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What EVERY Therapist Should Know About Insurance
By Barbara Griswold, LMFT
Author, Navigating the Insurance Maze
August 27, 2026
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Hello!
Well, it’s only August, so I’m not sure why it feels like October—unless it’s because school has started, and the craft store is already fully committed to cobwebs, plastic gravestones, and tiny skeletons.
My last newsletter focused on whether you should get an Employer Identification Number (EIN) so you don't need to use your Social Security Number on claims and superbills, which has a slightly higher risk of identity theft. Unfortunately, many of you got a broken article link. The accurate link to the article on this topic is here. Check it out!
In case you missed it, I also introduced my new Clinical Review Preparation Question List, with 22 sample questions an insurance case manager might ask if they contact you to review a case. Preparing with this list will help you feel confident when talking about your clients, and help you ace a review. Buy it now and keep it handy for when you need it in the future. Check it out here.
Stay cool,
Barbara
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ARTICLE
Running Overtime:
How to End Sessions
on Time Without
Feeling Like a Monster
Think you have to work harder or longer to make more money in private practice?
Fortunately, that isn't the case. Your calendar does not need to become a hostage to your good intentions. Instead, it may be helpful to look at how your practice could be quietly leaking money.
First: Waiving missed session fees
I’ve written before about one common way therapists are losing money every day: by not charging missed-session fees. And I get it -- this is hard. Your policy may be clear. But when the moment comes to actually charge the fee, that neat little cancellation policy can suddenly feel less like a reasonable written agreement and more like a test of your distress tolerance.
And this challenge appears to be growing. A Private Practice Survey by Zynnyme found that this problem has worsened by 27% in recent years, while the no-show fees therapists charged dropped by 8%.
For many of us, uncollected missed-session fees are a big income leak. If collecting these fees isn't easy for you, PLEASE read my article “Missed Sessions: Being Nice Can Cost You Thousands.”
Another way generosity can be a problem
But in this article, I want to look at a related form of problem generosity: our tendency to run overtime in session, and the often-invisible costs of those “just a few more minutes” moments.
How many of us run overtime?
One statistic from the Zynnyme survey especially caught my attention: 76% of therapists said they run overtime in sessions. That’s 3 out of 4 of us. Even more striking, that number was 36% higher than their survey a few years earlier, which means this little habit is not exactly on its way out.
On average, therapists reported going seven minutes over per session. Seven minutes. Doesn't sound like much, does it? And that is exactly why it so easy to miss. You didn’t begin with the grand business strategy called “Let Me Work for Free.” It began with compassion, urgency, discomfort, or the very human wish not to interrupt someone mid-sentence -- or mid-sniffle.
Zynnyme’s analysis put it well: “It’s small decisions, made kindly, in a hurry, one at a time.” But over time, this extra time may have become a pattern, for you and for your client, and quietly became the expected norm. And along the way, you silently lost your session breaks.
A look at the numbers
Seven minutes may not sound like much. But a few minutes here and there can become a surprisingly expensive habit --- both financially, and to your mental health.
If you provide 60-minute sessions and routinely go seven minutes over, you are giving away..... read the rest of the article to get the data on the financial and mental health costs of this behavior, and get 6 tips on how to stop running overtime without feeling like a monster
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GOT MEDICARE QUESTIONS?
My New One-Stop Medicare FAQ Page for Therapists
I've written a lot of Medicare articles over the years, trying to give you basic information and update you on important Medicare changes as they happen.
But now I've put together a helpful resource, both for Medicare providers and those who don't serve this population: A sort of one-stop Medicare Question and Answer site.
This free webpage is designed to answer your frequently asked questions about Medicare enrollment, the pros and cons of opting out and how to do it, billing and coding basics, how to find Medicare reimbursement rates, and so much more.
Check out the page now and bookmark it – I’ll try to keep it updated with new information as it happens. Check it out here
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WEBINAR: "WHAT'S MISSING FROM YOUR CHARTS: WRITING GREAT NOTES"
This recorded webinar is aimed at all therapists, since we all can have charts reviewed by insurance, disability, and licensing boards. Includes 8 note examples, 3 note templates, and telehealth note requirements. For info, click here
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2026 WEBINAR: "WHAT EVERY THERAPIST SHOULD KNOW ABOUT INSURANCE -- EVEN IF YOU WANT NOTHING TO DO WITH IT"
For all therapists, this newly-updated recorded training will give you all you didn't learn in grad school about dealing with a client's insurance. For info, click here
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WEBINAR: "TELEHEALTH LAW & ETHICS: WHAT YOU NEED TO KNOW ABOUT APPS, AI, AND OTHER ADVANCES IN CARE"
While applicable nationwide, this recorded course meets the mandatory telehealth course requirement for all California MFTs, LCSWs, & LPCCs. We discuss the safe usage of latest technology, including AI, email/texting, seeing clients in another state & HIPAA. For info, click here
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PRACTICE FORMS PACKET
Get 24 essential forms. Customizable. Designed to meet legal, ethical, and insurance expectations. For info, click here
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WEBINAR: "COUPLES THERAPY: BILLING, DOCUMENTATION,
& ETHICAL DILEMMAS"
Working with couples involves complex billing, documentation, and ethical issues. This recorded webinar answers all your questions, like when can you ethically bill insurance for couples? Who is your client? Do you need two charts/treatment plans? For more info, click here
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WEBINAR: "WHAT OUT-OF-NETWORK THERAPISTS SHOULD KNOW ABOUT BILLING"
This recorded webinar covers what every therapist should know about billing and insurance -- even if you have never signed an insurance plan contract. We'll discuss common errors made by out-of-network providers, sliding scale fees, and helping self-pay clients afford treatment. For info, click here
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WEBINAR:
"AUDITS AND RECORDS REQUESTS: WHAT EVERY THERAPIST SHOULD KNOW"
This recorded webinar is for all therapists, since even out-of-network therapists can have their notes requested by an insurance plan or other agency -- and can be asked to pay back monies already collected. Learn to prevent this. For info, click here
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WEBINAR: "HOW TO WRITE A 10-MINUTE TREATMENT PLAN"
Hate writing treatment plans, worry about the ones you write, or don't write them? This recorded training will teach you how to write brief plans that satisfy legal, ethical, and insurance expectations, so you feel confident if you receive a records request. For info, click here.
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PROGRESS NOTES TEMPLATE
This progress note template has been designed to pass an audit by the toughest insurance plans or licensing boards. Available in fillable PDF format, Word format, and Pages format. Have confidence in your session notes. For more info, click here
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WEBINAR: "THE FIRST SESSION: Juggling Clinical & Administrative Tasks"
This recorded webinar gives tips on juggling all those intake tasks -- building rapport and taking a history, doing a diagnostic assessment, while handling paperwork, payment and insurance issues. For more info, click here
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WEBINAR:
"SHOW ME THE MONEY: Understanding Rates, Raises, and Resigning"
This recorded course shows you how to increase your chances of getting a raise from a health plan, and outlines the practical and clinical steps to take when resigning. For info, click here
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WEBINAR: "ARE YOU COMMITTING INSURANCE FRAUD?"
This recorded webinar answers all your questions about contract violations, sliding fees, waiving copayments, and how to avoid common behavior that is actually fraud. For info, click here
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MY BOOK!!!
Navigating the Insurance Maze: The Therapist's Complete Guide to Working With Insurance -- And Whether You Should -- 10th EDITION
Get the digital version only or both the paperback and digital versions
Click here for info. Please buy direct from us - Amazon keeps 55% of profits!
CALIFORNIA LMFTs, LCSWs, LPCCs, and LEPs: You can now get 10 CEs for reading my book, and 2 can count as Legal and Ethical CE credits. Buy my book here and buy the CE test here to get your CEs. You can even take the test if you have already read any edition of my book.
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Barbara Griswold, LMFT
Author, Navigating the Insurance Maze: The Therapist's Complete Guide to Navigating Insurance -- And Whether You Should
theinsurancemaze.com 408-985-0846
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