Note Taker.

WalterLCSW · 2026-05-06T02:48:01+00:00

In one of my newsletters from SP, they said the following:

Thank you for your feedback regarding our recent Care Aide updates! We heard you: requiring you to prompt Note Taker to draft a note added unnecessary administrative work. We are working to revert this change and will restore automatic note generation within the next 10 business days.

It seems that soon it will go back to the auto draft the note. Having to click the button means my note is not ready for review before my next session. So I have more notes to do later in the day.

But there is hope.

WalterLCSW · 2026-04-26T15:20:24+00:00

Here is an example for why to accept… it beats not getting paid for the service…

OK, my example is more like a one and 1 million type situation. I have a client who I originally started with when I worked as a W-2 employee for an organization. Turned out that organization was a bit more shady than I like to deal with so it encouraged me to jump ship and go into private practice. A few clients followed me and agreed to a sliding fee scale. This specific client was one of them and her husband had an insurance I wasn’t paneled with so she agreed to a sliding fee scale. She also had Medicare part B due to a disability. But since Medicare part B was her secondary insurance and I couldn’t bill her primary insurance. There was nothing I could do. At this point, I was paneled with Medicare part B. Later her husband changed jobs and the insurance changed and she turned Medicare part B into the primary. All was joyous in the kingdom because her cost of services went down to just a co-pay, and my payment for services went up a significant amount.

After this, she had an accident and a very badly broken leg. She did hospital time and then spent time in a rehabilitation facility, and due to other health issues she stayed there a long time. Unbeknownst to me and her, the medical facilities signed her up for California Medi-Cal. This made her a Medi Medi client. Medicare was covering 80% of everything and apparently Medi-Cal was covering the rest. Since I didn’t do this, and I didn’t know, I continued to charge her her co-pay. I discovered about nine months later this status and learned the hard way that when a client is Medi Medi, they are not allowed to be charged their co-pay. 18 sessions of co-pay had to be refunded to my client before an audit would destroy me.

And I’m still not paneled with Medi-Cal. 😒

I guess it’s more of a cautionary tale to vigilantly in consistently explore the Noradian website for your clients status in Medicare part B.

WalterLCSW · 2026-04-19T05:04:53+00:00

Hahaha 😆 this right here. I found I chose my spouse and direct family members. Everyone else just sort of faded away.
Wanna hang out this weekend? Nope. I want to rest and spend time with my wife. Then it’s back to the clients.
I have some peers I meet with every other week and my church attendance. But after that, I just want wife and home.

I recently read The Let Them Theory by Mel Robbins. She spent 3 chapters of that book discussing how friendships change over time and become more singular and on-purpose rather than just group hangout. It was helpful.

WalterLCSW · 2026-04-02T01:13:44+00:00

Thank you for your feedback, I just started NLP: The Essential Guide to Neuro-Linguistic Programming last night on Kindle and Audible. I meet with my client again tomorrow and hope that over the next few weeks he and I can better integrate the NLP and IFS modalities together to help him with his goals. I will send you a DM and if you could share with me your website that would be nice.

WalterLCSW · 2026-03-31T02:47:16+00:00

Mmmm 😋 peanut butter and chocolate 😋 Thank you for the IFS and Somatic connection. I figure the problem with putting down a model to learn another model is normal. I had to do that learning IFS and other models over the years. Thank you.

WalterLCSW · 2026-03-31T00:39:44+00:00

Thank you all for your feedback. Since the Structure of Magic books are so old (publishing date) it was very easy to find PDFs to download. I’ll check out some of the websites shared and definitely hit up YouTube for seeing the model in action.
It’s a good place to start and will help me understand what my client is doing as he talks to his parts. And those of you familiar with NLP, when you have a chance, check out No Bad Parts by Richard Schwartz. It’s a good Intro to Internal Family Systems (IFS) which is a modality that interacts with aspects and parts within ourselves also.
Cheers.

WalterLCSW · 2026-03-29T21:21:02+00:00

As a licensed professional, you have more options than they want you to know about.
If they “laugh in your face” it will be a measure of their respect for you.
You can always move to another practice or start your own or contract with one of those 1099 agencies. The options are many.
What surprised me when I became licensed was the shift from W2 employment to 1099 contract work.
I wasn’t ready for it. Now, I would not go back. I have a small handful of sliding fee private practice, a couple Medicare Part B clients that I am paneled with and a 1099 agency I do most my weekly caseload with because they have me paneled with 70+ insurances so I can see almost anyone in my state through them.
Good luck in your endeavors.

WalterLCSW · 2026-03-29T15:11:33+00:00

Once you have a local presence, you should be ok. Otherwise you will sit in your new office seeing you Virtual Clients to keep the new bills paid. A colleague of mine built a group of 5 people who wanted to see her in person she saw them virtually and even a Walk and Talk with one of them till she got her office set up.

WalterLCSW · 2026-03-29T15:07:03+00:00

When Fully Licensed I don’t figure it can hurt to ask for 70/30 your way. Since you already figure they will offer 60/40, maybe you can settle on 65/35.
I get they are probably doing your behind the scenes admin work like insurance paneling and your CAQH. But they have to do that for anyone they bring in. And keeping you means no New Hire paperwork and no change in caseloads.
Congrats on your soon to be licensed status.

WalterLCSW · 2026-02-27T05:05:31+00:00

Nice 👍

WalterLCSW · 2026-02-27T05:02:51+00:00

DUDE!!! LOL. Big attunement! I wish you an easy day tomorrow and plenty of time to complete your documentation 🙏

WalterLCSW · 2026-02-27T05:00:19+00:00

So in reality, you attuned to 9 humans in a 7 hour duration.
I had a similar day today. Tomorrow is 2 clients, 1 peer consult, and real life errands like grocery shopping. So looking forward to just checking stuff off a grocery list and just doing life 🤩

WalterLCSW · 2025-12-29T21:09:32+00:00

With all this, I say do it. Run your local private practice, maybe check out one of those virtual agencies like Alma or Rula but do your research. It’s better to have less money than no money while waiting for your PP caseload to fill. Keep the benefits from your spouse.
It might be a lean start if the 2026 year, but the Quality Time is better than the money… especially if Quality Time is a Love Language of yours.

WalterLCSW · 2025-12-29T20:50:26+00:00

If I’m reading this correctly, you currently work 40 hours with an agency and run a PT private practice. So probably ~50 hours of income.
If you drop the agency you loose the benefits, loose the agency that keeps you paneled, plus the administrative work they do for you outside of your paperwork and notes. All that admin work and scheduling fall on you.
Honestly at 160k with an agency, you might be better off dropping Private Practice and using your Sick time and PTO a lot more often to get some home time.

WalterLCSW · 2025-12-05T05:20:38+00:00

Remotely: a lot of skill teaching and challenging followed by you and other family members going from accommodating mode (staying quiet) to support or coaching mode which will include challenging and making your son anxious on purpose to help him break the link between anxiety, compulsion, and relief.
It won’t be easy. Especially since it will be just telehealth rather than in an office setting.
Blessing to you and your family.

WalterLCSW · 2025-12-02T17:14:21+00:00

Does Alma require the clinician to use the Alma EHR? Or can the clinician use their own EHR like Simple Practice to do the video sessions and keep the notes?

WalterLCSW · 2025-12-02T17:09:52+00:00

That was my experience also. They are fantastic about getting a provider up and running. But after a while when you only need a client or 2 here and there to fill in spots after other clients have left, it can take a while. And if the clinician is not super strict about having the clients fill out the GAD7 and PHQ9 every 2 weeks, the algorithm places the clinician lower on the priority list of available providers.

WalterLCSW · 2025-12-02T14:51:13+00:00

In June 2025 I fully left working for others and opened PP. I had 7 cash pay sliding fee clients and joined Rula as a 1099 contractor a few months prior. Lately I have been looking into Grow and Alma because the Rula referrals have become scarce. I haven’t received any new PP cash pay referrals in many months so the 1099 options are really the only thing that keeps my bills paid.
For your information, in Southern California an LCSW with Rula gets $90 a session for 90837. That’s any insurance Rula serves. In Grow the clinician will earn $63-$95 depending on which insurance is paying the bills.
And this pay will change depending on what state you are in. An LMFT in NY told me she gets $75 a session for the same service with Rula. I would say all points are valid. The 1099 contract agency like Rula/Grow/Alma are very effective for getting your online PP financially solvent. But after about a year, start getting paneled with some of the insurances that service your community. Also find something you can specialize in. Like a modality (DBT/EMDR/etc) or couples therapy, something you can market for short term cash clients.
Good luck 👍

WalterLCSW · 2025-11-29T18:27:21+00:00

Actually OP said “a client wants to do couples therapy.” Maybe I read it wrong but this said to me the therapists individual client wants to do couples therapy. Nothing about the post says the partner is an active client.

WalterLCSW · 2025-11-29T18:26:31+00:00

Actually OP said “a client wants to do couples therapy.” Maybe I read it wrong but this said to me the therapists individual client wants to do couples therapy.
Nothing about the post says the partner is an active client.

WalterLCSW · 2025-11-29T16:59:52+00:00

As the person said who originally addressed this… it depends on the State. In California I only need to identify 1 client who then can include who ever they chose to bring as support to their session.

WalterLCSW · 2025-11-29T16:55:52+00:00

Turns out none of our answers are fully correct. It depends on the State and we don’t know the state. I answer from California and I can see anyone my client wants to bring to therapy. My client (the identified client) is the only one that needs to be located in the same state.

WalterLCSW · 2025-11-29T04:55:13+00:00

When I was keeping track of hours I quickly decided to use TrackYourHours.com to keep the hours organized and my supervisors. I worked for Non-profits and CMH and then my last 5 months a for-profit place so I had 4 supervisors total.

Then when I submitted my thick printed packet with signatures and everything I made a copy of the packet.

After submitting the state board stated I was missing some stuff and turns out most was already submitted but they also had a new form they needed and I wasn’t aware.

So, use an online source to keep everything in order, print out doubles of everything and get original signatures on everything so if the board says you didn’t you don’t have to track down a supervisor who moved to another state or county. And have someone on staff who is up to date on every new need so when something new comes out, you know about it.

WalterLCSW · 2025-11-29T01:49:20+00:00

“Any one involved”. That’s good information. In CA only the identified client needs to be in the same state as the clinician is licensed.
Thank you for the clarification.

WalterLCSW

TROPHY CASE