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Bob Walsh and Norm Dasenbrook
Sep 13, 2010

Tips For Tough Times

Ok, we've read the bad news about the current economy. Many of the counselors who visited our booth at the ACA Convention Center shared how their practices were doing. We asked them for details about payment issues, insurance re-imbursement, and cost effective strategies. Many told us their client numbers were steady but they also talked about new economic stresses for themselves and their clients. Almost all of our scheduled consults in the Career Center asked for tips on cost effective practice strategies. We learned of some strategies from them too. Counselors are learning to be leaner with their overhead costs and their time. Time, they say, is money, but not always.

Sharing office space with other licensed counselors helps pay your rent. Norm shares his office space with a colleague and splits the cost 50/50. Bob sublets space on days his office is empty, with a social worker and another licensed counselor. For each hour the office is used by them he receives $20, money not attached to his time. One counselor from New Jersey rents a “virtual office”. She explained that a large office building in her area provides single offices with support staff such as receptionist, secretary and equipment like copy machines, furniture and phone/ fax / computers. Her costs were a fraction of the expense of a new startup. She suggested a Google search to locate sites.

Using inexpensive insurance billing methods is another way to save money for the counselor. We have been researching software and services and have found some to be inexpensive or even free. Office Ally and Optum/UBH managed care has online billing and both are free, so no paper (green friendly) or postage are needed. Both offer free direct deposit into your business account, saving more paper. A bulletin in ACA’s Private Practice Pointers outlining our recent survey of electronic billing software and services is available at

Strategies that help the client as well as the counselor in these times, include half hour sessions at half price. Getting right to business in the session is needed here. Another is group counseling. The benefits of group are well known and makes access to therapy much more affordable. Time payment, spread over a longer period, reminds me of the way my kid’s orthodontist made the cost palatable. Time payment has worked when the therapist allows credit card or periodic remittance.

If there are a limited number of sessions offered through managed care, bi-weekly or even monthly appointments could be considered if the client and therapist agree and it is appropriate to treatment protocol, spreading sessions allowing more time for treatment at less cost.

Counselors did report some bad news about payment issues associated with this economy. A few insurance and managed care companies seem to be more vigilant examining claims and have noted insurance payments taking up to a month or so longer than a year ago, before the recession (for non-electronic claims). Utilization review seems to have more stringent overview also.

Norm Dasenbrook and Bob Walsh are counselors in private practice, consultants, and authors (

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