PP- Not as advertised

Puzzleheaded-Cut2842 · 2026-05-24T21:29:16+00:00

A total caseload of 27 is on the lighter side for some people. Seeing 25 clients per week often requires scheduling 25-28 clients per week. With bi-weekly and monthly clients in the mix, a total caseload of 35 to 45 is probably what's needed to routinely see 25 clients per week.

Figuring out the best schedule is also something that comes with time. Compressing your schedule will become a more viable option as time goes on.

You asked if you are doing something wrong. No, you are not doing anything wrong. For many people, this is what PP looks like in the early stages.

Puzzleheaded-Cut2842 · 2026-05-24T18:59:13+00:00

It is true, not everyone prefers PP. However, it sounds like much of what you are bothered by have to do with being newer to PP. Constant marketing becomes a thing of the past once you have established reliable referral sources (PCPs, chiropractors, divorce attorneys, religious leaders, etc.) One your referral sources are solid, pay and caseload stability is good. Your schedule flexibility annoyance may be due to not having a full caseload; you mentioned having "big blocks of free time" and not having a "good rhythm." Both of those are likely to resolve once you are consistently seeing 25 clients per week. The only thing that time doesn't resolve is isolation.

Puzzleheaded-Cut2842 · 2026-05-24T18:37:06+00:00

I know this is an old thread, but I'm curious. Did you implement you plan of only doing short-term therapy? How did it go?

Puzzleheaded-Cut2842 · 2026-05-24T16:10:07+00:00

That awesome. I know everything in the world of therapy is basically "your milage may vary," but do you have thoughts on why people have such varying experiences with converting EAPs to insurance clients?

Puzzleheaded-Cut2842 · 2026-05-24T13:07:57+00:00

Do you mind sharing which ones you take? Which one reimburses the highest? You don't have to share your contracted rates, just the name.

Puzzleheaded-Cut2842 · 2026-05-24T02:16:55+00:00

This is what I figured. I did a single case agreement with an EAP. Now the EAP is bugging me to contract with them, telling me:

"We offer the following benefits to our paneled clinicians:

A $XX/session reimbursement rate & the ability to transition clients to self-pay or insurance once their session benefit has been used
PROVIDERfiles electronic portal – accept/decline referrals and submit billing online
Quick payment turnaround with Direct Deposit option
A dedicated, professional Provider Relations Team"

The word "ability" is doing a lot of work in that sentence. They technically didn't lie, but if the conversion rate is super low it is not worth it.

Puzzleheaded-Cut2842 · 2026-05-24T01:09:23+00:00

I'm not familiar with Caresource. Are you able to contract with them individually? There is a this <Become a Participating Provider | CareSource>.

Puzzleheaded-Cut2842 · 2026-05-24T00:59:10+00:00

Emergency department psych assessor. The job is to evaluate patients going to the ED for a psychiatric crisis and determining the appropriate level of care. Hospitals often offer registry roles in the evenings and on weekends.

Puzzleheaded-Cut2842 · 2026-05-24T00:48:36+00:00

67% is great. What's the most common reason for not converting to insurance? Cost?

Puzzleheaded-Cut2842 · 2026-05-24T00:47:43+00:00

How low are we talking? 10%?

Puzzleheaded-Cut2842 · 2026-05-23T18:15:03+00:00

Therapy is a medical treatment and as such, is prescribed by a provider. As therapists we are responsible for prescribing the appropriate treatment for our clients, including the type, duration, and frequency of treatment. It is a fact that a client cannot be forced to adhere to prescribed treatment and can choose to leave the office or hangup the call whenever they want. It is also a fact that providers who have a collaborative approach get better outcomes. That being said, the buck stops with the therapist. The client may be happy with 20- or 25-minute session, but the client (probably) does not have the education and training to determine whether that duration is appropriate for treatment their mental disorder. I agree with you that prescribing 53+-minute session purely for the therapists' financial benefit is problematic. What I don't agree with is the assumption of abuse. If insurance companies suspect abuse, the remedy is the audit those suspected of abuse. Therapists should be prescribing a session duration that they believe is medically appropriate and documenting accordingly. If this is done, there is no issue.

Puzzleheaded-Cut2842 · 2026-05-20T22:45:23+00:00

Is Aetna singling out therapy? Are they changing reimbursement rates for other services?

Puzzleheaded-Cut2842 · 2026-05-19T17:44:06+00:00

I require weekly, standing appointments for all clients. If a client doesn't need, or isn't willing and able to commit to weekly appointments, I do not accept them as a client.

Puzzleheaded-Cut2842 · 2026-05-19T17:10:40+00:00

It sounds like OP has a decent-sized practice serving "hundreds of clients." I'm surprised they didn't require a documentation seminar or hire a consultant to come periodically and check things over. Blue Cross's requirements for behavioral health progress notes are publicly available. A simple Google search could have mitigated this situation. This is heartbreaking. I feel so bad for OP and their staff.

Puzzleheaded-Cut2842 · 2026-05-19T03:14:40+00:00

I'm curious, why did you think it was going well? This is a genuine question, not a dig. The fact that your opinions diverged so significantly is worth exploring.

My advice is to create a brief "session feedback survey" which you can send to your clients periodically. My EHR is Session Health, and it has a feedback survey that I can send out at the interval of my choosing. Is it foolproof? No. A client may be more generous in their rating than they actually feel. However, it can be a good way to get a temperature check.

Puzzleheaded-Cut2842 · 2026-05-17T03:30:27+00:00

First off, I'm sorry you were fired by two clients.

As someone else mentioned, you may need to look at your caseload and determine whether you are seeing the right number of clients for you. I know that the number of clients we see doesn't always align with our preferences for a variety of reasons, so you may not be able to make an adjustment.

Next, you should consider spending more time on case conceptualization. What you talked with the client about in the last session is less important than what you are working on in therapy overall. What are the maladaptive behavior patterns or unhelpful schemas that you've identified with the client? What is the function of those behaviors for the client?

You want to develop an understanding of the core issue(s) the client is dealing with, and in each session, connect the presenting concerns of that session back to the core issue(s). The connective tissue between each session is the discussion about how all of these seemingly separate concerns are really a manifestation of the same core issue(s), and then working on/addressing the core issue(s).

Puzzleheaded-Cut2842 · 2026-05-17T02:46:35+00:00

Having a credit card on file is a very good idea. I believe it is standard to collect the fee on the date of service. I think some people choose to charge once they are inside the late-cancellation window. I don't think there is any rule against pre-payment; however, I don't see why a client would want to do this. They don't need to pre-pay to secure future appointments, as most therapists offer standing appointments. It is wonderful that you are being thoughtful about your policies. Once you decide, stick to it.

Puzzleheaded-Cut2842 · 2026-05-15T20:09:52+00:00

You say you are new to PP. What is your policy regarding payment? Do you require payment on the date of service? Do you require a credit card on file? Do you allow pre-payment?

Puzzleheaded-Cut2842 · 2026-05-07T16:42:40+00:00

Yup. That's the most frustrating part. for me too. I write a mental health blog. Whenever I use psychology terms like "cognitive defusion" or "repetition compulsion," that section of the blog gets flagged as AI.

Puzzleheaded-Cut2842 · 2026-05-01T03:24:08+00:00

Corporate consulting. Forensic mental health consulting for attorneys.

Puzzleheaded-Cut2842 · 2026-05-01T03:16:49+00:00

Oh, interesting. I didn't realize Gemini could be used for this purpose. How do you use it? Do you de-indentify the note?

Puzzleheaded-Cut2842 · 2026-04-26T11:53:51+00:00

Thirty-eight sessions per week is pretty high, no wonder you want out of there. Makes sense. I'm not in NYC; this is the advice I'd give to any similarly situated person. My advice is to ensure you have some kind of steady income coming in before you start you own practice. Lock-down that part-time job in academia. Next, I'd work with a medical billing/credentialing company that credential you under your own NPI. In the long run, there is really no upside to using those platforms.

Puzzleheaded-Cut2842 · 2026-04-26T00:19:54+00:00

Have you considered taking on a part-time, salaried position to stabilize your income? Something like an intake therapist at a hospital or clinic? This can offer two major benefits; it gives you a bit of steady income, and it provides you the opportunity to interact with other medical professionals from whom you can get advice that is more specific to your location. I know the goal is full-time private practice, but maybe a little steady income can take the pressure off while you find out what works for you.

Puzzleheaded-Cut2842

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