their pain and the outcomes that you have in counseling and that who is connected to that person. If you can go through that, you are going to find so many more clients because it’s going to be that kind of authentic relationship that happens where people naturally are going to say, “You know what, you need the best and here is the best.”
Perry Rosenbloom: Joe, this is exactly why we have you on here man. That was just so perfectly articulate. I’m sure if anyone is listening to this [Inaudible 00:22:08.16] podcast, you have reading other marketing materials, you know, you create the avatar, but you took a step further. You start going and talking about marketing and figuring out who this person is connected with and you use the language, where do they vent, who do they vent to. And finding that forum, that’s how you begin marketing yourself. So you are creating that avatar. You are creating, you are figuring out who do you want to work with and making that transition easier [Inaudible 00:22:33.09] figuring out where they are hanging out and who they are venting to. I have never heard that language specifically used before and I think it’s just so true. That’s how you are going to acquire those customers.
Joe Sanok: Right.
Perry Rosenbloom: You are going to acquire and start, you know, growing your practice, that’s how you are going to market yourself.
Joe Sanok: Oh, it’s like even recently. So a close friend of mine recently told me that he had been diagnosed with diabetes. He knows that I am type 1 diabetic. So who does he call? His friend who has diabetes and then I am going to share with him, “Here’s all the things I have learnt from other people.” Here’s an author, here’s a podcast, here is the anti-inflammation things that you can eat that’ll help. Eat a bunch of cinnamon, that helps with blood sugar. So you just think about in your own life. If you are dealing with a pain or if your friends are dealing with a pain, they come to you. And then what you do? You don’t just sit there and say, “Oh, I am sorry you have diabetes now.” No, you will naturally say, I am sorry you have diabetes, that totally stinks, but there’s hope. Let me tell you a couple of things that had worked for me. If they work for you, awesome. If they don’t, that’s fine too. But as your friend, I’m not going to, like, hold back my information. And so we naturally do this in our own lives anyway, and so we just need to kind of be aware of when we need to make a big decision. How do we make that decision? When something goes wrong in our life. When our mom or dad is dealing with something. How do we make that decision and how do we end up purchasing something based on that pain? So it maybe, I am going to buy a blood pressure cuff for my mom because she is dealing with high blood pressure, which she is not, but if she were I had probably if I had friends that had dealt with that, I’d say which one is the best one? Now that’s really authentic, natural marketing that those blood pressure cuff companies have been able to do. So we make these decisions every single day. We just have to be more aware of the nuances of it and then how to take those out of our everyday experiences and then apply it to our own practice.
Perry Rosenbloom: That was great. So I would love to move on to some of the hesitation and the fear that you can feel when transitioning to a cash-based private practice. Do you see in all your consulting work a fear that a therapist will say, I want to be cash based, but I’m scared I am going to lose all my current clients. How do you handle that? Do you see that as a realty and how do you address that to your current clients?
Joe Sanok: Yeah, so I have helped probably… I don’t want to put actual number on it, but I have helped tons of people transition from an insurance-based practice to a private pay practice and that fear is definitely the number one fear. So I am really glad you are asking that because there are some practices that it doesn’t makes sense to go a 100 percent private pay. I had one consulting client that was in a really big military town and almost everyone had this one specific insurance if they were in the military. And this person helped with PTSD. So it really made sense for them because they had a passion for helping people in the military to keep that insurance, but then to evaluate other insurances that they were on and say well, maybe that doesn’t makes sense. So the first activity that I give my consulting clients is a list of all of the insurances you are on and then in the next column rank one to say ten, who is the easiest insurance to work with and who is the hardest insurance to work with. You know inside of you there is those insurances that their system is ridiculous. It’s a pain in the butt. They don’t pay you on time. There’s all these different factors. So first is rank them, like one through however many you have. Next figure out the exact amount that you are getting paid for each of them and then, maybe assess just your overall stress in regards to how many clients you have there on there or not. So you may have one that’s really hard to work with, but they pay really well and 80 percent of your clients are on that insurance. So you are looking to transition to a private pay practice that’s probably not the first insurance to start with. Maybe that’s going to be the one that you drop last once you get [Inaudible 00:26:32.27] basic marketing down. But the one that’s a pain to work with, they don’t pay you for 90 days. They are the lowest paying. They are super stressful. You have two clients from there that’s probably one that you want to look at first. So first step would be definitely you want to assess your insurance situation. Next I would say pick one or two of those insurances to kind of step down from. I would much rather see people to get graded approach than to just say, oh, I am off of insurance, and then be like why do I have no money. Well, because you didn’t do it in a way that’s going to really reduce the amount of risk. And so we want to make sure that this is a smooth transition and not just like a cliff you jump off of. So start with one or two, go through the process. So some insurances… I remember a consulting client that she started talking with me. In our first session, I said you need to at least look at all of the policies in regards to renewing your contract with them right away and she didn’t. The day after our second consulting phone call, she did call all of her insurance companies and per her contract her contract automatically renewed and you couldn’t get out of it for the next year. So she was stuck being on that insurance for the next year because of the contract. It just automatically renewed on a certain date. So you want to know what it takes to get off of the insurances. Some of them, it’s a 30-day letter, some it’s a 90-day letter, some it’s an annual contract and there is a set date. So you just wanted to kind of have a spreadsheet of if I wanted to leave all the insurances, what’s it going to take? So then you want to talk about like how is it that you are going to talk to you clients. So you’ve decided, I am going to get off of Aetna, Blue Cross, whatever one it is because of all those factors we talked about in step one. And then you are going to say, well, how many of these clients do I have? And you can do this in a few different ways. You can do it via email or you can do it in person in a session. Based on your schedule, I mean if you are not going to see someone for a month maybe they are more of sort of like an oil change plan where they drop in once a month. That’s not going to be the person that you are going to wait till they come in your office. You really probably within a one-week period of time want to let everybody know that’s on the insurance, so that you know that you have everyone. So via email or in person. And the way that conversation would go for me would be, hey Perry… and I would probably do this at the beginning of the session. I wouldn’t just drop it as they are leaving. Hey Perry, I have loved our work together and I want to continue that. However, as of this date, I am no longer going to be taking your insurance. I really value the work that we do together. There’s a couple of factors in this of why I am doing this, such as having to give you a mental health diagnosis, as well I know that your copay is $2000 per person… which a lot of people do have high copays… so you would be paying out of pocket for a number of these services on March 1st anyway. And then I would walk them through what does this mean for you. So in 2017, I am happy to keep your rate at… maybe you go a little bit lower than your new clients. That’s why you have to have your kind of clinical decision there. Because you want to have the therapeutic benefit continued to the best of your ability while also being able to make a living for yourself.[PRIVATE PAY PRACTICE – FURTHER DISCUSSION OF ISSUES] Perry Rosenbloom: Do you recommend for existing clients negotiating at all your rate with them?
Joe Sanok: Not usually. However, every October, November I send all of my private pay clients an email raising their rates. They are just used to it if they have been with me for more than a year. So on January 1st, I get a raise every year. My costs always go up. Perry, your costs for your business always go up. Somehow, you have kept your rates for websites down really far, which is amazing. But I raise the rates every year. And I let them know this is the time of year when you are thinking about your insurance for next year. I know you have done out of pocket, but you are going to want to look at your out-of-pocket reimbursement, your HSA, your flexible spending contributions. If this affects your ability to do counseling with me, please let me know. When you start to get a private pay practice, you are going to get fewer and fewer of those people who push back on rates. So I would say, in general, you don’t want to negotiate. Once in a while there are unique situations that I would want to leave clinical judgment for people to decide, but as a general rule of thumb, I would say probably not. And I think people also respect you more when you keep a solid rate.
Perry Rosenbloom: So returning on insurance, what about Medicaid though? What if you are seeing many Medicaid clients at the time that you are transitioning to a cash-based private practice?
Joe Sanok: Yeah, so that can get pretty complicated, like so Traverse City for example, we only have a handful of Medicaid providers, and that’s really difficult in regards to if you have built a practice around Medicaid to transition to a private pay practice without losing those clients. They are most likely not going to have… I mean if they have Medicaid, they are most likely not going to be able to afford services. So that’s where you could use something like open path collective that is a way that people will pay a one-time fee to be able to have access to clinicians, for I think it’s $30 to $50. So you could use something like that to monitor how many people you’re going to take at a sliding fee. Maybe there’s clients that you decide that you are going to do a lower rate for because of their situation. For us here, at Mental Illness Counseling, we have agreements with agencies in town. So for example, there’s Single Moms Ministry, there is Bethany Family Services, and a few other agencies, that if they make a referral to us, we trust their judgment on what that person can pay. Bethany has a State Contract where they can only get reimbursed the State rate which is about a third of what we typically get paid. But for us, kids in foster care often times don’t have access to quality clinicians and we want them to have access to it. So each clinic can then decide how many private pay people do I want. Include that in your numbers and then from there you know, okay, I can have three private pay people that are on a sliding fee scale and it’s not going to affect kind of my overall bottom line.
Perry Rosenbloom: What are some other [Inaudible 00:32:23.07] that you see therapists making as they transition to a private pay practice?
Joe Sanok: I think kinda going off of what we were just talking about, a fear of raising their rates – I think it’s a really big fear. I usually raise my rates a few times a year for new intakes and so…
Perry Rosenbloom: A few times a year?
Joe Sanok: Yes, yes. So it’s not for current clients. So it’s not like a client comes in at one rate in all year. They are like, great. I got to pay 20 bucks more per session. But I continually kind of push the boundaries of what I can charge from my counseling, and as you have fewer people it’s a lot easier to do that. I found that as I raise my rates, I actually get more people and more people that have a certain affluence that want to come, because they think that the expertise is higher because of that rate. I do think it is higher, but there is also that perception of something being worth more because you are paying more. And then people do more work because they are like, dang, like I need to put in the time if I am going to spend all this money in counseling.
Perry Rosenbloom: Absolutely. Are you buying the Ford Taurus, are the buying the Subaru Outback or are you buying Mercedes. You know, all three cars have their benefits, but you know certain ones are going to provide [Inaudible 00:33:34.21] attractive in types of clientele.
Joe Sanok: Absolutely. And this is going to make you raise your game because if you are going to be charging twice or more the going rate, which rate now I am charging about three times the going rate for private pay practices in Traverse City. There is a certain expectation there. Not that I have to always have the nicest office, but we found a great office in Downtown Traverse City that has a corner view of the water. There is building going up right next to me. I am actually watching them build the bricks that are going to take away my view, but you know, we are in a nice Downtown office. We have a refrigerator that has Starbucks Frappuccinos in it. It has La Croix. It has coconut waters [Inaudible 00:34:12.16] soda pop that, you know, we are trying people to stop drinking if they want to improve their mental health. We have a nice tea machine. And so these things that are kind of extra add-ons that you give to people, it may cost you an extra dollar per person because you are giving them a Starbucks every time, but how much more you can charge them because you have created this environment that feels like they are really special when they come to your office.
Perry Rosenbloom: Hmm, people pay for experiences. It’s a growing trend and you know, if you are providing therapy and you are charging certain rate, you have to provide that certain experience as well in addition to the great clinical work you do [Inaudible 00:34:52.06] charging three times the going rate, that’s wild.
Joe Sanok: Right.
Perry Rosenbloom: Congratulations. I’m… yeah, absolutely wow at you.
Joe Sanok: Well, and it’s been a process. I still remember this conversation I had with my brother who… at the time, he was doing business consulting in Chicago and I kind of in a bragging way said, the practice is going so great. I have this waiting list. It’s going to take 2 months to get a man. And he is like, why do you have a waiting list? Like I expected there to be like congratulations, and in typical brotherly fashion he is like why do you have a waiting list. And I said…
Perry Rosenbloom: Older bother?
Joe Sanok: Younger, younger, but he is very smart in the business world. Not that younger brothers can’t be smart (laugh).
Perry Rosenbloom: I [Inaudible 00:35:35.10] older brother I could like… I can see that being an older brother seems to say, like why you have a waiting list?
Joe Sanok: Right. But in this situation, like at that time, his business expertise was so much farther past mine. And so he said, so when someone comes, calls you for counseling, do they typically just like decide that minute like, yeah, I am going to call for counseling or have they thought about it for a while. And I like they probably thought about it for months, if not years often times. He is like, so they are going to pick up that phone, it’s going to take a lot of courage, and then you are going to say sorry, you can’t come in. That seems like a waste of your marketing assets. Why don’t you just raise your rates? I was like, pi, come on, like that just seems like unethical to just charge them more. And he is like, well, if someone called and said I will pay you a $1000 for 45 minutes, would you do it. And I was like, well, yeah. He is like, or what about $500 for 45 minutes. And I was like, oh yeah. He is like, so it is not really an ethical concern if they pay enough. So it is clearly that your numbers don’t align with kind of what is going into that. So how much would it be? So right away, I raised my rates. And when I feel like wow, I am way too busy to really provide the kind of work I want to do, I will tell my assistant, all right the new rate is this. And often times I get even more people, but then I set a higher rate.
Perry Rosenbloom: It’s really funny. In the software world, in the software business world, you are told to always be experimenting with your rates. Always be changing your prices and see what kind of impact that has. And you don’t really see that in the counseling world at all. A therapist might raise the rate, 5 percent, 10 percent at your end, but not to adjust with the supply and demand of the current moment. Do you ever have… so are your rates published on your website?
Joe Sanok: They are published on my Psychology Today profile and then on the website we put the range of rates. And so that’s the great thing about adding additional clinicians, is if someone is like, Joe, I would love to see you, but I just can’t afford you. I can say, you know what, I have Steve – he is at this rate. I have Nichole who is at this rate, Marylyn is at this rate. That’s one of the really great things about having extra people as part of your practice, and even if you have a single office, you have plenty of extra time that you are not in the office that you could have somebody else sublet. You get someone as a 1099 or W-2 based on, kind of, your State employment law.
Perry Rosenbloom: Wow! (laugh)…
Joe Sanok: Which is a whole another podcast episode.
Perry Rosenbloom: I know really… I want to ask you questions, but like you know, why don’t we save that for another one.
Joe Sanok: Yeah.
Perry Rosenbloom: So what are your thoughts about creating some innovative things, innovative materials to help attract private pay clients?
Joe Sanok: Yeah, so I think innovation is definitely the thing that sets most successful private pay practices apart from unsuccessful or struggling private pay practices. One thing that I did early on is I created a partnership with this restaurant in town where they would give me gift cards at a lower rate than what the gift cards were and then I had this thing called dinner and a counseling session. And so it was a certain rate and they got this $50 gift card to go out to dinner. The restaurant didn’t know that they were coming from me, like they didn’t mark them in a special way. I would just buy a bulk of them. And so I got some great free press around this dinner and a counseling session thing. Like what is this? You go out to dinner with these couples and…? I was like, no they come to a counseling session and then they go out to dinner afterward. Sort of as like a date to kind of put some animation into their relationship. So those sorts of things I think are so important. And what I have observed is that our best ideas usually come when we have slowed down. So when you are in the shower and you are just kind of letting your brain go all over the place or you are on a long drive and you turn off the radio. That time when you slow yourself down enough, it’s like these great ideas have been sitting inside of you, but they have just been covered up with all the stress and busy-ness and just like, just the basic things it takes to run a practice. And we have to slow down in order to let those great ideas come out to have those shower aha moments.
Perry Rosenbloom: Can I [Inaudible 00:39:48.3] take a clip of this and send it to my wife because (laugh)… I told her I can’t take shorter showers babe, like I am sorry. Like, I need that time to think. And she is like, yeah, but we have two young kids and I don’t get to take that long over showers. Me [Inaudible 00:40:06.04] take that long over showers. Slow down, take it. But, yeah, I need to take that clip and send it to her and say, you know, Brighter Vision will fail if I take slower showers (laugh).
Joe Sanok: Well…
Perry Rosenbloom: For longer showers I mean.
Joe Sanok: I don’t disagree with you, but then it’s also… so I continue to push the boundaries of scaling back, and so right now I work usually 3 to 3-1/2 days a week. And so on Mondays and Fridays I am present for the family and so I went those slow down moments, my wife is like, go for it because you are around for a 4-day weekend. And so continuing to push yourself to be able to slow down to spark innovation to me is one of the most essential parts of just growing a private pay practice that’s successful. Because you need to have those good ideas. You need to have those multiple streams of income. You need to have a variety of things you are working on while also having extreme focus which seems to kind of push against that idea of multiple ideas. When we slow down, to me that’s one of the essential, kind of, bedrocks of building a successful practice.
Perry Rosenbloom: So how do you slow down. You are transitioning to a private pay practice. You are like, you got into lot of things. You are potentially losing clients to because you are not taking insurance panels anymore and there is a lot of new stress and anxiety with that transition. How do you find that time to slow down?
Joe Sanok: Yeah, so I don’t think that is impossible. When I was working my full-time job, 40 hours a week plus, and then had my part-time private practice and the podcasts. So that probably 15 hours a week. So, I mean we are talking 60 hours a week of work. There is certain kind of boundaries that I set. So on Friday, when I get home from work, I wouldn’t do any work, email. I wouldn’t do anything that had to do with work. I wouldn’t listen to podcasts until Sunday morning. So I would take this time to really purge out all of the different just kinda… you know, when we pull out our phones, we naturally like go to our email or go to Twitter, whatever things we think are going to help us build our practice. So I think the first step is really purging, and then setting some boundaries and practices, and when we have those practices, what it looks like is intentionally doing things that are going to teach you to slow down. And so every Saturday morning, I have the choice to sit and clean up [Inaudible 00:42:18.03] and toys and make our house better. So that’s something that’s not necessarily moving the relationship forward or we can go out for a hike. And sometimes you have to say no, to having a clean house. Sometimes you have to say no to certain things because you know that you are then connecting with your family and you are slowing down. And so I purge, then I practice and then usually what then naturally happens when you give yourself enough time… and each person takes a little bit different amount of time and it’s kind of like a muscle that you build. Then you naturally move into this presence. And that’s where the sparks of innovation really starts to come out. You can start to do some clear goal setting where you set, achieve and outsource goals. And that again is another whole podcast episode too (chuckle).
Perry Rosenbloom: And, you know, you practice what you preach. You have something called Slow Down School.
Joe Sanok: Yeah.
Perry Rosenbloom: Can you elaborate on that for our audience?
Joe Sanok: Yeah, so it’s funny. My wife and I were walking through the Detroit Airport on our way to Asheville to go down to Brew Your Practice which Allison Puryear and Jane Carter and I put on. And we were talking about these ideas. Like I firstly discussed idea as a joke, like what if I put on a conference where we like head coloring books and playdough and we like slowed down and did all the stuff that we do to slow down. And my wife is an introvert and like loves that stuff. And she is like, that would be awesome. So on that airport ride down to Asheville in typical form Christina falls asleep and takes a nap, and I sit down with my journal. I sketch out the entire thing. And so as I started bouncing the idea off of people it really resonated with therapist because those that are introverted and need to recharge, don’t have a conference that they can really genuinely recharge, where they can stand up [Inaudible 00:43:53.18] Michigan, they can go for hikes. They can draw in a coloring book, and extroverts like me that just seemingly have like unlimited energy, we need to have people teach us to rein it in. That’s been one of the most important lessons I have learned from my wife, is I need to rein it in. This is not sustainable if I just run full sprint all the time. I can sprint and then rest, sprint and then rest, but if I go nonstop all the time, that’s not healthy either. And so over at Slow Down School dotcom, that’s where you can get more information about the conference. I also have a three part video series that’s over at www.practiceofthepractice.com/slowdownvideo. Our Cupla Media has done an amazing job. They do videos for therapists, and they flew in and helped me make this amazing video series to talk about not just the conference, but ways to slow down and then how I do my exact goal setting to set, achieve and outsource goals.[CONCLUSION / USEFUL LINKS] Perry Rosenbloom: Awesome. Well Joe, and to all our audience is saying we will have links to all that in this week’s show notes at www.brightervision.com/privatepay2. Joe, where can our audience follow you, learn more about you? Do you prefer Twitter, Facebook, what would you like?
Joe Sanok: Probably just head on over to www.practiceofthepractice.com and from there you can get a find you favorite social media links to follow me there and can feel free to connect with me. I love to chat.
Perry Rosenbloom: Absolutely. Well, Joe, thank you so much for being on today. This was amazing and I hope that everybody listening has taken notes because this is, you know, this is just a great guide book on transitioning to a fee-based service and how to do it from one of the best in the game.
Joe Sanok: All right. Thank you so much Perry. This has been a lot of fun.
Perry Rosenbloom: And for everyone listening, please… you can check up the rest of the Mini-Series over at www.brightervision.com/privatepay. Thank you again for listening everyone, and we will see you next week.[MUSIC]
Joe Sanok: If you want to check out Perry and Brighter Vision’s podcast, just search ‘The Therapist Experience’ on your favorite podcast player, and thanks so much for letting me into your ears and into your brain. Have an amazing week. Please rate and review us in iTunes, so that we can continue to climb the charts and serve more people. Thanks a lot for letting me into your ears and brain. Have a great day.[MUSIC]
Joe Sanok: Special thanks to the band Silences, sexy, for your inter music, and this podcast is designed to provide accurate and authoritative information in regard to the subject matter covered, is given with the understanding that neither the host, the publisher or the guest surrender any legal, accounting, or other clinical information. If you need a profession, go find one.[MUSIC] [End of Podcast Audio][Inaudible 00:46:45]