In this conversational segment, Kelly Alhooie and a colleague discuss practical strategies for managing a cash‑based therapy practice, focusing on plan‑of‑care requirements, insurance script timelines, and administrative efficiency. Kelly explains that there is no strict “plan‑of‑care police,” allowing practitioners to operate in a flexible, gray area, though some clinicians prefer a Type‑A, highly detailed approach. She outlines state‑specific rules—Florida’s 30‑day law and Virginia’s former 45‑day rule—governing when a physician’s script is needed for insurance reimbursement. To streamline compliance and patient retention, Kelly uses an automated email series that reminds clients of consistency, informs them of the script requirement after 30 days, and reduces drop‑off. She emphasizes that faxing a plan of care to a physician is unnecessary, shifting that responsibility to the patient and saving hours of administrative work. Overall, the dialogue offers pragmatic, low‑overhead tactics for cash‑based clinicians to balance regulatory compliance, patient communication, and operational efficiency.
Chapters
I just didn't like how I felt like I, I didn't know what to say to those people who were like, well, why is this so expensive? I have insurance. I'm like, I, I don't know what to say to you. Okay. Faxing plan of care to physicians. Like, I, some of this stuff I was thinking like, oh, I'm just going to figure it out as I go. And next week I have 17 clients on my schedule and I'm like, all right, I need to, I need to do this like Tonight, tomorrow, like, we need to get it going. So, do you have something that you rec— like a— and like, I— in Florida, it's like within 30 days. Is that what the plan of care— All right.
So this is what I do with plan of cares. And let me explain this. And, and there is no plan of care police. So it depends on how you want to operate. I operate in the very gray, loose area. I am not the Type A-er. I have people in the program that are Type A-ers that are like, Kelly, I need this 100%. I am not a Type A-er and I will take the risk over than being Type A. But I know that some people want Type A, like they want instructions on that. So I'm gonna give you both sides of the coin, okay?
Right.
So in Virginia, we had 45 days and then eventually we had direct access. So I have operated under 45 days. Okay. And what I used to do in Virginia was I— so we have email series going out to these people that have booked. Okay. Because the email series that I have set up basically say like, you can't quit. Consistency is key. Like reminding them why they're continuing. Because when they start feeling good, they want to drop off.
Right? Right.
In those email series, I've also set up like the third email in, Okay, where you can put, by the way, and I just quickly put a blurb because then it makes me feel better. Hey, it's been 30 days. I want to let you know, or we have a 30-day law here in Florida that basically if you want to be reimbursed from your insurance, you will need a script. Please contact your primary care and they can send it over to this email. And that way, I think this is like the best happy balance I have found. You feel confident because you have alerted the patient, okay? And that makes you feel better. However, there is no script police. The only way— the only reason why you actually need a script is because the insurance company, if they're trying to get a super bill, then they're going to be like, "Oh, you don't have a script. We're not even reimbursing. We're not even talking to you." Okay. Other than that, there is no one literally going, you don't have a script today for this patient, you can't see them. There's no police.
Right. Okay.
Yeah.
So I don't have to fax plan of care to doctor?
No, no.
And I can put it in the patient's court to sit— I mean, that's gonna save me like hours of work. So—
Trust me, because there's no way. It's so hard to keep up with it on a spreadsheet and then you're gonna have to hire an admin to like— no, no, no. Like you have so many other things you need to be doing.
