How to start a private practice and transitioning off insurance with Carrie Bock | POP 753

A photo of Carrie Bock is captured. Carrie Bock is a Christian, Licensed Professional Counselor. Carrie Bock is featured on Practice of the Practice, a therapist podcast.

How do you find the balance between bootstrapping and spending money to launch your new practice? Are there any limiting beliefs that could be holding you back from stepping into success? Do you want to transition to cash pay from insurance?

In this podcast episode, Joe Sanok speaks about how to start a private practice and transition off insurance with Carrie Bock.

Podcast Sponsor: Heard

An image of the Practice of the Practice podcast sponsor, Heard, is captured. Heard offers affordable bookkeeping services, personalized financial reporting, and tax assistance.

As a therapist, the last thing you probably want to think about is doing your own bookkeeping and taxes. Heard is here to help with that. Heard is the financial back-office built specifically for therapists in private practice. They combine smart software with real humans to handle bookkeeping, taxes, and payroll.

Regardless of whether you’re a seasoned clinician or are in the first year of your practice, Heard will identify areas for growth and streamline best financial practices for your business. When you sign up with Heard, you’ll be matched with an accountant who will help you track your income and expenses, file taxes online, and maximize tax savings.

You’ll also receive financial insights such as profit and loss statements and personalized monthly reports. You can say goodbye to poring over spreadsheets and guessing your tax deductions or quarterly payments. Focus on your clients, and Heard will take care of the rest.

Pricing begins at $149 per month for solo practices and can easily be tailored to fit your business’ financial needs. Sign up for a free, 15-min consult call today at  www.joinheard.com.

Meet Carrie Bock

A photo of Carrie Bock is captured. She is a Christian, Licensed Professional Counselor, host of the Hope for Anxiety and OCD podcast, and writer. Carrie is featured on the Practice of the Practice, a therapist podcast.

Carrie Bock is a Christian, Licensed Professional Counselor, host of the Hope for Anxiety and OCD podcast, and writer loving life just south of Nashville, TN. For many years she has had a passion for the intersection of mental health, the Bible, and the church.

Unfortunately, the church often hasn’t responded in a sensitive and biblical way to those with mental health issues. Carrie’s desire is to use her platform to spread messages of love, hope, and biblical truth. She wants to see Christians be healed from the shame of feeling “not enough” because they are struggling with anxiety, OCD, or any other mental health issue.

Visit Hope for Anxiety and OCD and By The Well Counseling. Connect with Carrie on Facebook and Instagram.

FREEBIE: Get Carrie’s Free Relaxation Audio Download!

In this Podcast:

  • Spending versus bootstrapping
  • Taking off
  • Let go of false beliefs
  • Transitioning from insurance
  • Carrie’s advice to private practitioners

Spending versus bootstrapping

My budget was zero so I pretty much did [everything] myself in the very beginning. (Carrie Bock)

At the beginning of starting a business, spending money feels terrifying because you don’t know yet whether you will get a return on your investment.

Finding the balance between spending and bootstrapping can be tough, but there is a middle ground that you can make use of.

Consider outsourcing basic tasks to experienced people on sites like Upwork to save you some time to work on the important stuff, and it won’t cost you an arm and a leg.

I have hired people to help me with the website and help me learn different things [like] how to do the website myself [and] how to build things on WordPress. (Carrie Bock)

Taking off

Building a practice is the first step, getting clients is the next, hiring a clinician is the next big step, and hiring a second person is the next bigger one.

Each step helps you to build momentum to keep your business running. There may be spaces within these steps, and that’s where the work that you do matters.

My business has changed quite a bit. There’s been a lot of ups and downs in terms of getting clients. (Carrie Bock)

Taking insurance to start a client base is a great way to build a caseload, and then to start to slowly wean off insurance and only take private pay once you have a caseload of clients that trust you and want to work with you.

Let go of false beliefs

I had a shift [from] the mindset of, “I have to help everybody”. I think that was a false belief that I had held onto. (Carrie Bock)

The simple truth is that you cannot help everybody. It is impossible, and if you try to do it, you may fail those that you can help who are in front of you.

Even though it feels difficult, as a therapist, to be successful in the work you do and the business you run you, will need to let go of the false belief that you need to help everyone who calls.

Make space for those that you can, make space for the rest on a waiting list, and then refer the rest out to other available and qualified therapists.

Transitioning from insurance

Take it step by step.

Stop working with one insurance at a time until you have only one or two left, if any.

The clients that want to work with you will make the switch to private pay, and you can offer superbills or reduced rates at your discretion.

Carrie’s advice to private practitioners

This is your practice and you can do what you want to with it. Ultimately, as you start doing new things, you will find the rhythm and the workflow that works best for you.

Useful Links mentioned in this episode:

Check out these additional resources:

Meet Joe Sanok

A photo of Joe Sanok is displayed. Joe, private practice consultant, offers helpful advice for group practice owners to grow their private practice. His therapist podcast, Practice of the Practice, offers this advice.

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!

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Podcast Transcription

[JOE SANOK] This is the Practice of the Practice Podcast with Joe Sanok, session number 753. I’m Joe Sanok, your host, and welcome to the Practice of the Practice podcast. I’m so glad that you’re here. We are covering all sorts of things around starting, growing and scaling a podcast, as well as leaving, a podcast, huh, a private practice, starting, growing, scaling a private practice. Yes, maybe sometimes podcast. We talk a little bit about that too, just helping people figure out those things that we just did not learn in graduate school, all the marketing business side of things and just getting going. So we just wrapped up a series, The How I Got Through It Series. We did that throughout June and July of 2022, talking with people about just really tough things they’ve been through and then how they got through it. If you missed any of that feel free to go back and listen through just some really impactful stories of people being through tough things and then how they got through it or how they’re getting through it. It’s not necessarily we landed on it and now we’re through it as much as, wow, I got through that. Here’s how and where I am today. Today we have on the show Carrie Bock. Carrie owns By The Well Counseling, which is a Christian, she’s a Christian Licensed Professional Counselor who specializes in helping clients with anxiety and OCD to overcome wounding childhood experiences via online counseling across Tennessee. Carrie, welcome to the Practice of the Practice podcast. [CARRIE BOCK] Thanks for having me. [JOE] Well, I always like hearing people’s stories of how they started a practice and maybe what was helpful during that time. Take us back to when you started your practice. Why’d you start the practice? What was your life like at that point? [CARRIE] Well, I had actually gotten divorced when I joined a group practice. I left my job in community mental healthcare, and it was just a really good time for me to branch out and do something new because I was single post divorce, I didn’t have children and I had a lot of time on my hands. So I had an opportunity open up to become a part of a group practice, so I was there for two years, basically building up my client caseload. Then the agreement and the arrangement with the individual that I was in the group practice with fell apart, and he was starting to make some serious changes to how he was running his business and the practice. So I made the decision at that point to leave, but I had about two months to get out of there, find an office, switch everything over with insurance. It was a lot to cram into two months. [JOE] Yes, I can’t imagine having to figure all that out. What was helpful during that time when you had to really fast forward and figure all that out in regards to starting a practice? [CARRIE] Well, fortunately I had a couple friends who had made the leap and done private practice, and I talked with them about it because, of course, there’s a lot of insecurity of am I actually going to be able to do this and pull it off? They instilled a lot of confidence in me because they said, “Yes, this is something that you absolutely can do on your own as a solo practitioner.” So that was helpful and really encouraging. I spent a lot of time looking into different things, learned how to build a website over time and then in the future learned how to build a better website. But I had a starter, something out there just so that people could find me and had to learn everything about Google listings and SEO. I didn’t even know what that was until I went to a marketing conference and I was like, “What in the world is that? Can you spell out the acronyms for us?” So there’s so much that I’ve learned in the last five years, just a bit at a time. I think for me, I just had to start somewhere. I think a lot of times people get paralyzed by fear, but I just had to do it. I just had to put myself out there and get it out there, network with other counselors, network with other people in the community, and got going. [JOE] Yes, and I think there’s always that push and pull when you first start of how much do you bootstrap it and learn things yourself, like starting a website, like you were talking about and how much you outsource it to someone else who knows what they’re doing which may save you time in the long run, but it’s expensive on the front end. How did you decide what you were going to put money into versus what you were going to bootstrap early on? [CARRIE] Well, basically my budget was zero, so I pretty much did it myself in the very beginning. Now, five years later I do get, I have gotten some help with some things on Upwork. I have hired people to help me with the website and help me learn different things of how to do the website myself, how to build things on WordPress. But in the beginning, I didn’t really have the budget for that. I did look into hiring someone for the website, but there were so many different quotes and I wasn’t quite sure what I was going to be getting. The people that seemed more confident were in the thousands of dollars and I didn’t have that money to spend on that right then. So I just had to do it myself. It wasn’t really an option, I didn’t really have money going into starting the private practice because even though it was something that I had wanted to do for a long time, just because of my current financial situation and the unexpectedness of the group practice changing, I thought that I would be there for quite some time. [CARRIE] So I didn’t exactly have a lead time to save up money to put into the business and so forth. [JOE] Yes, and I think that’s where often people’s time freedom when they’re first starting a practice, they don’t realize that they often can put in a lot of time into areas before they start seeing clients. One thing I always recommend is if you want to see 20 clients a week, but you only have one, put 19 hours a week into growing your practice. Then if you are at 10 clients a week and you want to be at 20, don’t just go grocery shopping for the extra 10. Put in 10 extra hours, work the number of hours that you eventually want to work whether or not you have those clients. It seems like then people really start to see that they can make massive progress because they’re learning things like WordPress or SEO or if your budget’s almost zero yes, you’re going to keep so many costs low and have to do it yourself, but then you know how to do all of it and eventually can train other people in your practice. When did things start to take off? I know that going from zero clients to one, that’s often the biggest jump, and then one to two is the next biggest. How did things start to click along in regards to client referrals? [CARRIE] I think more so the building part came when I was at the group practice because when I started my private practice, I just essentially transferred everyone over. And my business has changed quite a bit, so there’s been a lot of ups and downs in terms of getting clients. When I was initially starting out, I was completely insurance-based, so that I pretty much was not hard to get referrals because if you take insurance, you’re more in a minority of providers, at least in my area. So I pretty much filled up via insurance but then as I started to specialize down more, I started to get off of some insurance panels also because I realized I wasn’t going to be super profitable and I was going to be risking burnout if I kept the number of clients that I had to see in order order to take all the insurances. [JOE] How many clients did you have to see to really make it make sense? Do you remember about how many? [CARRIE] It was probably closer to 30. I don’t think that I saw 30 clients a week. I think it was probably maybe 25 to 27, but it was more than I really wanted to see. I’m a lot more comfortable within the 20 to 25 range versus the 25 to 30 range. That was my experience anyway, was that I felt like, okay, I’m not making that much money and I’m close to burnout. I’ve got to make a change here. I made a huge change by moving my practice two years later, closer to my house. That was a big drop in clients and I had to do some rebuilding at that point because I was 30 minutes away now. I was trying to get started in doing some virtual therapy, so I had encouraged some of my clients to switch over to virtual therapy, but this was pretty pandemic so some of them just went ahead and made the drive and said I just want to come see you and I don’t care. Some of them were open to virtual therapy, but since I had dropped my major insurance company that I was getting most of the referral from, I had to really rebuild at that point. So I spent time networking with other therapists in the area. I spent some time really honing in on my niche and making a decision there to really narrow down my focus. This was, I had been in practice for a couple of years, so it gave me time to really figure out, okay, these are the types of clients that I enjoy working with. I enjoy working on with complex trauma. So I enjoy working with clients that have a lot of anxiety. [CARRIE] I had started to get into the realm of OCD and using some of the things that were working for clients that had anxiety and also were, had some OCD symptoms. So as I got more knowledge and more training experience in that area, that definitely was a big niche that opened up for me. Disorders that go along with that, such as hoarding is another one. Then about a year and a half later to two years later, the pandemic hit and went to completely virtual and made the decision to stay completely virtual. So now sourcing clients is a lot different than it was obviously when I first started out and it was more geographical located and that was a big factor whereas now, I’m using Google Ads and I’m sourcing clients from all over Tennessee. [JOE] I wonder, when you were making that transition off of insurance or off of taking as much insurance, that’s a question I get all the time, were there mindsets that you had to have during, or were there moments that you really saw the benefit in leaving insurance? Dig into that a little bit for us. [CARRIE] Sure. I had to shift from the mindset of I have to help everybody. I think that that was a false belief that I had held onto, like every person that calls, I have to try to figure out how to help them and if I can’t help them, I have to figure out a referral for them. Fortunately, I have left that thought behind a long time ago because I get referrals for things that I don’t do, or clients reaching out for therapy and there’s nothing related to that on my website. I don’t feel that pressure anymore to try to point them to the right therapist. If I know someone or I have a referral, I will give it for them but there’s just so many different things that people reach out for. It’s not possible for me to have a referral for every single person that comes along. That was one thing I had to let go of. I think the other thing was just some money mindset stuff about income and being okay with helping people, understanding that you can help people and you can make money. Those two things are not in competition with each other. That’s not the right way to say it, but they don’t clash. I think in my mind it was like, okay, if I’m out here trying to help people, then somehow, I don’t deserve to make a lot of money or I shouldn’t be charging such a high rate. However, I’ve really shifted that a lot over the last two years to realize that people are paying for the expertise and the experience that I have. I’ve been in the field for about 15 years now, so that’s a big chunk of time. Not a lot of therapists can say that they’ve been in the field for a long time. There are lots of people who come in as a second career for them. Certainly nothing wrong with that, but when you’re looking at what people are needing or wanting and the results that they’re wanting, it’s important to find somebody with a certain level of experience, especially when you’re dealing with complex trauma because I know that a lot of my clients have been to therapy in the past and haven’t really gotten what they needed or wanted. [HEARD] As a therapist, the last thing you probably want to think about is doing your own bookkeeping and taxes. Heard is here to help with that. Heard is the financial back office built specifically for therapists in private practice. They combine smart software with real humans to handle bookkeeping, taxes and payroll. Regardless of whether you’re a seasoned clinician or in the first year of your practice, Heard will identify areas for growth and streamline best financial practices for your business. When you sign up with Heard, you’ll be matched with an accountant who will help you track your income and expenses, file taxes online and maximize tax savings. You’ll also receive financial insights such as profit and loss statements and personalized monthly reports. You can say goodbye to pouring over spreadsheets and guessing your tax deductions or quarterly payments. Focus on your clients and Heard will take care of the rest. Prices begin at just $149 per month for solo practices and can easily be tailored to fit your businesses financial needs. Sign up for free for a 15-minute consult today at www.joinheard.com. Again, that’s www.joinheard.com. [JOE SANOK] Now, when people call and say, “Hey, do you take our insurance,” how do you answer that? Because I think that’s something that a lot of people, when they’re making that switch, they struggle with. [CARRIE] I actually have everything set up so that I don’t deal with phone calls because they were my biggest waste of time. What I’ve noticed about clients that have high anxiety, they don’t like to make phone calls anyway. So it’s easier for them to go through my website, read it, see what I do, and then hit me up through the contact page and then I’ll email them back. I’ll put them in the portal or I’ll review their paperwork and see if they’re an appropriate fit. If I have questions, I’ll give them a call, but for the most part, I don’t spend any time on the phone. That was something that really frustrated me in the beginning of my practice because I would, I would answer the phone all the time and then you would get through, somebody would be telling me half their life story and then you come to find out they only want to meet on a Saturday or sometime that you don’t work or they, “Oh, I can only come in at 5:00 PM,” “Oh, I’m sorry, I don’t have any evening slots available right now.” It just became a big point of contention and frustration for me. So now I have a voicemail basically set up for new clients on my, when they call, they can hear, “Hey I’m in session a lot of times during the day and I don’t always have that opportunity to answer the phone. You can find out everything you need on my website.” Then that way we don’t have to play phone tag. It’s just very like, lighthearted. Nobody likes phone tag. You can find out everything you need to know on my website and you can contact me there and I’ll email you back within the next 24 to 48 hours. That probably may not work for every type of clientele, depending on who your ideal client is, because if your ideal client wants to talk to their therapist before they come in and wants to really have that connection on the phone, they may not work for you, but it’s working for me. [JOE] Walk us through what they, on the website, I want to hear about that workflow, so they call, they get directed to the website. Do you have your whole schedule there so people know, oh she doesn’t work Saturdays? Do you have all the, like, I don’t take insurances or how do you articulate all of that? [CARRIE] Yes, so the first page, the homepage on my website, I have basically what I do. I have a little intro video of myself so that people can get a feel for how I communicate, how I talk about therapy. That’s, I don’t know, maybe a five to 10 minute video. Then I have list of various different types of issues that I work with most often. It’s divided into trauma, anxiety and then it’s like three columns, trauma, anxiety and OCD. Then I talk, at the bottom, I have probably some longer form content that most people don’t have on their website, but once again, if you’re anxious, people want to read everything and they want to know a lot of information. So I have information about basically like these are my clients and I just put, my clients are awesome and have several different statements about my clients. Like my clients have a hard time trusting people. Maybe they’ve had negative experiences even with providers in the past, my clients have been through some tough things. So I go through several of those. At the very bottom there is my office hours. So it has the days and times I see clients and I’ve cut out my evenings, cut out my weekends, which has been absolutely wonderful for me. That was another shift I made. I’ve made so many changes in the last five years but then they can go over on the fees page and see the fees, the insurance information about super bills. I do take one insurance, I’m down to Cigna and then they can go over to the contact form if they want to contact me. On the contact form it says what time of the day are you looking for? You know, say something just very brief about what you’re wanting to come in for. Then I think it may ask, oh yes, are you looking to use insurance or pay out of pocket? Then that helps me know how to respond to them in the email once they have those specific things. So if for example they want a late afternoon slot, I can respond in the email, “Yes, I do have times in the afternoon or no I don’t. I think I may at this point in time or something like that if you want me to put you on a waiting list.” Then I just I email them back a chunk of information about my practice, “Hey, you may have seen this on my website, but here are things I like everybody to know before we move towards scheduling.” So there’s a chunk that says that I only work online because even though I have pictures of myself in front of a computer, I have information about what you read about online therapy and the comfort of your own home, people still miss that and they still think for some reason I have in-person sessions. So every once in a while I’ll get somebody. Then I also have, because I have a podcast, I have to explain to people that I can only see you if you’re in Tennessee right now. Hopefully that will be fixed with the counseling compact coming up but that’s another thing I have to tell people because I have had people reach out from other states that want to see me. I go through the pricing in the emails while here’s, if they say they’re paying out of pocket, I explain that. If they say that they have Cigna, then I ask them to check in their benefit, make sure that you know what their coverage is, provider on their plan and so forth. Then I say, “Hey, if this sounds good to you just let me know if you want me to send you the paperwork. If you have questions definitely reach out and send questions.” Every once in a while I will have someone in the email ask if they can talk to me on the phone first. I don’t have a problem with that. If they do ask I will say, “Okay let me know what’s a good, when is a good time to call you or let’s set up a time to talk about this more, answer some of your questions.” So I don’t have a problem getting on the phone with people. I just have found that it just hasn’t been incredibly necessary for me. [JOE] No, that’s great. Thanks for walking us through that workflow. I think that sometimes we hear, yes, I just send them to the website, but then folks are like, well, what happens then? How does it flow? Do you do super bills or do you have any automations through like an electronic health records? Or is it just as needed? [CARRIE] I use Simple Practice and I can create super bills through there, but I usually just ask people upfront if they need that. Usually, I don’t know, my experience with people paying out of pocket if most of them don’t file the super bilI, I do occasionally have one or two people who want that done and I can set that up in Simple Practice to do that. [JOE] As you look forward to where you’re headed next, how are you thinking through your next steps now that you have a growing practice? What’s next for you? [CARRIE] That’s a really good question. What I would like to do longer term is create some type of online course or module for people who have anxiety or OCD to go through, sort of get into the self-help materials. I would like to write a book or a workbook to help people with anxiety and OCD. That’s part of what I’m doing right now with my podcast is really just playing around with creating content, interviewing different people on a variety of topics. That’s been I think, really helpful for me to start thinking through some of those pieces. I have some materials created and just life has happened to me so I have not put a full course together or launched anything out yet, but hopefully that will be sometime in the next few years. [JOE] Well, the last question I always ask people is if every private practitioner in the world were listening right now, what would you want them to know? [CARRIE] I would want them to know that really it’s your practice and you can do what you want to with it because there’s so many different ideas and thoughts about how to run a practice out there. Ultimately, as you start to do it, you find what works for you and the rhythm that works for you. I found that phone calls didn’t work for me and I changed my workflow on that and found something that did work for me. So don’t feel like you have to do what other people are doing. Do what you feel is going to work best for you and your practice because you’re ultimately the one that’s working there at the end of the day. [JOE] So awesome. Carrie, if they want to, if people want to connect with you, if they want to hear your podcast or connect with your website, what’s the best way? [CARRIE] Well, my counseling website is bythewellcounseling.com. My podcast is hopeforanxietyandocd.com. The podcast has a Facebook and Instagram page as well if people want to follow that for encouraging contact or share it with clients. That’s how the best ways to reach me. [JOE] Awesome. Thank you so much for being on the Practice of the Practice podcast. [CARRIE] Thank you. [JOE] It’s so great to just hear people’s journey of how they’re growing and changing and expanding their practices and just that what we create doesn’t have to stay the way we created it. Just because you start a practice that you take insurance doesn’t mean over time you can’t say I don’t want to work with those insurances, or I want to work with no insurances, or I want to start a podcast. We are allowed to grow and change and expand and to shed different parts of our businesses. That’s completely fine. And as we level up, one thing that you really want to think about is just keeping track of your finances, your bookkeeping, your taxes, all of that. Our sponsor Heard is one of the best out there. When you sign up with Heard you’ll work directly with financial specialists to track your income and expenses, file taxes online and grow your business. They can help you with bookkeeping, with your taxes, your quarterlies, figuring out all of those things, whether you’re a first year clinician or whether you’ve been around for a while. So you can say goodbye to all those spreadsheets and guessing your tax deductions and quarterly payments and let Heard take care of the rest. Plans begin at $149 per month and can easily be tailored to fit your business’ financial needs. Sign up now over at joinheard.com. Again, that’s joinheard.com. Thank you so much for letting me into your ears and into your brain. Have an amazing day. I’ll talk to you soon. Special thanks to the band Silence is Sexy for that intro music. This podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. It is given with the understanding that neither the host, the producers, the publishers or guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.

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