The Business of Helping

The past week and a half have been full of learning, mostly about things they just don’t teach us in Graduate school – and how could “they” have? This was 16 years ago, there was barely anything called “the internet” in those days. Things are so different so I have to adapt. I am in a program called Business School Bootcamp – a two week intensive on getting a private practice up and running successfully. Is it all about making gobs of money? No, although it is about value – the value of what I provide and the value a potential client places on getting well. But it’s about finding ways for us to meet – the client who needs my help and the therapist who needs clients, so they can both thrive in the world.

To pat myself on the back, I have done a lot of the things in the lessons already – I did a lot of planning before I went full time. There is more I can do to get my name out there and I am working furiously to do it. So much of it is about technology – just getting search engines to find your website. Researching what people type into a search engine and then matching those words and phrases into the fabric of my website – the part you don’t see, The Code. Dammit, Jim, I’m a therapist not a computer programmer! Ok maybe I am a little now? If you understand that above reference, then you know that I AM a Star Trek fan.  I’m not too old to learn a few things.

So when you, a potential client, looks for someone to pour your soul out to, you type in a search – counselor in Denver area – or something to that effect. A lot of calls and referrals come through Psychology Today and I am grateful for that. This week I actually Googled “PTSD counselor in Commerce City, CO” and my website popped right up. It was a happy moment for me. Once you find your list – how do you know that therapist is going to be right for you? Recently I am getting more Medicaid clients, and I am among very few in my area who accepts it as payment. Right away that puts me on the top of the list of people to call. But I want clients to want to work with me, not just because I take their insurance. I want to have a site that says “I’m your person! I get you, I can really help you, and you’re going to really like working with me because I’m the shiz-net.”

I also chose to be on the Medicaid panels because I see kids in foster care, and all too often families on Medicaid are referred to the county clinics, which are often staffed with new graduates, interns, who are less experienced and over worked. I know because I have been there. I can’t be the best therapist I can be by being overworked, underpaid and having to deal with issues that are harder than I can handle (if I were there ;D). There should be equal access to quality services. Or so I believe. I want these clients to find me so I needed to make it easy to find me. So that’s why you would pick me, or why you would pick someone else. You found a therapist who “speaks” to you through all this media noise. Only I have tried to cut out the noise.

Give me a call and interview me. Then interview someone else. Interview a third person? Why not? This is your healing and your future we are talking about. 

To Join or not to join?

If you are a therapist, you are providing a medical service. Mental Health care is a part of being healthy and having someone to guide you is just as important as having a doctor to give you a check up – check your vitals, run some blood work, treat an illness. So therapists are professionals who have the ability to be paid by health insurance. Now… there are hundreds if not thousands of companies – more so now than ever – that offer insurance and pay providers in their networks.

I started off working a full time job while seeing clients through 2 EAP providers - that’s Employee Assistance Programs. They don’t pay well but the client work is interesting. The credentialing was pretty easy as well. Clients usually self refer and have a limited number of sessions that the company pays for. Beyond that I offer a reduced rate for them to continue for the same number of sessions they got through their benefits.

How can any one therapist get credentialed with all of these companies? Recently, I joined Cigna, and it was a fairly painless experience. They were efficient about sending documents back and forth, my recruiter communicated with me often, when everything was done they credentialed me in 3 weeks, when they had up to 90 days. I have been told by another Cigna provider that they pay timely and have been good to work with. Their rates are similar to what I have seen, mostly Medicaid rates but clients usually have a co-pay. Medicaid credentialing, here in Colorado anyway, has been a completely different sort of animal.

One therapist in a cohort group I’m in on Facebook said she contracted out her credentialing to someone who does it for a living – a medical biller or something. I had no idea people did that although it makes sense because doctors who open a practice have to accept a lot of insurances and they have even more documents to provide. Do they have time for that? I don’t think so. My mother has offered to help me do billing and what not and I could add her to my profiles as an office person, but I would prefer to pay her and I can’t right now and I don’t think I really want to join more insurance panels. I can take any client with PPO benefits – meaning they can see someone out of network. They pay me then submit the bill to their insurance to be reimbursed. The last person who asked me about that discovered she had to meet a huge deductible before she would be reimbursed anything. I tried to sign up with her insurance but they are not accepting new providers in my county unless I can prescribe and/or speak a language not usual for the area, like Farsi or Somali.

Getting back to Medicaid. In Colorado, the State was divided into regions a few years ago and companies bid on regions. I live in Adams County – which is covered by BHI. I want to work with kids from Denver (foster care) and Morgan Counties, these are covered by ABC. A friend of mine said to apply at Colorado Access. They had no application – they said send us an email. They emailed back: we don’t need anyone right now. I thought, that can’t be true! I went on the State Medicaid site, was able to apply and be approved as of June 1. However, if you’re not part of one of the managed care entities, you will bill and not get paid. Sadly, I am not going to get paid for a few clients, but I am okay with that now. They needed the help, they got better and I am not going to take any more until I can get paid.

I finally reached someone about my questions with BHI and she was great at explaining all of this to me.  I sent in my documents, waited, and then was told that I passed round one and in a months she and the team would start round 2. I had to send her more documents, that I really could have sent her with the first round had she asked. I am very close to being done, I have clients in a rural county Human Service Agency waiting for me to start. That was the reason I got ABC coverage in the first place, otherwise I would have been declined (there is a need for therapists in the rural areas). There has been so much outrageous duplication and waste in these processes. Being a Black Belt in LEAN/Continuous Process Improvement, I have truly struggled to be patient with the inefficiencies.

CAQH is a national clearinghouse for billing. Cigna required me to join so they can pay me and credential me through this company, however Medicaid wanted my number as well. There are a few more similar companies, depending on which insurance panel you are on. Again, duplication. Now Colorado has a ballot initiative this fall for a single payer system. I can really see the benefit to this but man if I have to scrap everything I have done to date just to join that one I might lose my ever loving mind.

In the meantime, I do a few other things – I do paintingparties, I sell my art as much as I can, I have done a training on Primary Perpetration Prevention for foster parents through Foster Source, a new support agency a neighbor of mine started this year. I saved up before I quit so I could have flexibility and a nice summer with my kids. I signed up (aka invested) for a Business School Bootcamp for therapists because I need to know MORE of how to make this work. Marketing, networking, getting referrals, it’s all part of this thing we do and it is an entrepreneurial business. It is not a passive activity. While I want to help people of lower income and who have struggled more to get ahead, I deserve to make a decent living doing it. So do you!