Starting a Counseling Practice Success Stories

Starting a Counseling Practice Success Stories

Episode 375: State of Therapy: Kelly and Miranda on What Happens When Insurance Stops Being Access.

Aug 6, 2026 · 38 min · 11 segments

Starting a Private Practice is the show for therapists who want a practice that holds up: good clinical work, real fees, and a business that does not quietly run on your unpaid hours. This one is not…

Starting a Private Practice is the show for therapists who want a practice that holds up: good clinical work, real fees, and a business that does not quietly run on your unpaid hours. This one is not a success story interview. It is Kelly and Miranda talking through what they are watching in the profession right now, starting with health insurance. The reason to hear it: a lot of clinicians took insurance specifically to be accessible. That logic breaks when the people you wanted to reach no longer have coverage. Kelly and Miranda walk through what actually changed, why therapists have been quietly bending their billing to make the math work, and what it looks like to build access on something sturdier than your own subsidy. **What You'll Hear** 00:00 What we are watching in July of 2026 05:20 What actually happened with the subsidies, and who let it happen 07:06 2.6 million people, two very different explanations 09:48 Doctors building around the system: cash pricing, membership models, in-house labs 11:06 The quiet math problem: when therapists bend billing to make care work 12:08 Letting the deductible write the treatment plan 16:54 A better care model, not a cheaper version of a broken one 17:30 Counting who has their hands in the pie 19:17 What happens when you hand your practice to people who do not do the work 22:37 Intensives, extended sessions, and tracking your own outcomes 25:11 Why therapists are already built for a cash-pay world 29:30 More people are looking for us, not fewer 32:44 Drain versus groundswell, and how to tell which one you are in 35:09 Stockholders, platforms, and deciding where you give your labor **About Kelly and Miranda** Kelly Higdon, LMFT and Miranda Palmer, LMFT are the co-founders of zynnyme and the co-hosts of this show. They have been business partners since 2010 and have reached 100,000+ clinicians with trainings, coaching, and a lot of unglamorous spreadsheet work. Kelly brings the operational side; Miranda brings the tech and marketing side. Both of them still think like clinicians first, which is why the business advice here never asks you to trade clinical integrity for revenue. Kelly uses they/them pronouns. Reach them at zynnyme.com, or start with the free training library at zynnyme.com/free. **Resources Mentioned** Free training library: https://www.zynnyme.com/free Platform Contracts Exposed: https://www.zynnyme.com/free/platforms Ditching Insurance and Platforms: https://www.zynnyme.com/free/ditching-insurance Private Practice Under Pressure: Ethics, AI, and the Fight to Keep Therapy Human: https://www.zynnyme.com/free/private-practice-under-pressure-ethics-ai-and-the-fight-to-keep-therapy-human The AI Policy Every Therapist Needs, with Dr. Maelisa McCaffrey: https://www.zynnyme.com/free/the-ai-policy-every-therapist-needs RedBud Surgery Center, Austin, Texas: https://redbudsurgerycenter.com/ Dr. Elisabeth Potter, MD: https://www.drpotter.com/ Are Third-Party Credentialing Platforms a Lifeline or a Trap? https://www.zynnyme.com/blog/are-third-party-credentialing-platforms-a-lifeline-or-a-trap-a-deeper-look-at-the-ethics-and-sustainability-of-alma-headway-and-grow-therapy Alma, Headway, and the Big Question: https://www.zynnyme.com/blog/alma-headway-and-the-big-question What to Ask a Recruiter Before Signing a Therapy Platform Contract: https://www.zynnyme.com/blog/what-to-ask-a-recruiter-before-signing-a-therapy-platform-contract All episodes: https://www.zynnyme.com/podcast Business School for Therapists: https://news.zynnyme.com/business-school/ **Want the Kind of Support Kelly and Miranda Talk About?** Business School for Therapists is our flagship program for therapists ready to build a practice that supports the life they actually want. It is a blend of live coaching and self-paced curriculum, plus a community of clinicians who normalize niching, real fees, and clinical depth. Twenty years in, it is the work we wish someone had handed us when we were spending our own weekends figuring this out. Learn more: zynnyme.com **Listen, Subscribe, and Leave a Review** Apple Podcasts: https://podcasts.apple.com/us/podcast/starting-a-counseling-practice-with-kelly/id1398391639 Spotify: https://open.spotify.com/show/7K8TQ13vJL4L3IvtWLLXV3 **Stay Connected** Website: [zynnyme.com](zynnyme.com) Blog: [zynnyme.com/blog](zynnyme.com/blog) Instagram: [instagram.com/zynnyme](instagram.com/zynnyme) LinkedIn: [linkedin.com/company/2456942](linkedin.com/company/2456942) Pinterest: [pinterest.com/zynnyme](pinterest.com/zynnyme) Facebook: [facebook.com/kellyandmiranda](facebook.com/kellyandmiranda)

Starting a Private Practice is the show for therapists who want a practice that holds up: good clinical work, real fees, and a business that does not quietly run on your unpaid hours. This one is not…

The Health Insurance Crisis0:43 – 5:19

Kelly HigdonHost

0:43

[laughs] But today we're gonna sort of talk about the state of the profession and what's happening in July of 2026.

Kelly HigdonHost

0:53

What are we navigating, um, as therapists, um, as human beings, as practice owners, if you're a practice owner or you're a potential practice owner, what are the things that are happening out there that we're, like, keeping an eye on and noticing the trend? And we thought today we would talk about health insurance as a starting point.

Kelly HigdonHost

1:18

And, and this, like, we're gonna, we're gonna talk about it from a different perspective today, um, because as business owners, as people who provide health insurance, um, we're already planning for and thinking about what kind of benefits we're offering our team of private practice coaches and our operational team for 2027.

Kelly HigdonHost

1:43

Um, we are having the experience personally of looking at the way that our benefits came back last year as subsidies were expiring for our employees or, um, whatever the, the pieces are in terms of what was offered to us as a small business, um, and how we keep seeing the, um, premiums go up and the deductibles go up while the actual coverage goes down.

Kelly HigdonHost

2:16

And so what we have noticed for ourselves is that while technically we have health insurance, realistically and, um, and in practice, our insurance is mostly just an out and it's not really, like, giving a lot back.

Kelly HigdonHost

2:39

Um, meaning we're paying premiums and then because we have high deductible plans for both the premium aspect but also because it's hard to get care, [laughs] um, we end up not actually utilizing our insurance.

Kelly HigdonHost

2:56

We're finding that paying out of pocket to see a primary care is cheaper than going directly through someone who takes our insurance, um, even for advanced care beyond, like, a checkup.

Kelly HigdonHost

3:11

You know, a checkups, quote unquote, are covered, so you get, like, one annual thing per year but what does that mean if I'm getting an annual checkup per year and I've invested, um, you know, $15,000 in premiums for one annual checkup? [laughs] And the, the promise of that if I had a catastrophic event, that if I only paid another $7,000 then that catastrophic event would be covered.

Kelly HigdonHost

3:42

[laughs] Um, and so it's a really interesting space and people are trying to figure out how to navigate this.

Kelly HigdonHost

3:51

I mean, some people are leaving the country because they've realized they can get better care elsewhere, that they can get comprehensive, even if it's just basic care or catastrophic care in other countries.

Kelly HigdonHost

4:04

They can pay less for the, the medications that they need or their children need.

Kelly HigdonHost

4:10

Some people are going to other kinds of plans or, or programs outside.

Kelly HigdonHost

4:15

They're kind of banding together to say, wait, when insurance companies were first created it was a nonprofit organization to help people who were in the hospital and for something unexpected that was catastrophic and it was supposed to help so that people were not bankrupt.

Kelly HigdonHost

4:36

And we have health insurance and people have health insurance care and wait, health insurance for healthcare is still bankrupting the, the majority of, of Americans who go bankrupt do so because of medical care.

Kelly HigdonHost

4:50

So, like, something's not working in the system so people are trying to, like, make their way through it and then of course, like, how does this all impact us in terms of mental health care? Right? For those of you who have been accepting insurance specifically because you want to make your care accessible, what happens when the people you wanted to create accessibility for do not have health insurance because health insurance isn't actually creating accessibility for them?

The Health Insurance Crisis0:43 – 5:19

Kelly HigdonHost

0:43

[laughs] But today we're gonna sort of talk about the state of the profession and what's happening in July of 2026.

Kelly HigdonHost

0:53

What are we navigating, um, as therapists, um, as human beings, as practice owners, if you're a practice owner or you're a potential practice owner, what are the things that are happening out there that we're, like, keeping an eye on and noticing the trend? And we thought today we would talk about health insurance as a starting point.

Kelly HigdonHost

1:18

And, and this, like, we're gonna, we're gonna talk about it from a different perspective today, um, because as business owners, as people who provide health insurance, um, we're already planning for and thinking about what kind of benefits we're offering our team of private practice coaches and our operational team for 2027.

Kelly HigdonHost

1:43

Um, we are having the experience personally of looking at the way that our benefits came back last year as subsidies were expiring for our employees or, um, whatever the, the pieces are in terms of what was offered to us as a small business, um, and how we keep seeing the, um, premiums go up and the deductibles go up while the actual coverage goes down.

Kelly HigdonHost

2:16

And so what we have noticed for ourselves is that while technically we have health insurance, realistically and, um, and in practice, our insurance is mostly just an out and it's not really, like, giving a lot back.

Kelly HigdonHost

2:39

Um, meaning we're paying premiums and then because we have high deductible plans for both the premium aspect but also because it's hard to get care, [laughs] um, we end up not actually utilizing our insurance.

Kelly HigdonHost

2:56

We're finding that paying out of pocket to see a primary care is cheaper than going directly through someone who takes our insurance, um, even for advanced care beyond, like, a checkup.

Kelly HigdonHost

3:11

You know, a checkups, quote unquote, are covered, so you get, like, one annual thing per year but what does that mean if I'm getting an annual checkup per year and I've invested, um, you know, $15,000 in premiums for one annual checkup? [laughs] And the, the promise of that if I had a catastrophic event, that if I only paid another $7,000 then that catastrophic event would be covered.

Kelly HigdonHost

3:42

[laughs] Um, and so it's a really interesting space and people are trying to figure out how to navigate this.

Kelly HigdonHost

3:51

I mean, some people are leaving the country because they've realized they can get better care elsewhere, that they can get comprehensive, even if it's just basic care or catastrophic care in other countries.

Kelly HigdonHost

4:04

They can pay less for the, the medications that they need or their children need.

Kelly HigdonHost

4:10

Some people are going to other kinds of plans or, or programs outside.

Kelly HigdonHost

4:15

They're kind of banding together to say, wait, when insurance companies were first created it was a nonprofit organization to help people who were in the hospital and for something unexpected that was catastrophic and it was supposed to help so that people were not bankrupt.

Kelly HigdonHost

4:36

And we have health insurance and people have health insurance care and wait, health insurance for healthcare is still bankrupting the, the majority of, of Americans who go bankrupt do so because of medical care.

Kelly HigdonHost

4:50

So, like, something's not working in the system so people are trying to, like, make their way through it and then of course, like, how does this all impact us in terms of mental health care? Right? For those of you who have been accepting insurance specifically because you want to make your care accessible, what happens when the people you wanted to create accessibility for do not have health insurance because health insurance isn't actually creating accessibility for them?