The State of Therapy: Tips for Therapists on Handling Insurance Rate Hikes and Technology

So, you want to start (or grow) a private practice, brave soul! Maybe you’re just launching, wild-eyed and clutching your paperwork, or you’re a group owner puzzling over reimbursement forms with a healthy side of existential dread. Perhaps you’re somewhere in between, wondering if it’s possible to stay sane and ethical in a mental health industry that changes more often than the DSM. Whichever crossroads you’re standing at, let’s chat.

We recently dove deep into some of the wildest, realest, and most vital issues therapists face today: insurance headaches, the rise of AI, and how to keep your clinical power in a system that occasionally seems too broken to fix.

If you’ve been tempted to pull the covers over your head when someone says ‘insurance commissioner’, or have nightmares about AI taking over your case notes, pull up a chair (and maybe a strong coffee). Today’s lessons, and a healthy dose of humor, are just for you.

Lesson 1: The Ground Is Shifting Beneath Our Couch. Embrace the Learning Curve

If you’ve ever felt a little lost keeping up with technology and insurance policy, you’re not alone. As Kelly put it right out of the gate:

“There's just a lot of a, there's a new learning curve here for all of us. And while we are trying to learn, the world is changing and the legalese around it I think is opening up different possibilities than we would care to have in our mental health care system.”

Translation: Every time you feel like you understand the rules, someone releases a policy update, throws in a new business associate agreement, or tells you that AI is now sorting your claims. Yay.

But here’s Miranda’s take: you can’t just ignore it, even if you want to.

“If you are a therapist, AI is impacting you right now, especially if you are taking insurance. If you're on any insurance contracts, whether you do anything, whether you ever open ChatGPT, AI is changing the game. That is what they're looking for. We're going to talk about some of these issues, but unfortunately it's not something that we can like ignore.”

Takeaway: Being in private practice means wearing both clinical and business hats and now, the tech translator hat, too. Expect the learning curve, and be gentle with yourself as you climb it.

Tip: Don’t shut down when you see new acronyms or tools. Take a breath, Google it, and remember everyone else is learning, too.

Lesson 2: Insurance Commissioners? They’re Not Just Bureaucratic Unicorns

Did you know every state has an insurance commissioner? Miranda’s ‘aha!’ moment came when news broke about Arkansas rejecting whopping insurance rate hikes:

“I didn't realize that the insurance commissioner actually is a part of keeping this system going. How much control that they have. Like, I didn't realize that they can't raise their rates without the insurance commissioner saying it's okay.”

The take-home message? The insurance commissioner is not just some mystical figure at the end of the bureaucracy rainbow. They have real power and actual humans (like you!) can talk to them.

Kelly offers this real-life example:

“For example, we had a client who got dropped from a panel, And I think 40% of her group practice was on this panel. She, she's in an underserved area. There weren't a lot of people on this panel. So then all the clients had nowhere to go.”

And the solution? She went straight to her state’s insurance commissioner, who actually stepped in and helped get her practice back on the panel.

Tip: Find out who your insurance commissioner is, how to contact them, and remember that advocacy isn’t just for other people. You can make your voice heard.

Lesson 3: Professional Advocacy. Whose Job Is It, Anyway? (Spoiler: Yours!)

Sure, you may dream that your professional association will ride in like the cavalry, but don’t count on it. As Miranda said:

“In my head, I would have said 20 years ago, like, this seems like something. Our professional association would be on top of it and that they would be navigating this and trying to change the law and trying to put all these things in place. And I just have not seen professional associations get into this conversation, at least not yet.”

That’s you, friend. And don’t underestimate your power. Even sending regular emails or letters (yes, AI can help you draft them) can plant seeds for real change.

“Maybe it's once a quarter, maybe it's once a year, I send a letter to my insurance commissioner, maybe... I can write a blog about it...those are some pieces.”

Mindset Shift: Your influence doesn’t just happen in the therapy room. It happens every time you show up in your industry, too.

Lesson 4: AI Is Already Playing in Your Sandbox. Time to Find Your Boundaries

Feeling creeped out by the idea of AI in health insurance? You’re not being a luddite, it really is complicated.

“AI is now getting involved in the approval process, the denial process. The whole actuarial profession is being disrupted I imagine buy this...these AI systems are designed to provide real time risk scoring and financial optimization. What essentially means algorithms will increasingly determine what therapy is deemed 'necessary' or 'cost effective.' This could overwrite therapists clinical judgment about what their patients actually need.”

Let’s be honest: this is scary stuff. But Miranda quickly turns it into action steps. If you’re worried about losing autonomy, she recommends tracking your outcomes and making your clinical value visible:

“The other aspect too of this tracking your clinical outcomes is when you have that data. Data is how you can affect change and make better decisions. And insurance companies make decisions on data. So when you are going to an insurance panel to ask for a raise and you have that kind of data, you will be much more likely to get what you need hopefully.”

Tip: Don't let AI be the only one with the receipts: track your clinical outcomes! It serves your clients, your case for raises, and your advocacy efforts.

Lesson 5: Mindset Matters. Rise Above, Don’t Shut Down

When business (and bureaucracy) feels overwhelming, Kelly invites you to reframe the pressure:

“Instead of shutting down when there's more pressure being applied, maybe by AI or insurance companies, like, how can we rise above it and get a better perspective as to, like, what is within our control, what is important to us and our values? I think anyone listening here is going to say they want to get good clinical outcomes.”

You may find yourself in victim/overwhelm mode (we’ve all been there). Kelly and Miranda challenge you to shift into your personal (and professional) power by focusing on what you can influence: your outcomes, your values, and the way you advocate for yourself and your clients.

Tip: When you hear yourself thinking, ‘but I can’t change that’ try ‘what can I do?’ Even small steps add up.

Lesson 6: Know Your Options And When It’s Time to Chart a Different Path

Therapists are famous for feeling stuck in crummy options. Bad insurance rates, open panel rejections, or the ‘should I join yet another app?’. Miranda gets it:

“The only option is to stay on this insurance panel. The only option is to, you know, use Rula or Alma or grow or whatever. The thing is like, we get into these where we feel like all of our options are terrible and don't, we don't really like settle into, like, if all these options really don't work, if we sit down and we say this is eroding what I'm doing clinically, it changes who I am as a person…”

The bottom line? If sticking with the status quo is draining your spirit and your bank account, it’s time to re-examine your business model, your boundaries, and possibly, your client list.

Tip: Honest self-check: Does my current path actually work for me (financially, clinically, and emotionally)? If not, it’s okay to pivot, advocate, or make bold changes.

Lesson 7: Build Your Buffer. Don’t Let a Slow Week Sink You

Miranda describes the precariousness so many therapists face:

“We do the math. We find that our fee needs to be blank. We don't feel comfortable charging that. So we charge just enough that if everything is okay, if we don't get sick, if we don't take vacation, if nobody ends early, if there's no like, lulls, we'll be okay. But if something happens in a week or two, then suddenly like our business and our finances like, do not make sense anymore.”

Building a sustainable practice means planning for real life: vacations, slow weeks, and all. If your only plan works when everything goes right, it’s time for a new plan.

Tip: Set your fees so that they cover your actual life. Sick days, holidays, professional development, not just a packed schedule.

Key Takeaways for Therapists Building Their Practices

• Proactive advocacy matters: Learn who your insurance commissioner is. Your voice is louder than you think.

• Track your clinical outcomes: You’re not just a therapist, you’re a walking, talking data point! Use that info for negotiation and advocacy.

• Embrace change and keep learning: AI isn’t going away, and neither are insurance headaches. Get curious, not frozen.

• Prioritize sustainability over survival: Plan for the slow seasons; don’t just hope they don’t come.

• Know your worth: If your business model drains your energy and finances, consider the power of ‘enough’ and be willing to change up your formula.

Tell Us:

What lesson from this episode will you carry forward? Drop a comment, share with a friend, or just take that first brave step!