I’ve been working with Susan Frager of PsychBilling Coach for the past 9 months and I’ve gotta say, she’s one of my favorite clients. She is amazing at what she does, and is doing all the right things to grow and scale her business. Plus, she’s just an awesome human being.
Susan provides coaching, support, and training on all aspects of billing and practice management for mental health providers. She’s smart, fiesty, and fun, and definitely knows her stuff. She has some great stories below to share her experience and the story of her business and how it continues to evolve.
First things first – what would your walk-on-stage music be?
I Won’t Back Down by Tom Petty. My webinar host, Grant says in my introduction that someone has to stand up to the insurance bullies. And, you know, I guess I never thought it would be me, but I guess somebody’s got to do it. Happy to do it. It’s it’s proving a lot of fun.
When did you start your business, and why did you create it?
Well, which business? Because there have been three. The original business had a different name and it was started in September of 1997 and had to do with representing therapists by writing treatment plans for them to submit to insurance companies.
Then I started Psych Admin Partners in 2004. It is a mental health billing service for counselors, marriage and family therapists, social workers, psychologists, nurse practitioners, psychiatrists – anybody providing mental health services.
What I do is so specialized, most people don’t understand what I do and why, and then they’re like, oh, that’s a business? It’s really funny when you go to Europe, and then you have to explain it to Europeans. I’ll never forget the Irish cab driver who let out a stream of four-letter words in a sexy Irish accent about just how wrong that was that somebody needed my services. And I’m like, yeah, well, I agree. But until I can move to Ireland, I guess that’s what I’m going to be doing.
Why did I create my business? I’m rather independent-minded, and I like to question, which is kind of ironic if you think about it, because my last name, I don’t know where my last name comes from. My family, when they came to this country, had probably an unpronounceable long Russian name, but Frager in German means questioner. I was like, okay, somebody at Ellis Island must have asked the immigration officials one too many questions. I guess that genetically it passed down a couple of generations because yeah, I ask a lot of questions and I ask a lot of uncomfortable questions and people don’t like that, especially if you’re in position of power.
So early on when I worked at an insurance company, I was always getting in trouble because I was like, well, that’s not right. And they’re like, it’s not about what’s right, Susan. It’s about what makes us money. And so needless to say, a square peg round hole. And I just thought to myself, how am I going to survive the next 35 years working for somebody in a system that I hate, that’s abusive?
The company that I now have is PsychBilling Coach. I got my LLC in late 2021 and went live in May of 2022. I took a leap of faith because I fired a bunch of clients to make it happen. And so for a year it was scary, really scary. I had my worst income year ever. But I’d come off of two years of the pandemic where I had been working 10-12 hours a day. And fortunately or unfortunately, as the case may be, making a lot of money in 2020 and 2021 because of the mental health services and all the need burned me right out.
The changes in my industry have been a long time coming, not just because of the pandemic. There are software changes. There’s the economic crisis. Inflation! It used to be that a solo practice clinician could afford a billing service. Well, billing services charge about 7% to 9% of income. That’s unsustainable anymore, especially for a smaller practice. And there’s software out there that renders the need for a billing service to prepare claims mostly unnecessary because you can do it yourself.
The problem for clinicians is what happens after you submit the claim and you don’t get paid. Because guess what? Insurance companies have lots of strategies to not pay claims. We all know that. And that’s where PsychBilling Coach comes in. I realized that there was a lot of experience in my head and a lot of things I’ve managed to piece together about the insurance industry that they don’t tell you. I want to take what’s in my head and share it with mental health providers so that they can turn around and continue to do what they do, which is mental health counseling.
Tell us about your business and what makes you unique in your field.
Well, believe it or not, I’m not unique in that I am both a biller and a clinician at heart. There are a few of us out there. I’ve met them and we’re really strange birds because It’s a kind of a left brain, right brain thing. It’s like we’ve got the therapeutic understanding, the clinical knowledge, but we’re also more business oriented and we understand the business of it, the business of practice.
Healthcare practices are businesses and anybody that does not understand that who is a healthcare provider in the 2020s will not make it. And that’s at the root of what’s causing a lot of healthcare providers to say I’m done is because they went in to practice medicine or psychology or whatever, not to be business people. And so, in mental health, there’s a lot of clinicians who transition to coaching to create a thriving private practice where you don’t have to take insurance. Great. OK. And that works very well if you serve clients that can afford to pay $300 a session or even $200 a session or even $150 a session. Because guess what? For the average person trying to afford therapy once a week at that $150 a session, four times. a month out of pocket is $600 a month. Well, there’s a lot of people that don’t have $600 a month to spare. And people have to pay a lot for their health insurance. So guess what? They want to use it.
Bottom line, I can get better fees for people. So this is what I do with both Psych Admin Partners as well as PsychBilling Coach. At PsychBilling Coach, I teach the clinician how to do it themselves. The next incarnation is going to be a membership subscription-based portal where you’ve got all the training, all the videos at your fingertips, and you just pay a flat monthly fee. And depending on the platform or depending on the subscription you purchase, you get a certain number of hours with me guaranteed each month (coming soon!)
If you could magically give all of your community members one thing in this world, what would it be, and why?
A decent American health care system would be nice, and then I could go open a bookstore or a doggy daycare or something less stressful.
What makes your audience special?
Therapists have to develop very, very strong boundaries or they’re going to take all their clients’ emotions. And the burnout potential is very high. And they’re special people because they are doing all that for very little money. I’ve done a deep dive into the economics of this. And with the rate of inflation from the time I started my business till now, therapists have lost potentially as much as 85% of their earning power. 85%.
They’re a special crowd because they’re not money motivated. Really, most therapists, the perception is that your therapist is greedy if they’re charging $200 an hour. Well, when I start telling you all of the expenses that they have, you’re going to see that that $200 an hour doesn’t really go very far. And they’re special because you know what? Money is not what makes them tick. They just want to help people. And I know that’s kind of a cliche. They really do. And so I feel like my job is to kind of, you know, help protect them so that they can do that. But at the same time, I have to empower them.
Has anything surprised you about starting a business?
Well, I’m not new in business, but I can tell you things are surprising me all the time. Still 26 years in. One of your past blogs said something like running a business is the best way to know yourself in a way you’ve never known yourself before. Wow, yes. I look on paper like super accomplished, right? And yet I struggle with thinking too small. Imposter syndrome. I think if you’re a woman and you’re our age, there’s no getting around that you’re going to have some level of imposter syndrome.
Why did you decide to hire out your website?
- Total lack of technical ability
- Total lack of understanding of SEO (other than what it is)
- Not much artistic or design talent
- Not much understanding of marketing or what makes a website that draws people in
You’re actually the 3rd web designer I’ve worked with but are by far THE BEST! You give a lot of thought to not only what looks pretty, but how the site represents my business in a way that makes people feel welcomed, interested, and ready to hire me. You care about things like user experience: what will frustrate people, make them give up and go elsewhere?
For example, my products were the same on the previous website, but I had very few sales. The interface was poor and the checkout experience was horrendous. For instance: you could only buy one product per transaction. (Why? No idea.) Within a month of our new website launching, I probably had more sales than I’d had the previous 6 months.
You also made me think about my website as an integrated part of my marketing plan – and you are very intentional about designing it accordingly. I learned a lot of things I’d never have considered before. All that translates directly into what you see online. And also improves SEO dramatically.
What’s possible for you and your business with your new website?
Anything! Increased sales and visibility thanks to better SEO. I get more people wanting my services, just putting themselves on my calendar without first expecting me to “sell” myself or justify why they should hire me. The same basic information was on my previous site – but the way in which you present it on the current website makes a huge difference.
What advice would I give someone who is thinking about investing in a larger web design project?
Well, number one advice, talk to Cory. Number two, do your homework. It’s kind of amazing how when I launched my first website, I didn’t do much research, and it showed. I didn’t know what I didn’t know. I didn’t know what a website can do for business. To me, a website was like a yellow page listing. And for Psych Admin Partners for many years, that’s all it really needed to be was a yellow pages listing on the worldwide web, which was the internet era’s Version of the Yellow Pages. If anybody even knows what the Yellow Pages is, if you’re under a certain age, it’s like, huh? What’s that? The Psych Admin Partners website had always been real static. I never changed it. My business never changed.
The difference is that PsychBilling Coach is a very dynamic company. I don’t do the same thing for each client. I assess and I customize. And so the website has to reflect that I can take that same knowledge in my head and I can do things a variety of ways. Here’s how I can get you what you need. And it was hard, I think, to design that. You helped me tremendously by picking my brain and making me think about what I wanted it to accomplish. So I guess the advice, aside from doing your homework on web designers, is to think about what you want to accomplish. And that will inform so much of the rest of your choices.
There are a lot of web designers out there. I would reach out to people, and they either wouldn’t call me back at all, or they’d call me back and it was clear they didn’t really have a clue. Or they would say, oh, I did this website for so-and-so and it had spelling and grammar errors or a site that didn’t render properly.
I looked a lot at sites that you had worked on. And then I looked at the vibe, the overall feel of it, the navigability. Did it draw me in? Did it not draw me in? Did it make me want to click the buy button? And then was it an easy flow to where it was easy to buy? And did it work? You’d be surprised how many websites I saw that didn’t meet that criteria. Once I finally sat down and did my homework, having had an epic fail with the first web designer…
And one of the things that you taught me Cory, and I’m giving you full credit, is you have to be really intentional about who your ideal client is. Cool graphics and pretty sites are okay, but if you don’t hook your ideal client, people will click away and you’ll never get them back. And I’m luckier than most in my business because I don’t have a lot of competition. But if you’re in a more crowded field, then you need something that’s going to stand you out from the crowd. And even in my very narrow field, I’m already seeing where there’s things you helped me do on my website that make me stand out. And the number one thing I’d have to say is that it reflects me. It’s my personality. People constantly tell me at the end of a consultation, wow, your website is you. And I love hearing that because it’s true. If it’s the website that’s conveying the know, like, and trust factor, then what you see is what you get, and then there’s going to be no horrible, unpleasant surprises, right?
Who are your favorite bloggers or podcasts right now? Or what is an influential book that you’ve read lately?
There’s a guy that I follow Justin Bariso, and his latest podcast, it was like he was speaking to me. It’s called EQ Applied and it’s about emotional intelligence. I’ve never paid the guy a dime, but I would.
I’m listening to “Blink” by Malcolm Gladwell whenever I get a spare moment. It’s about how we unconsciously make decisions, and how our perceptions and intuitions are either amazingly accurate, or lead us astray, and why. Fascinating stuff.
