Transkrip lengkap untuk Billing Under Fire: Supervisory Billing Explained (and more), with Susan Frager, MSW, Part 2

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WEBVTT 00:00:07.919 --> 00:00:08.720 Hi, everybody. 00:00:08.880 --> 00:00:22.399 My name is Civy Suckerman, and this is Therapists Unchained, a podcast hoping to educate, empower, and inspire mental health clinicians across the country facing the systems that we're facing in this ever-evolving mental health landscape. 00:00:22.640 --> 00:00:33.280 If you listen to my episode that came out two weeks ago with Susan Frager, the psych billing coach, this is an impromptu kind of part two with Susan. 00:00:33.439 --> 00:00:34.479 So she's back. 00:00:34.719 --> 00:00:38.880 This is the first time I've had a sequential back-to-back part one and part two. 00:00:38.960 --> 00:00:49.840 We didn't know there was going to be a part two, but there's been a lot of stuff happening and it felt really vital to get Susan on the show again to talk about some of the things happening. 00:00:49.920 --> 00:00:50.719 So welcome back. 00:00:50.960 --> 00:00:51.759 Thanks, Civic. 00:00:51.920 --> 00:00:52.799 Glad to be back. 00:00:53.039 --> 00:00:59.920 And just so you know, if you're not already familiar, I have been working closely with the Mental Health Insurance Reform Task Force. 00:01:00.000 --> 00:01:05.439 If you haven't listened to my episodes with Nicole Sartini, I highly recommend that. 00:01:05.680 --> 00:01:14.719 The first episode specifically, it talks a lot about the uh vision behind the Mental Health Insurance Reform Task Force. 00:01:15.040 --> 00:01:19.840 And I'm just going to be calling it the task force because it's too many words to continue saying. 00:01:20.079 --> 00:01:23.519 But Susan also is involved with the task force. 00:01:23.760 --> 00:01:47.040 And one of the things that has come up, and this is a major reason why I wanted Susan back on the podcast so quickly, is because of what if you're not familiar with what's going on specifically in Michigan, but I think it's spreading, is Blue Cross Blue Shield in Michigan recently sort of changed their, I would you say contracts? 00:01:47.120 --> 00:01:48.560 I don't know how you'd frame it, Susan. 00:01:49.120 --> 00:01:50.640 It's their policy. 00:01:50.959 --> 00:01:51.280 Policy. 00:01:51.519 --> 00:01:51.840 Thank you. 00:01:52.000 --> 00:01:54.719 Their payer policy with respect to supervisory billing. 00:01:54.959 --> 00:01:55.200 Yeah. 00:01:55.280 --> 00:02:08.319 And so one of the things I really wanted Susan to speak to, because I see this a lot in my therapist groups, is this conflation of incident to billing and supervisory billing. 00:02:08.479 --> 00:02:16.080 Even Blue Cross Blue Shield in what they're talking about with this new policy, which we'll talk about, is conflating those terms. 00:02:16.240 --> 00:02:23.199 So, Susan, what I would love for you to do for everybody, because people, you know, I'm not a professional biller. 00:02:23.439 --> 00:02:25.120 You've been doing this for a long time. 00:02:25.439 --> 00:02:27.520 You know all about all of this stuff. 00:02:27.759 --> 00:02:35.599 Can you help people understand specifically what the actual difference is between incident to billing and supervisory billing? 00:02:35.919 --> 00:02:36.400 Uh, sure. 00:02:36.479 --> 00:02:37.360 Thanks, Civy. 00:02:37.599 --> 00:02:45.360 So incident to is primarily a Medicare concept coming out of the medical field. 00:02:45.599 --> 00:02:50.080 It has very limited ability to be adapted to behavioral health. 00:02:50.319 --> 00:03:10.240 People, and when I say people, I mean mental health clinicians sometimes think they can adapt it because they have been misled by people who don't understand the difference, or by insurance companies who are conflating it, like Blue Cross Blue Shield of Michigan, but they certainly aren't the only blue or the only payer that conflates it. 00:03:10.479 --> 00:03:18.479 Essentially, to understand incident two billing, you sort of have to go back to your graduate training, maybe your internship placements. 00:03:18.960 --> 00:03:28.800 If you were ever in a facility, a hospital, a treatment center where you worked on what in social work we used to call the treatment team approach. 00:03:29.039 --> 00:03:30.719 That's incident two billing. 00:03:30.879 --> 00:03:44.000 The treatment team is headed by a physician, either a medical physician or a psychiatrist, somebody who directs the care, determines the treatment goals, the treatment plan. 00:03:44.159 --> 00:03:45.840 They see the client first. 00:03:46.400 --> 00:03:50.800 It is, from a billing perspective, their client. 00:03:51.599 --> 00:04:00.960 So under incident two, everything is billed under the psychiatrist, which a lot of people like because when you bill it under psychiatrists, now you're getting 100% of Medicare. 00:04:01.520 --> 00:04:12.960 So for that reason, it is one of the most frequently and highly audited and clawed back procedures that one can encounter with Medicare. 00:04:13.120 --> 00:04:18.959 They are constantly auditing incident two, they are constantly finding errors and clawing back. 00:04:19.199 --> 00:04:21.360 It's under a lot of scrutiny. 00:04:21.519 --> 00:04:33.920 In Medicare's eyes, the line between just misunderstanding incident two billing and abusing it to the point of what they would consider fraud is very, very, very thin. 00:04:34.800 --> 00:04:35.120 Okay. 00:04:35.759 --> 00:04:58.319 Other people have used incident two, quote unquote, as a way to get around credentialing a new person on the team, or maybe not totally get around credentialing, you know, somebody who joins a group, but just in the nine or 12 months it takes to get them added to your group, they're like, well, we'll just build incident two. 00:04:58.720 --> 00:05:03.040 It's understandable, absolutely, but it's unfortunately wrong. 00:05:03.360 --> 00:05:14.399 So am I understanding when you say that that it would be that the supervising provider in under incident two would be listing themselves as the rendering provider? 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--> 00:05:14.879 Yes. 00:05:15.199 --> 00:05:15.519 Okay. 00:05:15.920 --> 00:05:35.120 Yes, because in Medicare's eyes, the psychiatrist is the rendering provider, and then a nurse practitioner, a social worker, maybe a dietitian, you know, anybody is just carrying out pieces of the psychiatrist treatment plan. 00:05:35.199 --> 00:05:38.639 And this is also done a lot in just fully medical settings. 00:05:38.879 --> 00:05:42.160 Let's say a person has diabetes, let's say. 00:05:42.399 --> 00:05:48.800 So the primary MD is the billing physician. 00:05:49.120 --> 00:05:57.519 They send the person with diabetes to a nutritionist or a diabetes educator or somebody who monitors their blood sugars. 00:05:57.680 --> 00:06:07.839 All of those subsidiary people get paid by primary care MD, who then turns around and bills everything as a bulk package. 00:06:08.000 --> 00:06:09.519 It's called bundled. 00:06:10.000 --> 00:06:15.839 And then Medicare just pays for the bundle to the primary care physician. 00:06:16.000 --> 00:06:24.319 There are, I believe, seven criteria under Medicare that you have to meet for something to be legitimately classified as incident two. 00:06:24.480 --> 00:06:30.480 And most of them have just absolutely no bearing on what we do in mental health supervisory billing. 00:06:30.639 --> 00:06:38.079 Because in the end, supervisory billing, the supervisor isn't the therapist of record. 00:06:38.160 --> 00:06:39.839 It's the supervisee. 00:06:40.000 --> 00:06:44.399 It's the associate, you know, the person who's provisional provisionally licensed. 00:06:44.639 --> 00:06:45.759 They're the therapist. 00:06:45.920 --> 00:06:52.480 The supervisor is simply signing off on hours for state licensure and is acting as a case consultant. 00:06:52.959 --> 00:07:06.319 And so in that situation, the supervisee, the associate or provisionally licensed person is on the claim as the rendering provider, and the supervisor is the billing provider or the practice is the billing provider. 00:07:06.399 --> 00:07:07.600 Is that accurate? 00:07:08.319 --> 00:07:11.360 If done correctly. 00:07:11.439 --> 00:07:17.040 And when I say correctly, I mean the way the NUCC, the National Uniform Claim Committee, wants it done. 00:07:17.360 --> 00:07:22.319 However, and I'll be going over, I'm giving a webinar on this on July 17th. 00:07:22.399 --> 00:07:24.720 I'll be going all over this in great detail. 00:07:24.879 --> 00:07:30.160 But the problem is many insurance companies don't want it done that way. 00:07:30.720 --> 00:07:40.879 They just want it as if, City, let's say I'm being supervised by you, they want you to submit the claim as if you saw the client and I'm nowhere on the claim. 00:07:41.120 --> 00:07:49.759 To me, that reeks of insurance fraud, but it's not insurance fraud if Aetna puts it in writing that you should do it that way, and they do. 00:07:50.000 --> 00:07:55.120 The problem happens is that I think they do it for two reasons. 00:07:55.360 --> 00:08:01.600 One is so that they can easily track by volume what to audit. 00:08:01.920 --> 00:08:10.079 Because if Civi, you have a group of, let's say, six clinicians, four of them are supervisees, you're supervising all of them. 00:08:10.319 --> 00:08:21.839 All four of us see two or three etna clients per day, and then you may have a couple that's way more ethnic clients than you can ever legitimately see yourself in a day. 00:08:22.160 --> 00:08:25.839 So it falls under what's called an MUE or a medically unlikely edit. 00:08:26.000 --> 00:08:34.080 Because if 14 claims a day go in under your NPI number, they're gonna know that they need to audit and they're gonna know it's supervisory bill. 00:08:34.559 --> 00:08:36.720 That's reason number one I think they do it that way. 00:08:36.879 --> 00:08:43.360 Reason number two is they don't want to roster the, they don't want to take the time. 00:08:43.519 --> 00:08:52.240 And when I say roster, it means they take the NPIs and basic credentials of the provisionally licensed clinician and add them to your group. 00:08:52.399 --> 00:08:53.759 They don't want to be doing that. 00:08:53.919 --> 00:08:56.159 They, you know how overwhelmed they are. 00:08:56.240 --> 00:09:01.279 You can't even change an address in under, you know, how many months, or get somebody credentialed. 00:09:01.360 --> 00:09:05.679 They don't want to be bothered with provisional licenses, that's just more work for them. 00:09:05.759 --> 00:09:08.080 So it's easier for them to just say, Oh, you bill it. 00:09:08.399 --> 00:09:10.000 And give us a reason to audit you. 00:09:10.480 --> 00:09:11.440 Exactly. 00:09:11.759 --> 00:09:12.559 Exactly. 00:09:12.799 --> 00:09:29.919 But in incident two, it's different because it's absolutely legitimate for the physician to be the only rendering provider because the physician is controlling the treatment plan and also has a one-to-one relationship with the patient. 00:09:30.159 --> 00:09:46.159 Whereas a supervisee, supervisor in mental health, you know, if you're supervising me and I'm seeing a client, you don't have any direct relationship with my client unless maybe I have an emergency and I have to be out and you need to take care of my client. 00:09:46.320 --> 00:09:50.639 But in most cases, you wouldn't meet my client, you wouldn't assess them. 00:09:50.879 --> 00:09:55.679 And the client, if asked who their therapist is, they'd say it was Susan. 00:09:55.840 --> 00:10:00.240 So it's a very different model in um behavioral health. 00:10:00.480 --> 00:10:24.720 The other thing with respect to Medicare and Incident Two in behavioral health is that master's level clinicians who participate with Medicare cannot be billing providers under incident two, meaning the head of the treatment team cannot be a social worker, an MFT, or a counselor. 00:10:26.960 --> 00:10:29.120 It is not permitted under Medicare. 00:10:29.279 --> 00:10:37.120 Only a psychologist, nurse practitioner, or

psychiatrist can be the head of a incident two treatment team. 00:10:37.759 --> 00:10:39.200 Okay, I guess that does make sense. 00:10:39.440 --> 00:10:39.679 Right. 00:10:39.759 --> 00:10:41.120 That's a Medicare rule. 00:10:41.279 --> 00:10:56.159 So any, you know, MFT who tries to build Medicare for the services of a provisional licensee and calls it incident two, you're gonna get busted if you get audited and you will be clawed back. 00:10:56.639 --> 00:10:58.960 And hopefully that is the worst thing that happens. 00:10:59.120 --> 00:11:08.240 I mean, hopefully that's the worst thing that happens to you and not extrapolation or other penalties, you know, verging on potential fraud. 00:11:08.320 --> 00:11:12.879 And there's so much misunderstanding out there about this. 00:11:12.960 --> 00:11:20.320 And I really worry for clinicians who don't understand and make innocent mistakes and and are gonna face consequences. 00:11:20.480 --> 00:11:26.799 That's to me the biggest scary, scariest part of this whole uh topic. 00:11:27.120 --> 00:11:53.759 Well, and I think when insurance companies are conflating it, and it's my understanding too with incident two that if insurance companies are calling this incident two, the other piece is that under incident two billing, the lead provider, let's just say, who should actually be a physician in a real incident two for the most part, is supposed to be present for the most part while the service is being rendered. 00:11:54.000 --> 00:11:54.559 Correct. 00:11:54.799 --> 00:12:01.360 They have to be reachable when the patient is seeing the subsidiary providers. 00:12:01.759 --> 00:12:11.360 The physician has to either be present in the same office or now there's some rules around immediately reachable that go back into the COVID era. 00:12:11.440 --> 00:12:18.960 And to be really honest, I can't quote them because 28 years into my billing career, I have yet to bill a single incident to that. 00:12:19.440 --> 00:12:24.960 Because legitimately incident to billing, because it's not a model that applies to us. 00:12:25.120 --> 00:12:30.000 So I haven't really memorized all of the requirements with regards to accessibility. 00:12:30.080 --> 00:12:33.600 But yes, that is part of it, is they do have to be accessible. 00:12:33.919 --> 00:12:41.759 Yeah, and so that reminded me, and I want to talk specifically about what's happening in Michigan, but there's also stuff happening in Arizona. 00:12:41.919 --> 00:12:42.080 Yes. 00:12:42.240 --> 00:13:01.519 And I don't have it in front of me, but my understanding is that there was a provider, at least I mean, I'm sure there's multiple, who's a supervisor who received notice that they were I don't know if it was if they weren't present or whatever it was, that they got clawed back, like the request was like for over like$500,000. 00:13:01.759 --> 00:13:04.480 Like it was Yeah, I think it was about three quarters of a million. 00:13:04.720 --> 00:13:07.039 Um and crazy, crazy. 00:13:07.360 --> 00:13:19.600 Well, but that that brings up another issue that I have a lot of problems with any and all commercial insurance companies with the potential, except exception of United Healthcare. 00:13:19.679 --> 00:13:25.919 And I say potential because I'm not familiar enough with United's because they have a very different way of handling supervisory billing. 00:13:26.080 --> 00:13:28.559 But for the moment, we'll we'll talk later about United. 00:13:28.639 --> 00:13:30.000 Don't forget to ask me about them. 00:13:30.240 --> 00:13:46.879 But my biggest beef, aside from them misclassifying incident two versus supervisory billing, is that they don't come out and say, here is our expectation with regards to what is acceptable documentation. 00:13:47.039 --> 00:13:51.120 There is nothing I read provider manuals routinely. 00:13:51.279 --> 00:13:52.080 This is what I do. 00:13:52.159 --> 00:13:59.679 I teach clinicians to know these things that insurance companies don't tell you so that you don't get tripped up and clawed back. 00:13:59.840 --> 00:14:06.799 I read these things and they put them out knowing that who has time to sit there and dig through and read them. 00:14:06.960 --> 00:14:07.759 Well, I do. 00:14:07.919 --> 00:14:11.440 And I can tell you there's nothing in there about how you're supposed to document it. 00:14:11.600 --> 00:14:24.960 Well, to me, that's an open invitation for a clawback because if you're supposed to be held to a standard that you don't know what the standard is and nobody's really defined it, then they can basically just say, Oh, well, yeah, I guess we'd like$750,000 back. 00:14:25.120 --> 00:14:26.960 Thank you very much, ching ching. 00:14:27.039 --> 00:14:34.240 And, you know, the person is being cited for documentation errors that she didn't know what the standard was. 00:14:34.559 --> 00:14:35.759 It makes me crazy. 00:14:36.000 --> 00:14:50.879 Yeah, I mean, that I feel like, yeah, I mean, that's across the whole thing because across all of healthcare, because I remember doing some research about like what actually medical necessity is, and there's no agreed upon meaning to that, what that even means. 00:14:51.360 --> 00:14:55.440 Well, there's more than supervisory billing documentation of the years. 00:14:55.759 --> 00:15:02.480 Yeah, there's, I mean, it's just like there's so much, there's so much that we're up against that's not that there's a lack of clarity on. 00:15:02.639 --> 00:15:06.960 And this particular piece, this incident two versus supervisory. 00:15:07.200 --> 00:15:14.799 I'm my spidey senses are being triggered with this when I see what's happening in Arizona, when I see what's going on in Michigan. 00:15:14.960 --> 00:15:22.960 And then again, to go back to Arizona for a moment, was that, and I really hope I'm not getting this wrong because I had forgotten about it until this very moment. 00:15:23.039 --> 00:15:34.159 So I'm going to talk about it, but that they

wanted to change it so that the supervisor had to do the intake for their supervisee. 00:15:34.320 --> 00:15:39.600 And I remember seeing a lot of stuff, people freaking out in Facebook groups about this. 00:15:39.759 --> 00:15:53.039 And it feels like they're trying to hold us to incident two, that that is what they're doing, that the somehow the supervisor is qualified to create a treatment plan, but the associate is not, even though the associate is the one to be treating the person. 00:15:54.960 --> 00:16:10.000 Because incident two is a creation of Medicare, the way things work when commercial insurers borrow from CMS is they are allowed legally to morph it, adapt it, change it. 00:16:10.080 --> 00:16:18.960 There is no obligation under the law for them to use the exact same definition as a government payer. 00:16:19.120 --> 00:16:19.919 That's part of the problem. 00:16:20.080 --> 00:16:25.919 So they are within their rights legally to do that if they want to. 00:16:26.080 --> 00:16:28.399 Um, and yes, I think that is part of it. 00:16:28.480 --> 00:16:32.799 Although, to be honest, I'm just starting uh putting together my webinar for the research. 00:16:32.879 --> 00:16:36.559 So I'll have more research coming from both Arizona and Michigan. 00:16:36.639 --> 00:16:43.440 But I have worked with clinicians in both states, and one of the group owners in Arizona was like, How am I gonna do that? 00:16:43.600 --> 00:16:51.519 I I I'll never be able to see my own clients if I have to see everybody's all my supervisees' clients for the first time and develop treatment plans. 00:16:51.600 --> 00:16:58.480 And and you know, the the the vibe I get is well, not our problem. 00:16:59.600 --> 00:17:00.480 Oh, exactly. 00:17:00.639 --> 00:17:02.159 Exactly, exactly. 00:17:02.399 --> 00:17:08.480 And then just to offer more clarity on what recently transpired in Michigan, it got a lot of press. 00:17:08.640 --> 00:17:26.880 So Blue Cross Blue Shield, this is my understanding, I'm not an expert in this, but this is my understanding of what happened, is they Blue Cross Blue Shield of Michigan changed their policy to basically, and I think they're actually calling it incident to billing, they're not even calling it supervisory billing because I I I that's my understanding, they're not calling it that. 00:17:27.039 --> 00:17:40.400 But they're basically saying that if a clinician is provisionally licensed, that the only way that they can bill under a supervisor is if they work in a facility setting. 00:17:40.640 --> 00:17:42.160 Is that how you understand it? 00:17:42.400 --> 00:17:48.559 Well, like I said, I haven't had a chance to really this is so impromptu. 00:17:49.039 --> 00:17:58.880 And what with what with Aetna and Alma and CIQH and Data Spring and it's like I can't even keep up. 00:17:58.960 --> 00:18:02.400 And it's I'm sitting here going, it's summer, I want my vacation. 00:18:03.519 --> 00:18:05.440 This is supposed to be the slow time, right? 00:18:05.599 --> 00:18:06.960 Um, I do have it. 00:18:07.039 --> 00:18:15.759 It is a there's an FAQ dated June 1st, and it's called Incident 2 Services and Billing Professional, Frequently Asked Questions for Providers. 00:18:15.920 --> 00:18:19.359 Now, my guess is just looking at it, I mean, this is 11 pages. 00:18:19.519 --> 00:18:22.640 I've got it up on my big monitor here, which you can't see. 00:18:22.799 --> 00:18:25.759 But my guess is it's not specific to behavioral health. 00:18:26.079 --> 00:18:33.519 The way Blue Cross of Blue Shield, Michigan wrote it, it does not sound to me like they're even talking about behavioral health. 00:18:33.680 --> 00:18:38.720 And that's part of the problem with a lot of these payers, is they just hand down these policies. 00:18:38.880 --> 00:18:40.319 They're really meant for medical. 00:18:40.400 --> 00:18:45.200 We are such a small proportion, and everything is so different in mental health. 00:18:45.279 --> 00:18:51.920 And frankly, I don't think they want to even freaking bother with us, but we're just a thorn in their side, we're pesky. 00:18:52.319 --> 00:18:57.440 And so these policies that are 11 pages may have half a paragraph about behavioral health. 00:18:57.759 --> 00:19:00.720 And so I am gonna have to read it very, very carefully. 00:19:00.880 --> 00:19:09.279 But that is my understanding also, is that this is primarily facility-based community mental health and not private practice. 00:19:09.759 --> 00:19:21.599 And I think you bring up a this is a big point that I that I think you're bringing up, which is that hospitals or facilities are the predominant training sites for physicians. 00:19:21.839 --> 00:19:22.160 Yes. 00:19:22.319 --> 00:19:26.960 That makes sense if you're a physician, because that they are training sites. 00:19:27.279 --> 00:19:37.200 And I'm gonna come back to that in a moment, uh, talking about sort of some of the policy or model legislation I'm working on around this because I think it's an issue. 00:19:37.519 --> 00:19:53.839 But with mental health providers, specifically therapists, master's level, we don't our training sites are group practices and community mental health, but not as much facility-based settings. 00:19:54.079 --> 00:19:56.559 And not maybe substance abuse. 00:19:57.039 --> 00:19:57.359 Yeah. 00:19:57.519 --> 00:20:08.559 And then on top of it, my concern is we know across the country, like I just had Jessica Frick on from Pennsylvania. 00:20:08.799 --> 00:20:16.559 She was telling me that the community mental health centers in her community in Erie are all owned by insurance companies. 00:20:16.960 --> 00:20:27.759 So I go, all right, so BCBS of Michigan is now saying everybody has to train in a facility, basically, if you're provisionally licensed or working towards licensure. 00:20:28.799 --> 00:20:33.359 And what happens when all these facilities are owned by insurance companies, right? 00:20:33.599 --> 00:20:44.559 Well, I don't have the

data on what Blue Cross Blue Shield, Michigan owns, but I can tell you that in Michigan, Michigan, it's one of those states where Blue Cross is the dominant payer. 00:20:44.640 --> 00:20:51.759 I think I saw a statistic somewhere that said something like 70% of Michigan is Blue Cross Blue Shield. 00:20:52.480 --> 00:20:57.920 Yeah, I mean it it feels like they're trying to put a chokehold on the whole pipeline, right? 00:20:58.079 --> 00:21:00.079 Um I'm sure that's not their intention. 00:21:00.240 --> 00:21:04.559 I'm sure that they would disclaim it as being their intention, but that is the result. 00:21:04.960 --> 00:21:05.680 Absolutely. 00:21:06.079 --> 00:21:14.319 Yeah, and then they they control everything, they could control training sites and models that you get to work on under. 00:21:14.640 --> 00:21:28.720 And it's gonna, in my opinion, my concern is the impact on clinical growth and getting actually like I'm not saying that you can't get quality supervision in a facility setting, but the But there aren't gonna be enough placements for everybody. 00:21:28.960 --> 00:21:31.599 No, there's no way that there's gonna be enough placements. 00:21:31.920 --> 00:21:37.440 And then, and and where are interns gonna work to get their hours? 00:21:37.599 --> 00:21:39.519 You know, like it exactly. 00:21:39.759 --> 00:21:57.599 And then when I see the language where Blue Cross Blue Shield is calling it incident two and not making that distinction, it it can it, I think it further confuses the conversation because I hear a lot of clinicians in like Facebook groups talking about incident two, and I'm like, we don't do incident two. 00:21:57.920 --> 00:21:58.160 I know. 00:21:58.319 --> 00:22:09.359 And I feel like I'm I'm like, I don't mean to be That argue person, but I like we need to get our terminology straight so that we can advocate for ourselves, so that we understand what we're fighting for. 00:22:09.519 --> 00:22:24.079 And that's really why I wanted somebody other than me to speak to the difference between incident two and supervisory billing so that we can be using the correct language when we're advocating for ourselves on these issues. 00:22:24.319 --> 00:22:36.079 And I wanted to talk a little bit too about my um, I went down this rabbit hole where I was trying to come up with like what could our argument be at the national level? 00:22:36.319 --> 00:22:42.799 The parity issue, in a lot of ways, is off the table because of stuff going on around those laws. 00:22:43.200 --> 00:22:45.200 Unless there's a state parody law. 00:22:45.359 --> 00:22:48.079 And um I you may have seen me look at my phone. 00:22:48.240 --> 00:23:01.119 My computer once again is crashing, and I was there's two documents from Blue Cross Blue Shield, Michigan, and one of them is called the Incident 2 FAQ, the other one is called supervisory updates. 00:23:01.279 --> 00:23:06.799 And I was trying to see if there was anything in there, and it's there's nothing in there, it's just a one-page. 00:23:06.960 --> 00:23:08.559 Hey, look at the FAQ. 00:23:09.440 --> 00:23:12.640 Um, so I I apologize for interrupting you on that. 00:23:12.880 --> 00:23:28.079 But yeah, um, unless Michigan or Arizona has some sort of really hard state parity law, parody is it would be nice if we could use it, but parody has become so toothless thanks to yeah, that's yeah. 00:23:28.160 --> 00:23:31.599 And in my research, what it said is basically this has to become a statute. 00:23:31.759 --> 00:23:34.240 Like we need to get to the level of a statute. 00:23:34.400 --> 00:23:40.319 And the argument in the It is a federal statute, but not for us, I think. 00:23:40.559 --> 00:23:45.119 Oh, no, mental health parity and equity act, MHP. 00:23:45.440 --> 00:23:50.160 Well, I'm talking about I'm talking about, I should back up and fully explain what I'm talking about. 00:23:50.319 --> 00:24:04.160 So my argument on this is that the systems, the government, everybody, and this is written into statute, the physician residency pipeline, right? 00:24:04.240 --> 00:24:08.559 There's an understanding, and it is built into our healthcare system. 00:24:08.640 --> 00:24:11.200 It's even funded by the government. 00:24:11.519 --> 00:24:14.559 They pay training hospitals for residents. 00:24:14.720 --> 00:24:22.640 So the training is paid for by the government that there's an understanding of what the training pipeline is for physicians in this country. 00:24:22.880 --> 00:24:30.079 There doesn't seem to be an understanding of the training pipeline for master, especially master's level mental health providers. 00:24:30.640 --> 00:24:48.400 No, no, we're expected to just work it out on our own, and that falls on the individual uh student, clinician who is expected to, you know, have huge student loans, internships not paid for, and in a lot of cases, associates probably aren't even making minimum wage in a lot of cases. 00:24:48.720 --> 00:24:52.000 And that's just kind of eh, too bad, so sad, figure it out. 00:24:52.079 --> 00:24:53.599 Uh, there's no support. 00:24:53.839 --> 00:24:54.799 You're absolutely right. 00:24:54.880 --> 00:24:56.000 And there needs to be. 00:24:56.319 --> 00:25:06.400 And now, if they're taking away our people's ability to do supervisory billing, which is really the only funding stream, which isn't, if you're being honest with yourself, is not a funding stream. 00:25:06.559 --> 00:25:07.839 It's just paying for the service. 00:25:08.000 --> 00:25:15.920 Like, we don't get billions of dollars in training subsidies from the federal government to help bring forward the next generation. 00:25:16.240 --> 00:25:18.000 You don't even get a dollar in subsidies. 00:25:18.079 --> 00:25:18.720 You get zero. 00:25:19.200 --> 00:25:20.000 We get zero. 00:25:20.319 --> 00:25:29.920 So my angle is that I mean, I guess it is kind of a parity argument where it's like we have this infrastructure built for physicians that's recognized.

00:25:30.160 --> 00:25:36.319 We need a separately recognized understanding of the training pipeline for mental health providers. 00:25:36.559 --> 00:25:39.599 And I it is a parody issue, but I think it goes beyond that. 00:25:40.000 --> 00:25:44.319 Well, it's a parody issue, but unfortunately it's not covered under the MHPAEA. 00:25:44.480 --> 00:25:45.200 So yeah. 00:25:45.519 --> 00:25:46.000 Exactly. 00:25:46.160 --> 00:25:46.400 Yeah. 00:25:46.720 --> 00:25:51.839 So in my research, it was talking about sort of a different angle, which I'm still investigating. 00:25:51.920 --> 00:26:00.480 But part of the reason I'm sharing this is because I recognize that I've had a few people tell me, I started listening to an episode of your podcast and I got really depressed. 00:26:00.559 --> 00:26:01.359 I think you were Susan. 00:26:01.759 --> 00:26:02.160 That was me. 00:26:04.240 --> 00:26:06.720 But you're not the only, you're not the only one that's doing that. 00:26:06.960 --> 00:26:11.279 And I try to all, you know, to amplify voices of people that are doing incredible work. 00:26:11.519 --> 00:26:17.680 But a lot of this stuff sucks, and people feel like, all right, well, boy, Siv, like, this is a lot. 00:26:17.759 --> 00:26:20.319 And now I now I'm feeling paralyzed. 00:26:20.480 --> 00:26:44.720 So the reason I'm talking about the policy work is because I want people to know that there are a lot of folks right now actively strategizing to figure out ways that we can legislatively start to find these gaps and these holes and push on them and come up with strong and creative arguments to help advance our work. 00:26:44.960 --> 00:26:45.200 Right. 00:26:45.279 --> 00:26:51.440 And that's what I try to do, like in my newsletter, is I try to focus on state-level positive developments. 00:26:51.599 --> 00:26:56.160 I haven't focused on this, but you might want to look at, and I can send it to you after we're done. 00:26:56.400 --> 00:27:01.759 Governor Kotek in Oregon put forward a whole training mental health thing recently. 00:27:01.920 --> 00:27:10.799 And I don't think it's been launched yet, but the proposal has been made to help fund the mental health pipeline in Oregon. 00:27:11.119 --> 00:27:17.680 And for instance, there was a very wonderful initiative that did pass in Illinois. 00:27:17.759 --> 00:27:30.720 It's going to be live January 1st, where insurance companies that operate within Illinois have to pay a minimum of 141% of Medicare to behavioral health clinicians. 00:27:30.880 --> 00:27:46.079 And there are already certain insurance companies who shall remain nameless who are actively working to get around that because I've already called them on it and been successful because they disclaimed that that was the reason. 00:27:46.160 --> 00:27:51.759 And I'm like, mm-hmm, we'll let the insurance, you know, commissioner in state of Illinois decide that. 00:27:51.839 --> 00:27:57.519 But in the meantime, you're not gonna, you know, do my

clinician wrong, and yeah, you're gonna pay these claims. 00:27:57.599 --> 00:28:15.119 And I may or may not write more about that as we get closer to January 1st in Illinois, but you know, it seems like kind of for every move we make, the insurance companies and the venture capital, they're five, six, seven, eight steps ahead of us, they anticipate. 00:28:15.359 --> 00:28:23.359 And because they have the resources that we don't have, and also they don't have a lot of the legal constraints that we have. 00:28:23.519 --> 00:28:29.200 Like, for instance, the constraint against collective bargaining, they are able to do so much more, and it is depressing. 00:28:29.279 --> 00:28:30.640 It's depressing as heck. 00:28:30.880 --> 00:28:36.079 There's times I even get depressed, and and I'm just like, oh my God, this is just, you know. 00:28:36.880 --> 00:28:37.839 And there's a lot. 00:28:37.920 --> 00:28:43.359 I mean, like you were you were kind of joking about like CAQH turning into data spring and this happening and that happening. 00:28:43.519 --> 00:28:45.839 And there were there's a lot being thrown at us. 00:28:46.000 --> 00:28:50.720 And I I I understand that like it can feel really overwhelming. 00:28:51.039 --> 00:29:01.920 And I have to be honest, like both you and I, I mean, Susan, poor Susan got booted out of Zoom for the last task force meeting, but there were like a hundred and some people there. 00:29:02.640 --> 00:29:05.279 I mean, to me, that's amazing from all over. 00:29:05.519 --> 00:29:08.160 I think we actually have representation now in all 50 states. 00:29:08.319 --> 00:29:16.400 Woohoo! So I want people to know, like, yeah, there is a lot of stuff coming down that is, and I try to highlight because I want people to be educated. 00:29:16.480 --> 00:29:24.240 I don't want to freak you out, but we need to understand this stuff and you know, have your, you know, moments of grief and anger. 00:29:24.400 --> 00:29:24.799 Do it. 00:29:24.960 --> 00:29:29.200 I feel that way, and recognize that we can sit in that. 00:29:29.359 --> 00:29:30.880 I'm gonna sound like a therapist here. 00:29:31.039 --> 00:29:34.000 We can sit in that, or we can use that to fuel our action. 00:29:34.079 --> 00:29:39.279 And what I'm trying to do for myself is use it to fuel action. 00:29:39.440 --> 00:29:40.720 How do we push this? 00:29:40.880 --> 00:29:43.839 How do we like come together and strategize? 00:29:44.000 --> 00:29:46.799 And so I want you people to know that that is happening. 00:29:47.039 --> 00:29:49.119 And I just found out about a bill. 00:29:49.200 --> 00:29:55.680 I don't want to get it wrong, so I'm gonna open my email right quick because I sent it to somebody recently in my email. 00:29:55.759 --> 00:30:01.920 But there is something slowly, as things are, slowly moving through Congress. 00:30:02.079 --> 00:30:03.519 I'm gonna see if I can find. 00:30:03.759 --> 00:30:09.519 Are you talking about the um Elizabeth Warren and Josh Hawley

um breakup big medicine? 00:30:09.839 --> 00:30:10.720 Is that the one you're talking about? 00:30:11.119 --> 00:30:12.880 This is, I found it. 00:30:13.039 --> 00:30:21.200 It's House Resolution 8081, which is the Mental Health Access and Provider Support Act of 2026. 00:30:21.440 --> 00:30:23.119 Oh God, please send that to me. 00:30:23.359 --> 00:30:24.720 I will forward this to you. 00:30:25.200 --> 00:30:26.720 No, I hadn't I hadn't heard of that one. 00:30:26.880 --> 00:30:28.240 I hadn't heard about it either. 00:30:28.319 --> 00:30:33.519 I'm opening it here real quick because I believe that because there's two different bills. 00:30:33.680 --> 00:30:34.640 It's very timely. 00:30:34.799 --> 00:30:54.880 If if you've read my my current blog series that's coming out in parts, the last one that I just did uh was about it had a lot to do with our Medicare rate, the 75% CMS rate that we are at, how we got there, I will say, because I'm such a fan of Susan and she's knows so much about this. 00:30:55.119 --> 00:30:59.039 Before we recorded, she was like, I just read that piece and you nailed it. 00:30:59.200 --> 00:31:00.160 So I felt really good. 00:31:00.240 --> 00:31:03.759 I felt like, oh, good, I did a good job because Susan approved of it. 00:31:04.000 --> 00:31:10.640 But the text of this house resolution basically would lift us all up to the 85% range. 00:31:10.880 --> 00:31:12.240 Oh my, that's amazing. 00:31:12.400 --> 00:31:14.079 But I just found out about that. 00:31:16.960 --> 00:31:18.640 I believe PAs get that. 00:31:18.880 --> 00:31:21.920 Dieticians you had in your article get that. 00:31:22.160 --> 00:31:40.400 There's no reason for us to be at 75%, other than that 1989 compromise that you mentioned in your article, which really triggered a lot of memories for me because I was in social work school at the time that was being hammered out, and everybody was like, woohoo, look at us, aren't we, aren't we wonderful? 00:31:40.480 --> 00:31:41.039 Blah, blah, blah. 00:31:41.119 --> 00:31:47.200 And it's like the only reason they grade to it was so that it would pass politically, which, okay, that's fine. 00:31:47.279 --> 00:31:51.839 I'm sure they intended to do better uh later on, and it just never happened. 00:31:52.000 --> 00:31:58.480 And so at this point, we're essentially doing something because we've always done it with no other re reason. 00:31:58.799 --> 00:31:59.200 Mm-hmm. 00:31:59.359 --> 00:32:00.240 Yeah, absolutely. 00:32:00.400 --> 00:32:05.200 And I wanted people to know about it because I think that this is an opportunity. 00:32:05.359 --> 00:32:08.799 It's on people's radar at the house level, at least. 00:32:09.119 --> 00:32:11.839 So make a little mental note. 00:32:11.920 --> 00:32:25.119 If you're listening to this podcast, write it down, contact your your state rep or your house representatives and find out more information so that we can unify around this because it's already a house resolution, Bill. 00:32:25.440 --> 00:32:26.000 Potential. 00:32:26.319 --> 00:32:32.319 One suggestion when you contact your rep, especially if you don't work with Medicare. 00:32:32.480 --> 00:32:47.279 And if the reason you don't work with Medicare is because you feel like the reimbursement rate is too low, then point that out that so many more people would be willing to work with Medicare if they could be sure of getting a better rate. 00:32:47.519 --> 00:32:55.839 And that would open up access, keyword, key, key term, access to more people with Medicare. 00:32:56.079 --> 00:33:01.119 And this is really important because you know, I do a lot of education about Medicare. 00:33:01.440 --> 00:33:07.920 I help a lot of people get enrolled, I help a lot of people try to decide is it better to enroll, is it better to opt out? 00:33:08.319 --> 00:33:20.720 And let's face it, we're all getting older, and I think I read that by 2030 it's gonna be like 20% of the population is Medicare eligible. 00:33:20.880 --> 00:33:25.359 And so that's gonna be a big issue for legislators. 00:33:26.079 --> 00:33:28.720 It's interesting that you're bringing that up, Susan. 00:33:28.960 --> 00:33:32.319 Yes, I found out about another thing happening. 00:33:32.480 --> 00:33:43.440 Yes, I don't know where it is, but it's in the Senate, uh, number 683, which is called More Behavioral Health Providers Act of 2025. 00:33:43.839 --> 00:33:55.759 And this bill provides for additional Medicare payments to healthcare practitioners who provide services in mental health professional shortage areas for individuals with mental health or substance use disorders. 00:33:56.079 --> 00:33:57.359 Did it apply? 00:33:57.759 --> 00:33:58.880 It's just hanging out. 00:33:59.039 --> 00:34:09.199 This bill applies to physicians, physician assistants, nurse practitioners, clinical nurse specialists, clinical social workers, clinical psychologists, marriage and family therapists, and mental health counselors. 00:34:09.519 --> 00:34:12.960 It's been introduced, but that's all that I've learned about. 00:34:13.119 --> 00:34:14.880 Well, that's that's interesting. 00:34:14.960 --> 00:34:17.920 I would love information about that to write on that as well. 00:34:18.159 --> 00:34:28.559 Right now, the only category of clinician that can get extra payment for practicing in a hipsa, a health care health provider shortage area, is a psychiatrist. 00:34:29.039 --> 00:34:32.880 No other practitioner in behavioral health can get that. 00:34:33.199 --> 00:34:35.519 So what they're trying to do is change the language. 00:34:36.400 --> 00:34:44.000 Like 75% of this country is a mental health hipsa, and you can look it up to see if you are in one. 00:34:44.239 --> 00:34:46.880 Believe it or not, I mean, you know where I am, Civy. 00:34:46.960 --> 00:34:49.760 Uh Olympia, I'm in a hipsa. 00:34:50.239 --> 00:34:55.039 I'm I'm a 16-17 score, and it's scored on a 25. 00:34:55.280 --> 00:35:01.599 And I think anything over like, I

can't remember, is it 12 or 15 is considered a hipsa. 00:35:01.840 --> 00:35:05.679 And they specifically break it out to like primary care, dental, and mental health. 00:35:05.840 --> 00:35:06.800 Those are the only categories. 00:35:07.039 --> 00:35:10.320 Are they only counting psychiatrists or psychiatric nurse practitioners? 00:35:10.480 --> 00:35:20.159 I would have to go back and and read the site, but yeah, it's possible that if they only reimburse psychiatrists, then that's all they count. 00:35:20.239 --> 00:35:29.440 And of course, psychiatrists, I mean, I think the statistic is like, you know, four in five psychiatrists don't take Medicare, don't take insurance. 00:35:29.679 --> 00:35:32.239 So yeah, that would definitely make sense. 00:35:32.480 --> 00:35:42.079 Yeah, and I will try to remember to put links to the texts of these things in that are in motion in the show notes so that people can. 00:35:42.239 --> 00:35:44.000 There's not a whole lot, they're very short. 00:35:44.079 --> 00:35:48.960 Like the text is basically like strike out this paragraph and put in this paragraph. 00:35:49.119 --> 00:35:51.519 Like it's very minimal at this point. 00:35:51.760 --> 00:35:58.400 But I think that we need to know, like, I've been involved in this advocacy work for a while, and it was kind of accidental. 00:35:58.559 --> 00:36:03.199 I don't even remember how I found about about it, where I was like, wait a minute, where did this come from? 00:36:03.360 --> 00:36:04.800 I didn't even know about this. 00:36:05.039 --> 00:36:17.440 So I think it's important to see what is already being pushed forward so that we can rally behind it instead of everybody kind of doing their own thing and not like knowing what everybody else is doing so that we can. 00:36:17.760 --> 00:36:20.559 Um there is another resource that's really valuable. 00:36:20.639 --> 00:36:22.880 Um, are you familiar with the group Inseparable? 00:36:23.119 --> 00:36:23.360 Yes. 00:36:23.599 --> 00:36:23.679 Okay. 00:36:24.639 --> 00:36:57.280 Tell people about it because they They published a workforce report, I think in April, maybe in March, and they went state by state, all 50 states, and I think maybe even DC, and they talked about the mental health landscape in each state and where they kind of broke it apart into four or five different areas that they think are are most urgently needed for intervention to improve the situation, and they sort of ranked all states by kind of their progress towards that and any bills that are pending on the state level. 00:36:57.519 --> 00:37:00.000 And um, it's it's really very enlightening. 00:37:00.239 --> 00:37:00.559 Okay. 00:37:01.119 --> 00:37:02.320 So inseparable. 00:37:02.719 --> 00:37:03.440 Inseparable. 00:37:03.599 --> 00:37:08.000 It's it's the 2026, excuse me, inseparable workforce report. 00:37:08.239 --> 00:37:09.440 That's great information. 00:37:09.679 --> 00:37:12.159 You had me write down United, and I just want to look.

00:37:12.719 --> 00:37:13.440 I'm trying to read it. 00:37:13.599 --> 00:37:16.480 Okay, so with supervisory billing and united healthcare. 00:37:16.639 --> 00:37:16.880 Okay. 00:37:17.119 --> 00:37:25.599 Currently there are only four states where United has to provide, has to allow supervisory billing. 00:37:25.760 --> 00:37:27.840 And that's because of state statute. 00:37:28.000 --> 00:37:29.039 There's only four. 00:37:29.280 --> 00:37:38.480 It is California, Iowa, Massachusetts, and I'm writing these down because I've been I was talking with the Washington Mental Health Commission. 00:37:38.719 --> 00:37:39.360 It's not Washington. 00:37:40.000 --> 00:37:49.280 Well, no, I brought it up at their pol policy and professional advocacy committee as a point that I think we need to be trying to get on a state level. 00:37:49.440 --> 00:37:50.719 And they're totally game. 00:37:50.800 --> 00:37:54.719 So I'm frantically writing down the state names so that we can look at model levels. 00:37:54.880 --> 00:37:55.599 I I can get you that. 00:37:55.760 --> 00:37:58.000 I can get you the other um state. 00:37:58.320 --> 00:38:10.400 Anyway, United's policy is that in those states, any in-network provider, in network only, can provide reimbursable supervisory billing. 00:38:10.559 --> 00:38:19.119 Outside of those four states, you cannot, it is not covered unless you get a special addition to your contract. 00:38:19.280 --> 00:38:25.360 So you can only be a group, and then the problem is you have to be a big enough group. 00:38:25.519 --> 00:38:28.079 They never really define big enough. 00:38:28.400 --> 00:38:44.239 And then my understanding is they do some sort of like pre-audit and they look at how you document, and you have to come up, you have to meet a certain standard, but I haven't been able to ever find that information because it's all behind you know login walls and things like that. 00:38:44.559 --> 00:38:50.800 And I would have to, I guess, work with a group that had that kind of contract and they could maybe tell me. 00:38:50.880 --> 00:38:56.480 So if anybody's listening and feels like they want to, you know, share that information, you can, you know, reach out to me. 00:38:56.639 --> 00:39:05.119 But the problem is a lot of groups have approached United and they're told they're not big enough, or we're not doing that anymore, or we've got everything we need. 00:39:05.360 --> 00:39:06.880 Because guess what? 00:39:07.360 --> 00:39:15.920 One of the recent developments that's been overlooked in all the drama is that Headway just announced that they're sponsoring supervisory billing. 00:39:16.320 --> 00:39:17.760 You can't see me rolling my eyes. 00:39:17.920 --> 00:39:19.920 I can see you rolling your eyes. 00:39:21.599 --> 00:39:25.599 Except in Michigan, I guess, unless they become a facility too. 00:39:26.079 --> 00:39:29.679 Well, they're working on it because of Medicare Access, which I know. 00:39:29.760 --> 00:39:33.039 That's why

I kind of said that to like spur that part of the conversation. 00:39:33.840 --> 00:39:37.840 Can you help people understand sort of that access thing if you as much as you know about it? 00:39:38.239 --> 00:39:40.880 Um it's actually a blog on my website. 00:39:40.960 --> 00:39:43.360 I think I came out with it the last week in April. 00:39:43.440 --> 00:39:46.480 It's called Finding the Value in Value-Based Care. 00:39:46.639 --> 00:39:59.199 It goes into what is value-based care, what's how Medicare has derived this, what are their criteria for this program called Access, which is essentially what they're trying to do. 00:39:59.360 --> 00:40:04.880 They're trying to pay for outcomes, not a 908.34, a 908.37. 00:40:05.039 --> 00:40:08.800 They're trying not fee for they're trying to go away from fee for service. 00:40:09.119 --> 00:40:09.599 Correct. 00:40:09.840 --> 00:40:10.159 Okay. 00:40:10.719 --> 00:40:17.920 So you have to have enough scale to be able to sign up as a provider for access. 00:40:18.800 --> 00:40:47.760 And honestly, the I looked at the list when I did the blog, and as of like April 23rd, and um, they the deadline didn't close till May 15th, so there may have been other people who joined after I did my blog, but the platforms that have signed up that I knew about Headway, Sondermind, something called Innerwell, which specializes in at-home ketamine treatment, which I'm just like, how can that even be safe? 00:40:47.920 --> 00:41:05.760 And I have a note venture capital, but no known insurer investment, Isaac Health, which specializes with dementia and caregivers, insurer investors, care source and intermountain healthcare, Sondermind, we all know about Sondermind, and then something called Total Life. 00:41:06.239 --> 00:41:13.599 They have an insurer investor, G-E-H-A, and other investors of note, Google and Charm EHR. 00:41:13.840 --> 00:41:22.239 So those are the platforms, and then there are a whole slew, just a slew of AI and tech. 00:41:22.639 --> 00:41:27.920 Headspace is one, um, slingshot AI, which is just basically a chat bot. 00:41:28.079 --> 00:42:00.800 And then they have this thing which kills me called, I was telling you about it before we started recording, called Meo Mind, where all they do is they pedal session recordings or transcripts and they sell them to third parties with the goal of somehow that if I'm Civvy's client and some third party listens to our session, that they can get some sort of like I'm forgetting the word, like some sort of at one hand remove, they can get some sort of um like through osmosis. 00:42:00.880 --> 00:42:01.280 They'll get it. 00:42:01.679 --> 00:42:07.360 Through osmosis, they can get some sort of benefit, but of course, there's no reimbursement to Civi for that. 00:42:07.679 --> 00:42:12.639 And I it's supposedly de-identified, and supposedly they ask for permission. 00:42:12.719 --> 00:42:15.440 And I'm just, to me, it's just horrifying. 00:42:15.599 --> 00:42:17.199 It's

just absolutely horrifying. 00:42:17.360 --> 00:42:23.280 And their website claims that clients give consent for their therapy sessions to be recorded and published. 00:42:23.360 --> 00:42:24.000 I wonder. 00:42:24.159 --> 00:42:26.239 I'm not a lawyer, I'm not an ethicist. 00:42:26.480 --> 00:42:27.440 Informed consent. 00:42:27.519 --> 00:42:30.719 I I don't know any more than anybody else, but I just really wonder. 00:42:31.119 --> 00:42:38.320 Well, I'll be honest, this informed consent, I think on both sides for a lot of this shit, is under duress. 00:42:38.639 --> 00:42:44.880 Because if it's like, well, in order to see your therapist, you have to sign this. 00:42:45.360 --> 00:42:51.199 How is that not signing something under duress if you're saying I can't receive services unless I agree? 00:42:51.599 --> 00:42:53.519 Even more subtle and more gentle than that. 00:42:53.599 --> 00:43:05.039 I I put this on LinkedIn, so it's not exactly private, but I saw a nurse practitioner during COVID for depression, and I had one of those policies that waived patient responsibility for telehealth. 00:43:05.119 --> 00:43:08.400 And of course, I have you know really super high deductible being self-employed. 00:43:08.559 --> 00:43:10.480 So, you know, I was taking advantage of it. 00:43:10.639 --> 00:43:16.239 And I mean, I'm well educated, I've got an MSW, I've been billing since 1998. 00:43:16.400 --> 00:43:18.960 I certainly know my way around this system. 00:43:19.519 --> 00:43:29.199 And when the nurse practitioner came on telehealth, she said, you know, I use this AI recording model, and it helps me help you. 00:43:29.760 --> 00:43:35.039 And I think that was probably the first time I heard about AI recording models, and that was now six years ago. 00:43:35.360 --> 00:43:43.039 And, you know, I was going through depression, I had a lot of anxiety, and just the phrase, it helps me help you. 00:43:43.199 --> 00:43:54.079 Well, I don't want to like get in my way of my therapist helping me, so of course I'm going to say yes, but did I get any kind of assurance of anything? 00:43:54.400 --> 00:43:54.719 No. 00:43:55.440 --> 00:43:59.760 And I said yes because I felt like to say no would be to. 00:44:00.639 --> 00:44:02.559 Number one, disrupt my treatment. 00:44:02.639 --> 00:44:03.679 Number two, displease her. 00:44:03.760 --> 00:44:06.000 And let's face it, there is a power dynamic. 00:44:06.400 --> 00:44:13.440 And if somebody with a master's in social work feels that way, how do you think you know 98% of the people out there are gonna react? 00:44:13.519 --> 00:44:16.960 They're gonna be like, okay, I understand, even if they feel uncomfortable about it. 00:44:17.119 --> 00:44:24.800 And in fact, NPR had a big article recently about that where they interviewed somebody who felt that way about her therapist. 00:44:24.960 --> 00:44:28.639 She gave consent and she was really uncomfortable with it. 00:44:28.960 --> 00:44:40.480 And um, that's I I that's when I, you know, disclosed all this personally because I posted that uh link to the NPR article and I said, look, this is my story, and I totally believe this. 00:44:40.559 --> 00:44:48.559 And people aren't recognizing in the informed consent that there is a power differential between the clinician and the client. 00:44:48.880 --> 00:44:55.760 And you know, then you bring up this whole duress thing about, well, you know, if you're working for a platform, you may not have a choice. 00:44:56.000 --> 00:44:59.280 You you either use AI or you don't get service or you don't get paid. 00:44:59.599 --> 00:45:02.639 Yeah, and now Headway wants biometric data. 00:45:03.440 --> 00:45:05.360 Yeah, I'm sure you heard about that too. 00:45:05.679 --> 00:45:06.239 Oh, yeah. 00:45:06.400 --> 00:45:07.360 I heard about that. 00:45:07.599 --> 00:45:08.239 Oh yeah. 00:45:08.960 --> 00:45:12.800 Yeah, I mean, that's how is that I'm not under duress where it's like, well, what am I gonna do? 00:45:13.199 --> 00:45:14.719 If I'm already here, what am I gonna do? 00:45:14.800 --> 00:45:16.480 Now they're asking for biometric data. 00:45:16.800 --> 00:45:19.280 So either I can give it to them or stop getting care here. 00:45:19.920 --> 00:45:25.760 I feel like what they're weaponizing is something that came out many, many years ago called the red flag rules. 00:45:26.639 --> 00:45:35.440 Um the red flag rules many years ago were a kind of it was the intention was to prevent identity theft in healthcare. 00:45:36.239 --> 00:45:47.199 So, like if you've ever gone to a doctor and they take your picture so that they can verify that you are the same person as on your identification, that's what that's for. 00:45:47.920 --> 00:45:56.239 I feel like Headway is using that and sort of manipulating it to God knows what end. 00:45:56.320 --> 00:46:04.639 I mean, don't they have some sort of lawsuit pending against data breaches with Google or Google something? 00:46:04.880 --> 00:46:05.519 I don't even know. 00:46:05.599 --> 00:46:31.519 I'm not a cybersecurity expert, but it just seems to me like their their justification is you know preventing identity theft, and it's got this precedent in these very old set of rules, and yet it's I mean, these these rules go back 20 years long before AI and they were never meant for an AI telehealth kind of system. 00:46:32.480 --> 00:46:41.119 Um, they were meant for an in-person system, and they're taking it and just kind of running with it because there's no there's nobody to stop them. 00:46:41.679 --> 00:46:45.519 Yeah, they're like, oh, it's an opportunity because hey, I can we can capture this. 00:46:45.679 --> 00:46:51.760 How they're gonna use that is probably in the fine print that nobody if it's even there. 00:46:52.000 --> 00:46:58.960 And speaking of headway, I want to go back to something that you said about because they are they were on the access model list for Medicare. 00:46:59.280 --> 00:47:02.400 And you also said

that they're now doing supervisory filling. 00:47:03.039 --> 00:47:07.519 And the whole part with the access was the value-based care. 00:47:07.599 --> 00:47:15.199 It's also my understanding, though, that with at least this stuff through from Blue Cross Blue Shield, I'm kind of going full circle here. 00:47:15.360 --> 00:47:21.599 The Blue Cross Blue Shield stuff in Michigan, I think it was under that that I was seeing that, or maybe it wasn't through that. 00:47:21.679 --> 00:47:31.360 I'm confusing myself, but that under the access model, supervisory billing does not get paid for the value-based care piece. 00:47:31.760 --> 00:47:34.480 Well, it can't because this is Medicare. 00:47:34.639 --> 00:47:36.639 Medicare doesn't cover supervisory billing. 00:47:36.960 --> 00:47:38.559 So, how is Hedwig in a circle? 00:47:38.719 --> 00:47:42.960 I mean, so they're just they just won't uh access is only for people with Medicare. 00:47:43.119 --> 00:47:47.280 So for supervisory billing, if you have Medicare, you don't qualify for that. 00:47:47.599 --> 00:47:47.920 Okay. 00:47:48.400 --> 00:47:49.280 All right, folks. 00:47:49.440 --> 00:47:54.000 This has been a second edit because uh more technical difficulties. 00:47:54.079 --> 00:48:00.960 And Susan and I were just joking that maybe like AI is trying to shut this interview down because it doesn't like where it's going. 00:48:01.119 --> 00:48:08.639 And and we're being spied on right now by some investor-backed, like venture capitalist-backed something here. 00:48:08.960 --> 00:48:11.519 So if we're gonna get this out if it kills us. 00:48:11.679 --> 00:48:14.719 Yeah, if you don't hear from us, you'll know what happened. 00:48:14.880 --> 00:48:16.559 I'm gonna preserve the recording. 00:48:16.719 --> 00:48:20.320 Um, this is this is what you know, the voice of the resistance. 00:48:20.639 --> 00:48:21.360 Yeah, I know. 00:48:21.679 --> 00:48:24.239 I've never had this many tech issues in an interview. 00:48:24.400 --> 00:48:24.559 Never. 00:48:24.880 --> 00:48:25.440 Me neither. 00:48:25.679 --> 00:48:26.320 It's nuts. 00:48:26.400 --> 00:48:30.639 It does feel like is are we being watched right now that they don't want Susan to speak? 00:48:30.800 --> 00:48:32.079 That's what I think is happening. 00:48:32.239 --> 00:48:41.519 But, you know, I think what I was saying, because I've lost track of myself a million times now, is that we were talking about Headway and supervisory building and how Hedway wants to be a facility. 00:48:41.599 --> 00:48:53.760 And I said, but Hedway like tries to walk the bridge because they are trying to be billing, saying that they're a billing service to get people on, but then they're really so much more and so much more into control. 00:48:54.159 --> 00:49:06.960 And you were talking about kind of how at the beginning they appeared like they were a solution, and so it was easy for people to kind of under kind of, oh, this will be the answer to all my administrative problems. 00:49:07.280 --> 00:49:16.159 Yeah, and I think that again, I know what I was talking about that people weren't looking at that long game of what is what are they, what is their plan for this? 00:49:16.320 --> 00:49:24.880 Because if they're getting gazillions of dollars in venture capital, all these companies are getting all these like series A funding. 00:49:25.199 --> 00:49:29.199 I don't even know what all that series crap is, but I don't understand it. 00:49:29.280 --> 00:49:39.760 It's just series A is like your first round of funding, and then you have to show like profitability or potential enough, and then series B is like they pump more money into you. 00:49:40.079 --> 00:49:41.119 And I think that's what it means. 00:49:41.199 --> 00:49:41.760 I don't really know. 00:49:42.480 --> 00:49:53.280 But yeah, that there is an endgame here that people don't want to talk about, and that I understand in the short term, people are like, I have to pay my mortgage, I have kids, I have like I have like, what do you want me to do? 00:49:53.360 --> 00:50:18.000 And I totally get that, but we're we're starting to see what's happening, and it it's I think it's they now feel so safe, it feels kind of blatant at this point because they have gotten tens of thousands, tens of thousands of providers on I'd say it's probably more like hundreds of thousands at this point. 00:50:18.320 --> 00:50:26.480 Yeah, and so they're in a position where they they carry the market, they deeply influence the pipeline. 00:50:26.800 --> 00:50:29.679 We can't challenge them with a marketing budget. 00:50:29.920 --> 00:50:33.599 We can't, I mean, how do you step up against headway for a marketing budget? 00:50:33.840 --> 00:50:37.760 Well, and they know that we're legally constrained and can't collectively bargain. 00:50:37.920 --> 00:50:38.320 Mm-hmm. 00:50:38.559 --> 00:50:38.960 Mm-hmm. 00:50:39.840 --> 00:50:44.079 So I just want folks, you know, a big part of this podcast is education. 00:50:44.320 --> 00:50:49.360 And if you know folks that are still holding tight to these platforms, maybe have them listen to this episode. 00:50:49.519 --> 00:50:50.880 All the episodes would be great. 00:50:51.199 --> 00:50:54.480 I'm not here to shame people or make you depressed. 00:50:54.800 --> 00:50:57.440 Because again, I know this stuff is depressing. 00:50:57.760 --> 00:51:05.599 But we have to face what's happening because they're already 20 steps ahead of us. 00:51:05.920 --> 00:51:09.039 And there are many of us that are coming together. 00:51:09.360 --> 00:51:10.480 Get involved. 00:51:10.800 --> 00:51:13.679 Go to buildbetterhealth.org. 00:51:14.000 --> 00:51:17.840 Sign up to get engaged in the mental health insurance reform task force. 00:51:18.079 --> 00:51:31.760 If you're like, I don't know how to do any of that, just reach out and say, hey, who's the state lead from my state so I can connect with them so that like I can at least know what's going on and be

involved to whatever extent that you feel like you can. 00:51:32.000 --> 00:51:38.800 There are hundreds of people at this point across the country that aren't just joining a membership group. 00:51:38.880 --> 00:51:43.360 They're actively engaged and we're strategizing. 00:51:43.519 --> 00:51:45.199 And I want people to hear that. 00:51:45.440 --> 00:51:59.440 We are strategizing right now on federal policy, linking up states with each other who have passed, like what happened in Illinois with that 141% rate, that law that got passed. 00:51:59.679 --> 00:52:08.079 Um, how do we connect that information to other states, which is what the state leads are kind of doing, is trying to disseminate information to their states. 00:52:08.400 --> 00:52:11.280 So there is a coalition building. 00:52:11.519 --> 00:52:25.280 I don't want people just to sit in the despair of what feeling like they're watching their profession collapse and have a corporate takeover because there are people that are working together across discipline, right? 00:52:25.519 --> 00:52:28.400 We would love for our professional associations to be doing this. 00:52:28.559 --> 00:52:30.079 The reality is they're not. 00:52:30.239 --> 00:52:31.599 They're probably not going to. 00:52:31.760 --> 00:52:32.480 This is where we are. 00:52:32.639 --> 00:52:34.480 Well, there's we can set an example. 00:52:34.639 --> 00:52:35.679 We can set an example. 00:52:35.920 --> 00:52:37.199 Yeah, there's a little bit of hope. 00:52:37.440 --> 00:52:48.880 Two APAs, American Psychology, Psychological and American Psychiatric, got together and wrote an R uh letter to Aetna about Alma, Aetna, the, you know, reimbursement rate. 00:52:49.039 --> 00:53:00.719 I mean, yeah, it's probably, I'm not gonna say it's token, but I don't expect it's gonna have any impact because professional associations have been, you know, by and large, relatively ineffective. 00:53:00.960 --> 00:53:11.199 But what mental health insurance reform task force is doing is is much more grassroots, and they have um legal experts that they're consulting with. 00:53:11.280 --> 00:53:13.519 You know, they have technical experts that they're consulting with. 00:53:13.679 --> 00:53:14.880 That's why I signed on. 00:53:15.039 --> 00:53:39.039 I'm not here to promote my business because I've got plenty of business, but the credentialing, I've got credentialing webinars on my website, but I've also got behind a membership platform one whole module of several lessons on credentialing that I think I'm gonna turn into a product that's a single, single, you know, you don't pay a membership, it's just a one-time thing, and it's literally everything you need to know about credentialing and contracting. 00:53:39.199 --> 00:53:40.559 It's it's ready to go. 00:53:40.639 --> 00:53:48.880 I just need to actually like get it, export it out of where it lives now, put it into a format like a PowerPoint and put it on my website. 00:53:48.960 --> 00:53:55.920

I mean, and and if not me, I mean, there's a million other people that can help you with credentialing and contracting. 00:53:56.000 --> 00:54:06.559 And at this point, as rates on the platforms are going to start to fall, you'll find that the rates on the platforms aren't going to be any better than the rates off the platforms. 00:54:06.800 --> 00:54:07.920 Yeah, and I love that. 00:54:08.000 --> 00:54:13.679 And I also because we are pretty much out of time for this episode, I do want you to speak. 00:54:13.840 --> 00:54:15.840 You you you mentioned it at the beginning. 00:54:16.000 --> 00:54:21.679 A big part of me having you back on the show so quickly was because I do want to amplify what you're doing. 00:54:21.760 --> 00:54:24.639 And you have a webinar scheduled for July 17th. 00:54:25.039 --> 00:54:30.079 Can you give people a little and there'll be a link in the show notes on how to register for that and all of that? 00:54:30.159 --> 00:54:31.440 But yes, well, a sense of. 00:54:32.079 --> 00:54:40.159 So if if people aren't able to attend, you can register and get the recording and the handouts after the fact, or you can buy it in my web store. 00:54:40.320 --> 00:54:44.639 It's always the same price, whether live or you buy it on demand. 00:54:44.880 --> 00:54:48.800 It's called Stop Stumbling Over Supervisory Billing. 00:54:48.960 --> 00:54:55.280 It's gonna start with the whole incident two versus supervisory thing that Cidy and I were talking about. 00:54:55.679 --> 00:55:02.239 And then it's going to go into how do you document supervisory billing? 00:55:02.480 --> 00:55:12.000 I've worked with documentation experts to come up with what I recommend as a documentation standard to protect yourself against audits. 00:55:12.320 --> 00:55:15.599 How do you keep yourself audit safe? 00:55:15.840 --> 00:55:18.239 How do you recognize the audit triggers? 00:55:18.480 --> 00:55:24.079 How do you look at or understand when you can do this and when you can't? 00:55:24.400 --> 00:55:27.280 Because even, I'll give you an example. 00:55:27.440 --> 00:55:34.400 Even let's say Aetna, where you can do supervisory billing and it's pretty much across the board and they're hands off. 00:55:34.559 --> 00:55:42.800 There are certain policies you can't, because there are certain policies, well, not for one, Aetna Medicare Advantage, you can't do it there. 00:55:43.039 --> 00:55:54.239 Another one would be what's called self-funded plans, because self-funded plans often are handled by an administrator, like let's say Maritain, which is owned by Aetna. 00:55:54.800 --> 00:56:00.559 But if that employer who determines what's covered, that's what self-funding means. 00:56:00.639 --> 00:56:02.480 The employer gets to design the plan. 00:56:02.639 --> 00:56:05.760 The employer might say, Well, we don't want to pay for supervisory billing. 00:56:05.920 --> 00:56:06.480 Now what? 00:56:06.559 --> 00:56:09.039 Your supervisory billing, and then you find out after

the fact. 00:56:09.119 --> 00:56:22.400 So it's gonna be it's gonna get into a lot of the ethical, sticky issues and how as a practice owner you can do the best you can to keep yourself safe and make decisions, what to think about. 00:56:22.719 --> 00:56:23.280 Fantastic. 00:56:23.440 --> 00:56:26.400 I'm like, ooh, I need to take that because I'm probably doing stuff wrong. 00:56:26.559 --> 00:56:29.199 I hope I'm not, but I probably am. 00:56:29.440 --> 00:56:34.239 So I'm definitely, I'll probably do the on-demand though, because my schedule is I'm it's so hard for it. 00:56:34.400 --> 00:56:37.840 Well, and to be honest, um, I'm expecting this to sell out. 00:56:38.079 --> 00:56:47.199 So if people can't attend live, I'd ask that you maybe do it on demand because I have my Zoom license only allows a certain number of people at night. 00:56:47.360 --> 00:56:51.039 I haven't looked at registrations lately, but it we're still more than a month out. 00:56:51.119 --> 00:56:53.360 Um, and it's obviously gonna get some publicity. 00:56:53.440 --> 00:56:55.519 So Sivy, you're gonna fill my room, right? 00:56:55.920 --> 00:56:56.639 That's the goal. 00:56:56.800 --> 00:56:57.519 That's the goal. 00:56:57.760 --> 00:56:58.320 Yeah, yeah. 00:56:58.480 --> 00:57:04.079 And yeah, it's it's it's meant to kind of shed some light on this. 00:57:04.239 --> 00:57:20.719 I mean, this is a poorly documented, and yeah, whether we want to sit here and say it's by intention or just because insurance companies are primarily focused on medical and we're the afterthought, you know, the redheaded stepchild, whatever you want to call it. 00:57:20.880 --> 00:57:34.559 Whether, I mean, you can you can think about conspiracy theories, you can get angry, you can not get angry, but the reality is we're still left with no documentation, no expectations, no understanding, no guidance. 00:57:34.719 --> 00:57:43.360 And let's face it, calling customer service and asking customer service is not going to get you what you need because they don't know. 00:57:43.760 --> 00:57:44.960 Yeah, they have no clue. 00:57:45.119 --> 00:57:46.559 I mean, we have no clue. 00:57:46.800 --> 00:57:51.840 Anyone that's called a provider rep at any insurance company knows that. 00:57:52.000 --> 00:57:54.079 That is absolutely 100%. 00:57:54.719 --> 00:57:55.199 Right. 00:57:55.519 --> 00:58:04.480 So this is literally like meant to be a starting point because there's lots of things I don't know because the insurance company hasn't figured them out yet. 00:58:04.639 --> 00:58:14.719 I mean, I'll probably end up doing this webinar more times as things develop, as policies develop, as states do different things, as insurance companies do different things. 00:58:15.039 --> 00:58:21.039 But what it will be on July 17th is what I know as of July 17th. 00:58:21.360 --> 00:58:23.599 Uh, and it's ever evolving. 00:58:23.679 --> 00:58:43.599 So that's why it's important to like stay connected to, you know, my

pod, uh your Civil's podcast, my newsletter, you know, mental what what mental health insurance reform task force comes out with, other, you know, newsletters and trusted, I would say independent publications, because there's plenty of publications out there. 00:58:43.760 --> 00:58:45.920 Some of them are just in the pocket of venture capital. 00:58:46.079 --> 00:58:47.760 Sad to say, but it's really true. 00:58:48.000 --> 00:58:48.639 Yeah. 00:58:48.960 --> 00:58:53.840 So please check out Susan Frager, the psych billing coach. 00:58:56.079 --> 00:58:59.519 She's yeah, she's got a great newsletter, a great blog. 00:58:59.760 --> 00:59:01.280 Definitely check out her website. 00:59:01.440 --> 00:59:13.599 All the ways to connect with her will be in the show notes, including how to register for the July 17th, which I think we're saying if you can do it on demand, please do it on demand because it's probably gonna be a standing room only. 00:59:13.920 --> 00:59:16.800 It's virtual, so it's not really standing room only, but you know what I mean. 00:59:16.960 --> 00:59:25.519 There'll be a lot of people there signed up because uh Susan is a very well-respected person in the world of mental health insurance billing. 00:59:25.599 --> 00:59:29.679 She's been doing this for a long time, which is why I'm so grateful that she has. 00:59:29.840 --> 00:59:44.320 I mean, we've now sat and talked for probably like 10 hours total, because I don't I don't remember if I said this in the last episode, but that was the second time we had to record the last episode because the first time there were tech there were technical difficulties, Susan. 00:59:44.480 --> 00:59:47.679 In the first time that we tried to do That's right, there were. 00:59:48.239 --> 00:59:48.960 It's like following us. 00:59:49.039 --> 00:59:50.960 Like there's this is really scary. 00:59:51.280 --> 00:59:53.119 The powers that be do not want more. 00:59:53.599 --> 01:00:01.440 Well, and you know, when I started to talk at right at the task force meeting on Wednesday, that's when my Zoom crashed. 01:00:01.679 --> 01:00:06.159 Yeah, there I think the powers that be are spying on you because they know that you I think they are. 01:00:06.400 --> 01:00:08.239 I think they are all right, everybody. 01:00:08.400 --> 01:00:10.719 Well, we need to hold her like she's a national treasure. 01:00:10.800 --> 01:00:12.559 Everybody keep their eye on Susan Frager. 01:00:12.800 --> 01:00:14.159 We can't let anything happen to her. 01:00:14.400 --> 01:00:16.719 If I disappear from the airwaves. 01:00:17.760 --> 01:00:19.679 It's always such a joy, Susan. 01:00:19.760 --> 01:00:22.239 Like you and I like clicked immediately. 01:00:22.320 --> 01:00:27.199 I'm sure I'll hand you on again, and I'll see you at the task force meetings and events and all of that. 01:00:27.360 --> 01:00:31.360 And I'm so grateful for all the time that you've given and the support you've given to the podcast. 01:00:31.599 --> 01:00:32.960 Super, super grateful. 01:00:33.199 --> 01:00:39.840 You're really at the core of what I want to do around educating people because there is, I think it's an intentional complexity. 01:00:39.920 --> 01:00:40.960 I think it's by design. 01:00:41.039 --> 01:00:42.000 Um, absolutely. 01:00:42.320 --> 01:00:45.119 But it is so vital that people understand this stuff. 01:00:45.280 --> 01:00:48.639 And listen, I've been doing this for 20 years and I'm still learning stuff. 01:00:48.719 --> 01:00:50.639 And things, like you said, things are changing. 01:00:50.800 --> 01:00:53.280 And it's hard to keep up with all this shit. 01:00:53.519 --> 01:00:57.920 Like my menopausal brain cannot hold all of this information. 01:00:58.079 --> 01:01:00.480 So if people are feeling overwhelmed, guess what? 01:01:00.639 --> 01:01:01.519 We all feel that way. 01:01:01.679 --> 01:01:06.639 It's not like I have some magical powers that I can hold all of this, or even Susan can hold all of it. 01:01:06.719 --> 01:01:09.760 She has to go look stuff up too, because it is complicated. 01:01:09.920 --> 01:01:14.480 So if you're feeling like it's too much, it's it is it is too much. 01:01:14.559 --> 01:01:15.199 And that's fine. 01:01:15.519 --> 01:01:19.039 Well, and I've got a what I'm calling my external brain. 01:01:19.119 --> 01:01:21.440 I've got a whole, it's in development right now. 01:01:21.599 --> 01:01:22.800 People can subscribe. 01:01:22.960 --> 01:01:29.760 I'm I'm not necessarily developing it just for the purpose of having a subscription. 01:01:29.840 --> 01:01:36.639 Although if people want to subscribe, they certainly can because a lot of building services are finding that it's very useful in training their employees. 01:01:36.800 --> 01:01:38.960 But so anybody who wants to subscribe can. 01:01:39.039 --> 01:01:40.320 It's called the Rescue Builder. 01:01:40.400 --> 01:01:46.320 It's not even done because I don't have venture capital money and I'm not using freaking AI to build it. 01:01:46.480 --> 01:01:48.800 It's a repository of all of this stuff. 01:01:48.880 --> 01:01:54.159 And I gotta tell you, it's a full-time job keeping up with this stuff. 01:01:54.480 --> 01:02:01.199 And I have another full-time job, which is I'm, you know, consulting and doing projects for people and expedited appeals and all that. 01:02:01.280 --> 01:02:04.559 So that's why it's been over two years in development now. 01:02:04.880 --> 01:02:09.280 And I'm just like every day I wake up and I was like, will I ever get freaking done with this? 01:02:09.440 --> 01:02:14.159 And probably not, because as soon as I get done done, I mean I'm gonna constantly have to update. 01:02:14.320 --> 01:02:22.159 Like right now, before I release the uh the credentialing piece, I'm going to have to update C AQ H into data spring, right? 01:02:22.320 --> 01:02:26.800 So there's always the update, but it's it's a it's it's just a resource. 01:02:26.960 --> 01:02:36.320 There's lots of

resources out there, and the important point is to know that they're out there, use what works for you, and you don't have to feel alone. 01:02:36.559 --> 01:02:37.760 Thank you, Susan. 01:02:38.159 --> 01:02:39.119 Thank you for having me. 01:02:39.360 --> 01:02:39.760 I love it. 01:02:39.840 --> 01:02:40.079 Yes. 01:02:40.960 --> 01:02:42.079 This is this is great. 01:02:42.159 --> 01:02:47.519 Um, and we will persevere and tell those tech demons where they can stick it. 01:02:47.760 --> 01:02:48.480 Exactly. 01:02:48.719 --> 01:02:49.119 Exactly. 01:02:49.280 --> 01:02:50.159 I'm right there with you. 01:02:50.320 --> 01:02:51.199 I'm right there with you. 01:02:51.360 --> 01:02:54.719 So thank you so much for being here yet again at such short notice. 01:02:54.800 --> 01:02:56.320 We just booked this like two days ago. 01:02:56.480 --> 01:02:58.880 I was like, we need to do a part two right now. 01:03:00.400 --> 01:03:01.840 I'm glad I was able to fit it in. 01:03:02.000 --> 01:03:02.880 Me too. 01:03:03.039 --> 01:03:12.559 Uh so if if you listen to this episode first, go back to the last episode and listen to that one too, because we had another really great conversation. 01:03:12.719 --> 01:03:14.960 We talked about like the transparency data. 01:03:15.119 --> 01:03:17.519 There was a lot of really great information in that. 01:03:17.840 --> 01:03:19.840 So thank you, Susan, for being here. 01:03:20.400 --> 01:03:26.800 Just a second to update this whole transparency data because of what Alia just did this week. 01:03:27.039 --> 01:03:28.880 What did Alia do this week? 01:03:29.199 --> 01:03:38.480 Alia put forth a public transparency air quotes database that ever that they say is really useful. 01:03:38.559 --> 01:03:40.639 And I went, oh, do you remember that? 01:03:41.039 --> 01:03:44.239 I shared it because it was like three insurance or four insurance companies. 01:03:44.559 --> 01:03:49.599 And it was very it wasn't even it was showing what Hedway, Alma, I don't remember which ones. 01:03:49.920 --> 01:03:52.000 Headway, Alma, Rula, all of them are getting. 01:03:52.239 --> 01:03:54.559 But it was very like it was tiny little. 01:03:55.440 --> 01:03:57.679 It was also so condense. 01:03:58.000 --> 01:04:02.400 Like they didn't, it was condensed, like they didn't separate out by discipline. 01:04:02.559 --> 01:04:08.719 They didn't separate out by very, very tightly dialed in geographical. 01:04:09.039 --> 01:04:11.599 Um just like it's essentially useful. 01:04:11.760 --> 01:04:14.239 Oh yeah, and state is essentially useless. 01:04:14.480 --> 01:04:15.199 I mean, think about it. 01:04:15.360 --> 01:04:16.639 Think about Washington State. 01:04:16.960 --> 01:04:21.599 Seattle and you know, Republic are getting different rates. 01:04:21.760 --> 01:04:22.000 Yeah. 01:04:22.159 --> 01:04:26.239 You know, and the Cigna rate, I was like, I get paid more than headway than any of them for Sigma. 01:04:26.800 --> 01:04:27.360 Right, right. 01:04:27.519 --> 01:04:36.320 So this whole price transparency thing, and it kills me because it's like they're trying to, what they're doing is they're giving you a little bit of a hook. 01:04:36.559 --> 01:04:44.239 And Alia is very, very scary because of how they're funded and what they're trying to do. 01:04:44.400 --> 01:04:47.440 They're trying to say that we won't charge you anything. 01:04:47.519 --> 01:04:49.280 We're gonna charge the insurance company. 01:04:49.440 --> 01:04:52.880 But what data do you have to sign over in order to make that happen? 01:04:52.960 --> 01:04:54.960 Because nothing in life is free. 01:04:55.119 --> 01:05:02.239 And it just, I saw that and my blood boiled because price transparency data is not easy to sort through. 01:05:02.400 --> 01:05:04.400 And go back and listen to the other podcast. 01:05:04.480 --> 01:05:08.960 I won't go on and on about it, but go back and listen to the other one because it talks a lot more about that. 01:05:09.119 --> 01:05:14.320 But that's what I mean about how everything is happening so fast in this industry. 01:05:14.480 --> 01:05:17.679 Because that just happened, what, yesterday or the day before? 01:05:17.920 --> 01:05:21.840 It was recent because I shared it on a bunch of sites and people like, isn't this a VC? 01:05:21.920 --> 01:05:25.280 I said it is, and I'm I'm not sharing it because I think people should join it. 01:05:25.440 --> 01:05:33.280 I'm just sharing it because I think people need to know that a lot of people I don't think know that the data is public and they have a right to look at it, first of all. 01:05:33.519 --> 01:05:36.559 So, and I was like, and they're not really showing very much. 01:05:36.639 --> 01:05:39.440 It was like aggregated and aggregate, aggregated. 01:05:39.519 --> 01:05:42.320 I can't yeah, it's aggregated to the point of uselessness. 01:05:42.559 --> 01:05:48.000 But I can guarantee you that the only one that I was like, well, I'm doing better than they are was Cigna. 01:05:48.239 --> 01:05:53.679 All the other ones, like Aetna, I was pissed off even with the aggregated data that at how much higher it was. 01:05:53.760 --> 01:05:55.360 So you should see my data. 01:05:56.159 --> 01:06:08.400 The reason that I shared it more than anything was for people to look at it and go, this is bullshit, because there's no reason that I should be being paid less than Headway or Rula or Alma or whatever. 01:06:08.559 --> 01:06:10.239 But go listen to the other episode. 01:06:10.400 --> 01:06:12.239 Yeah, stuff is changing constantly. 01:06:12.320 --> 01:06:25.119 And I also want people to know that I am in the works of trying to figure out how to have a second podcast focused on more regular updates about stuff happening. 01:06:25.280 --> 01:06:27.760 It will not be a full-hour interview with anybody. 01:06:27.920 --> 01:06:38.400 There'll be shorter pockets where I will be kind of reading through the day's news of this happened, that happened, you

should know about this. 01:06:38.559 --> 01:06:40.079 This is what I think this means. 01:06:40.320 --> 01:06:52.559 So be prepared that this might this podcast might be expanding to have those types of like legislative updates, policy updates, insurance updates, et cetera, as far as the mental health landscape. 01:06:52.800 --> 01:06:56.239 Because, like we've been saying, stuff is changing constantly. 01:06:56.400 --> 01:06:58.400 There's stuff popping up all the time. 01:06:58.559 --> 01:07:06.639 And I want a place that people can come where it's recorded, where people can be know that they can get the latest information on what's coming up. 01:07:06.800 --> 01:07:10.239 But, you know, I'm only one person, so I'll do the best I can at making. 01:07:10.719 --> 01:07:12.639 Oh, and you mean you're not taking venture capital money? 01:07:12.960 --> 01:07:15.119 And I'm not taking venture capital money. 01:07:15.360 --> 01:07:21.760 Believe me, this podcast, I wouldn't be recording it from my dining room table if that were the case. 01:07:22.000 --> 01:07:25.280 But anyway, folks, please listen to the other episode. 01:07:25.360 --> 01:07:30.000 If you haven't, it came out two weeks ago because this I know when this is coming out now. 01:07:30.239 --> 01:07:33.679 Again, big thank you to Susan Frager, the psych billing coach. 01:07:33.840 --> 01:07:35.440 Big thank you to my audience. 01:07:35.599 --> 01:07:41.679 I have to give you some props, people, because the this podcast is starting to blow up. 01:07:41.840 --> 01:07:44.880 I've had more downloads, more cities added. 01:07:45.119 --> 01:07:50.559 We're almost at 600 cities across the world that this podcast has touched. 01:07:50.880 --> 01:07:55.679 So we've we've had the best month we've ever had, which tells me that people are sharing with colleagues. 01:07:56.000 --> 01:07:57.280 Please continue to share. 01:07:57.760 --> 01:07:59.679 Check out, I know, I love it. 01:08:00.000 --> 01:08:02.639 Check out the Psych Building Coach website. 01:08:02.719 --> 01:08:04.239 The link will be in the show notes. 01:08:04.400 --> 01:08:11.840 Go to buildbetterhealth.org to find out how to get involved in the mental health insurance reform landscape or landscape, the the task force. 01:08:11.920 --> 01:08:16.000 I'm just gonna say the task force, the mental health insurance reform task force. 01:08:16.319 --> 01:08:20.560 And stay tuned because I have a lot of really exciting guests coming up. 01:08:20.720 --> 01:08:27.119 I'm gonna have somebody from the psychotherapy action network who was sued by Talkspace. 01:08:27.199 --> 01:08:30.399 I'm meeting with her next week to get something on the books to schedule. 01:08:30.560 --> 01:08:31.680 That's a whole thing. 01:08:31.840 --> 01:08:34.399 So we've got lots of great stuff coming up. 01:08:34.479 --> 01:08:39.600 So keep can continue to share, like, rate on your podcast platforms, all of that stuff. 01:08:39.680 --> 01:08:41.439 That's how we build up the algorithm. 01:08:41.680 --> 01:08:43.439 So again, thanks, Susan. 01:08:43.520 --> 01:08:44.560 Thanks to my listeners. 01:08:44.640 --> 01:08:49.039 And my name is Civy Suckerman, and this is Therapists on Chains.

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