Growth Strategies for Insurance-Based Practice: With Amy Plano, MS, RDN
65m 36s
In this podcast episode, host Jeannie Patrucci interviews Amy Plano, the reimbursement dietitian, who advocates for insurance-based private practices for dietitians. Amy shares her journey from working at Yale to building a multi-six-figure practice that is almost exclusively insurance-based, proving that success doesn't require a self-pay model. She emphasizes that accepting insurance makes care accessible, allows dietitians to make an impact while earning well, and attracts referrals from doctors who prefer to send patients to in-network providers. Amy outlines the initial steps for getting started, including obtaining an NPI, setting up a business entity, getting an EIN, and securing liability insurance. She explains the CAQH process as a common application for insurers and notes that credentialing can take three to six months depending on the state. She also discusses the hybrid model, where dietitians bill insurance for medical nutrition therapy sessions but charge for additional services like meal plans or metabolism testing, always ensuring transparency and value. Throughout, Amy stresses the importance of retention, serving with integrity, and designing products based on client needs rather than chasing trends. She encourages dietitians to define success on their own terms, whether full-time or part-time, and to focus on being a good human as the foundation of a thriving practice. The conversation highlights that insurance-based practices can be profitable and sustainable when approached with the right mindset and support.
So the why for me has always been making our care accessible.
We want to be the experts out there.
So we have to make sure that the care is accessible to everybody.
And so part of why you should is that you can make an impact
while making good money.
And I'm not anti-cash.
But if you have benefits on your policy
and you can see a registered dietitian,
you're more than likely to go to one who accepts
your insurance.
This is like with any type of, you know, any type of medicines.
Welcome to the Nutrition Content Creator Podcast.
This is where health and wellness professionals come
to nail the nutrition content game,
scale their practices,
and get clients the results they are looking for.
Get ready to unlock your potential
as a nutrition professional.
I'm your host, Jeannie Patrucci,
registered dietitian nutritionist,
culinary coach and expert nutrition content creator.
And I'm super excited to go on this journey with you,
supporting you with actionable steps you can take
to save time and become more competitive.
In this podcast, I'll provide you with solutions.
I'll be sharing my knowledge and expertise
on how to create compelling, dynamic nutrition content
that attracts, serves, and retains your ideal clients,
content that also supports you with growing your practice.
Let's get into today's episode.
The stigma surrounding accepting insurance
in private practice is so interesting to me.
The idea that you cannot be super successful
in a private practice unless you are self pay
and sell high ticket programs is simply not true.
You absolutely can have a thriving insurance-based practice
and our guest today is here to prove it.
Amy Plano is an expert at reimbursement
for registered dietitians.
Her mission is to help dietitians simplify the process
of accepting insurance in their practices.
She teaches dietitians exactly how to make money
using a health insurance-based payment model.
Amy demystifies the insurance process
and shows you the specific steps necessary
to leverage accepting health insurance
in your nutrition-private practice
to make the money that you deserve as an RD.
If you are skeptical about exactly how you can make money
solely relying on insurance, let Amy be your proof.
Her practice is almost exclusively insurance-based
and she easily generates a multi-six-figure salary.
I'm honored to have her as a guest today
and I know you'll learn a ton.
Enjoy.
Welcome back to the podcast.
Everyone, we have a guest I know
who is going to deliver huge value to you today.
We were just chatting before we went live
and Amy, you've got great energy.
I'm really excited to have this conversation
and share your energy, your knowledge, your expertise
with our communities.
So Amy Plano, welcome to the Nutrition Content Creative
Podcast.
Thank you for having me and I cannot believe that we haven't met
or we haven't physically met in person.
It's crazy.
I know, it's not.
But as I understand, you don't live too far for me.
So we're going to make an in-person meeting happen in 2024.
Absolutely.
Okay, perfect, cool.
What I'd love for you to start out with,
I always ask every guest three questions,
who you are, who you serve and how you serve them.
So can you start by sharing with our listeners who you are?
So I am Amy Plano.
I am the reimbursement dietitian.
I help dietitians get credentialed,
build the SHIT out of insurance
and get the money they deserve, right?
And so I'm a registered dietitian by trade,
traditional, untraditional background.
I think a lot of dietitians come in this as the second round.
So my original degree is in biochemistry
and I had it come back to another degree in dietetics.
And then I had a traditional path.
So I did my internship at Yale.
Yeah, and then while I was working at Yale,
I worked outpatient.
And I know a lot of dietitians,
like I knew during my internship
that I didn't want to work inpatient.
And so on my graduation day,
I was actually hired to work outpatient.
No.
Yeah, and so working outpatient at Yale,
and I know it's different in every clinic,
we were really learning,
like we were really doing a lot of the billing encoding.
Like so we were dropping charges.
And so I learned pretty much how to build very basically,
you know, through my job.
And then I had started my private practice
while I was in intern.
And so my background was in sports performance
and eating disorders.
So while I wasn't doing eating disorders,
while I was in intern,
I was doing like sport nutrition in general,
nutrition counseling.
So yeah, and so I was hired on my graduation day,
and I started my practice right out of my internship.
I got credentialed with the insurance companies.
Oh gosh, within like five months
of graduating from my internship.
What can you just share with us?
What year was that?
That was 2007.
(laughing)
So like that was when, remember the listservs?
Like we didn't have Facebook.
Yeah, so there was no resources and I don't say this
like facetiously or to my own horn,
but I literally had to write the book for, you know,
for reimbursement because at the time
we didn't have the resources that we had.
And like a typical dietitian,
I was probably working like 10 jobs, you know,
to make, you know, I was, yeah, running my practice.
I was working out patient.
I was actually teaching full time at a local university,
so the University of New Haven.
What else was I doing?
Gonna go, yeah, and then doing any opportunity
that came up for contract work,
whether it be health there,
whether it be taking blood pressure.
I feel like, I've literally, if you ask me
like the lower-hanging jobs, I've done them all.
Like there's not, you know what I mean?
Like there's my mother-in-law laughs
because like we'll be talking about a job
and I'll be like, oh, I worked there.
Like, you know what I mean?
I did that.
Yeah, I bartended, I cooked in the kitchen, you know,
all of these different things.
Yeah, and I have no regrets.
Like I'm really grateful for those opportunities.
In working outpatient, I think I'm a different type
of business coach where I do believe,
and I know it's somewhat controversial,
but the time that I spent outpatient,
so I worked outpatient seven years part time
before I went full time into private practice.
And I really believe, I know it's different for everybody,
but like those seven years were really instrumental
in terms of the opportunities and the ability
to build my skills, you know,
and I think a lot of business coaches are like,
oh, just going to private practice, where for me,
I don't think I would have been successful
or as successful without that, you know.
So, it's so interesting that you met that.
Can I share a bit of my story with you?
I see that you met that.
So, you know, I opened up my practice in 2016,
right out of my internship, right?
I passed the exam.
I actually renovated the building,
built my teaching kitchen, hung my shingle,
opened up my doors like a week after I passed the exam.
So, I was a lot of pressure.
I was sitting, I think, then I'm like,
what if I don't pass, right?
But what I did that was different.
In principle, I agree with you 100%.
Like it's really hard to just open up private practice
on your own and figure out a lot of this stuff, right?
Especially if you're going to be taking insurance.
So, I brought in other very experienced
registered dietitians with me.
So, I had a team around me to support me, right?
My focus was culinary nutrition.
I had spent 28 years as a culinary instructor.
And so, I was bringing that nutrition
again to that niche, but I knew my limits, right?
So, someone walked through the door with CKD,
that with not my patient, right?
So, yeah, in principle, I agree with you.
And I would encourage anybody listening,
if you're thinking about going into private practice.
Oh, I just, you know, doing that,
maybe doing outpatient part time is the answer, right?
And then partnering with someone that you trust,
that you can share the practice together, right?
Yeah.
I just wanted to add that, I love that.
Right, and I'm sure you would agree.
It's never an all or nothing.
Like, you can always figure it out.
Absolutely, yeah.
You see people will say, how did you do it as an intern?
I was like, I just, I really feel like
as registered dietitians, at least,
I mean, I had to go back and get a second bachelor's.
And so, like, no, me and I, and it's like,
why it's so much vested in those that like,
I have this saying that I will not be,
I will not be unsuccessful because of me.
Meaning like, it's possible that I won't succeed
at all the things that I do,
but I won't be the reason why I don't.
You know what I mean?
So, you know, so that's always been important to me.
And I always say, like, if you can learn how to piggyback
the fat on a TPN in the NICU, you know,
during your internship, you know, while business is hard,
there's nothing you really can't do.
Exactly.
Yes, exactly, exactly.
Thank you for sharing your story.
That was great.
Now, share with us.
Who do you serve?
Like, who are your clients?
Yeah, so my, so, and also in full transparency.
So I run, I still run and operate my private practice.
So I have a private practice that is a brick and mortar.
In, I'm sorry, a hybrid in Connecticut.
So we see in person and we see,
virtual. So I have six dieticians on that side of my business. And I oversee the business. I see
like maybe four patients a month where I used to see 42 to 45 a week. So, you know, so I've run
that side of my business because I do believe I know I'm like kind of like a weird coach, but I feel
like in order to continue to continue to be the best coach and mentor, I kind of have to have my
hands still in it. You know, so that's why I kind of keep my skills. You know, I still maintain
my CDE, which is no longer called a CDE, but so I maintain that side. And then I, you know, so I
serve registered dieticians, registered dieticians and CNS is looking to start insurance-based practices.
And why I say CNS is a certified nutrition specialist because in non-licenture states, they can
accept insurance as well. Okay. Yeah, so that's who I serve. You know, I hear all the time
from a dieticians coming into our community who like they just want to start using materials
and they're wondering, you know, can I be an insurance-based practice and still earn six
figures? Now, my answer is yes, because I don't have an answer. Yes, too, but they really,
they're like, show me. Like, and that's really what this conversation is really, really helpful.
Absolutely, really support them. Yeah. And I love working with registered dieticians, isn't it?
It's so funny. And why, right there, Amy, though, like, you bubble up that, that, you know,
just natural nurturing, it's like, I just want to help and I just, I'm going to be there for you
110%. Yes. And I think especially now and kind of the business coach space, like a lot of smoke
and screens, like, you know, I'm going to help you or in millions or whatever, like all of these
promises, like, dieticians are like, you know, like, yeah, show me the real you, show me how you're
going to show up for me. Yeah. And, and like, show me the money, like, really, oh yeah,
the steps, how I can be profitable using insurance. So I, I just, yeah, I, I love the community as
well, but I do agree with you. Not but, but and I do agree with you. Yeah. That, you know, they,
they hold you accountable. And really just, I, what I love about it is it just makes me perform
at a much higher level. Oh, of course, of course. In serving your colleagues, I think is like,
I don't know, I feel and I'm sure you see in your products and your services, I think we always
attract like minded people. And, you know, I think at this point, I have about 190 dieticians in my
membership, which we'll talk about. And then I have about 90 dieticians in my group coaching
program. And I could single handedly tell you that like, I know everybody, I know where they live,
I know their background. Yeah. I would hang out with all of that. Yeah. I mean, like, all of them,
I would consider a part of my family where, yeah, you asked me like 15 years ago, I'd be like,
I'm good. I don't really want to hang out with dieticians, like, right, when I love it. And,
like I said, especially when you come from the clinical world, working one on one with patients,
like, I don't know, it's literally been the best thing that I've ever done, but it took me a long
time to do that. My husband used to, so my husband's a personal trainer and we run like a wellness
studio. And so I, we run our practice out of the wellness studio. And so probably like in like 20,
he used to always come in on like a busy Saturday and be like, why aren't more dieticians doing
what you're doing? Like, you'll make like, you know, a thousand dollars on a Saturday morning.
And then, you know, and I said, because they don't know how to do it. Yeah. Show them how to do it.
And I'm like, oh, it's so much work. Like, you know, and you know, to put back the back end of
everything. Sure. Yeah. So I think that it was like that, that kind of sparked it. Okay. Like, wow,
like, if we could get more dieticians accepting insurance, we could have the impact that we really
want to have and help people that we want to serve. So, um, but yeah, it was a long road, you
know, kind of getting here because, yeah, and that was the barrier was like, what would it be like
to work with your dieticians? You know, like I said, it was like, it defied gravity, you know,
for me, it's, it's the best thing I've ever done. That's amazing. And how do you serve? You're
up to me. You've already alluded to that. So you have a chorus. You have a membership. And kind of,
what kinds of activities go on in those two spaces? Yeah. So I've always, so one of the reasons,
so like I'm, I'm the type of person that has a why I'm the type of person that really believes in
mission, like a mission statement for my practice, like, uh, having values that dictate kind of,
you know, like my North Star information. Yeah. No, my person, I, like, my podcast that just went
live this week was a recording of a, of a workshop that I did called elevate your practice.
And the very, you know, I'm in the content creation business and I train people how to create
content basically for your sales funnel to drive traffic. And that is my, that was my first line.
Like you do not take one step in your practice or one, do not create one piece of content unless you
are very clear on your values. Yeah. Since your values are your North Star, that, that was a
words right out of my mouth. I don't even know. I, we didn't even talk about that. I know. I know. But it does,
it, it sounds kind of woo, woo, but you know, it's so true. And what's interesting to Amy is like in
the world of content creation where we're getting towards, you know, leveraging AI to help us create
content, you can't just say things. You need to write it down. Yeah. Write down your values and say,
okay, if my value is compassion and nurturing and empathetic, guess what? You're going to be
showing up on video because it's really hard to communicate those values in a logo, right? So
it's just so interesting to, you know, explore that with our community. Yes. That you really just
have to do some work to figure out what are your values. And then also, you know, when you're
collaborating with other professionals or when you're hosting people on your podcast, like you need
to find people whose values align with yours. So, right. So I already, I already knew that we're
going to be a good match. And I also think too, like, you know, I think when, you know, the more you
interact with professional and listening colleagues, and I use this as my, you know, I've also worked
with coaches in the past. And well, it always has, it hasn't always been rainbows, unicorns,
and glitter. The value of working with the coaches, sometimes you learn what you're also not willing
to do like with your, you know, no need in your space in place. One hundred. One hundred. If you're not
willing to, if you don't want to be active on social media, and you're not willing to show up
very regularly on social media, then don't hire a social media coach. Exactly. So like all of those
decisions help inform what your next steps are like this, right? And we're going to get now to,
you know, the part, it part of your business strategy, or if, as a listener right now, you are
thinking about accepting insurance as part of your strategy, Amy is really going to break it down
for you today. I do want to start with why should we consider taking insurance? What's the value?
Yeah. I think like it kind of, so for me, the kind of come back, comes back to my value system,
is like, you know, I wanted to make an impact, but it was also really important. I have to be clear.
I also need to make money. And I think that a lot of times people think that those cannot be
mutually inclusive. And I have a sign in here that says, I have to be successful because I like
expensive things. And that is the truth. You know, knowing me, but I also love my job as a registered
dietitian, I want to serve all the people. So, but with that being said, I know we all say those
things. And we all, like you said, want to be empathetic. But for a lot of people, when I filter
them into my coaching programs, like that, why needs to be apparent to me? Because serving for a
bigger purpose, because insurance can get really frustrating and muddy and messy. If you don't have
that North Star, like you said, to come back to you, you know, so for, you know, so why should you
accept insurance? So the why for me has always been, you know, making our care accessible.
And so part of why you should is that, you know, you can make an impact while making,
you know, good money. A lot of patients, I think, but I just had this, I was at a go-read event
last night, and I was talking to somebody at my table. And they were, we were talking about, you
know, what do you do? I'm a registered institution. I said, I run an insurance-based practice. And
they were like, you know, does insurance cover, you know, nutrition? And I'm like, oh my god,
does it cover it? Like, you know, me and I was like, you know, pretty much for every person in
this room, you know, somebody has benefits. So, you know, so people want to use their benefits.
And I'm not, I'm not anti-cash. But if somebody has a, you know, if you have benefits on your
policy and you can see a registered dietitian, you're more than likely to go to one who accepts
your insurance. Right. Like with any type of, you know, any type of medicine show, you know,
you can make an impact. They want to use their benefits. And the coverage is solid. Like,
after the Affordable Care Act, which is when you came in, it sounds like in 2016, you know,
that had been a game changer. So now we have a lot of preventative coverage. I mean, depending
upon your state, some of your patients may have unlimited visits. So, you know, I think back in
the day, like in 2007 and not through 10N where we didn't have great coverage, it was hard to keep
our patients accountable. Right. And so, yeah. Yeah. Yeah. With the vast
amount of visits, it's critical and we're able to see them, you know, quite often. I think
we were talking about this, but doctors love to refer to insurance based dietitians.
Yes, so that's big, big point number two. And that was, you know, that was part of my initial
business strategy because it's a culinary instructor. I already knew all of these doctors
because they were bringing me into each patient, so to cook healthy foods. Yes.
And so when I accepted, when I went before I was credentialed, I went and I had very
established relationships with these docs, but they work as part of it larger as you find now,
even the small groups are part of large medical system. And they would say to me, "Gene,
I'm so sorry, but I can't refer to you unless you accept our patients' insurance."
So I had to wait, it was just two months, so we made it work. But yeah, it wasn't until then that
the floodgates opened and we started having all of these referrals come in. Revisit, I just want,
I don't want to derail the conversation, but I think it's important to note, you know, one of the
first, the first reason that you gave for accepting is really just inclusivity and accepting,
you know, as many patients, serving as many people as you can, and understanding that some patients
have unlimited visits. Some patients have 28 visits a year, and that just don't mistake,
that that does not mean they're going to come back to be a practice. So that's right,
that she's better at, that's kind of my role. Yes. So in terms of like marketing, it doesn't really
look that much different. No. Because even though that patient is not paying out of their pocket,
they are still your ideal customer avatar who you need to speak to, and you need to engage,
and you need to add tremendous value to your practice so that they come back because you only earn
that money when they're in the seat or when they're on that Zoom call with you, right? Or not,
when they're on their EHR call with you, right? So I just didn't want people to think, oh my gosh,
I, that's so exciting, I get, they get unlimited visits. Yes, that's great, but the work has to be
yes, right? You need to acquire them first, which the insurance company self you with,
I'm sure you talk about that, but then you need to serve them and retain them, which is part of
the sales funnel, right? So yeah, I love that you jumped in on that too, because I think that,
and I think that it's really important. So like, I focus on this, whether I'm with, you know,
in my private practice, like, understood, you know, with my boss, you know, business hat on,
or with my dietitians and my coaching program is that it's all about retention, right? And so it's
like if I, if I never had another dietitian endurance my program, right? Could I continue to serve
them and deliver at the highest level of value while maintaining the same if not grow my income?
And so I focus a lot on return, you know, obviously like ROI or LTV long, you know, like the long-term
value of a patient, long-term value of a dietitian in my coaching program. So yeah, you have to show
up, and that's why I think there's also, you know, that's why one of the things I would love to do,
and you know, is on my docket, is to create like a private practice university where, you know,
we have me doing insurance, but we have like ED specialists, like teaching the counseling and
doing supervision. We have dietitians who are well-coaches coming in because you're only going to be
as successful as your weakest link. And for some of us, that's the counseling piece, right? So,
but yeah, you have to be delivering. And I think like with anything, I always say,
the patient has to see value in the, in the exchange, right? So whether or not they're voting with
dollars in a cash-based practice for that value proposition, you know, I work in weight management,
and I never know if I should say this because it's not like a testament to my skill set. But the
four patients that I've been seeing, I've been seeing every single two weeks since 20, like 16,
like every two weeks, and so like, you know, I used to really feel badly, and I would say to my
husband, like, you know, I was like, I get paid a lot of money to do this, and he was like, Amy,
like, they're getting something from this exchange, like they're seeing the value, and it's like,
you know, they're come back, you know, year after, year after, year. Yeah, yeah. So I, I hope that, you know,
that that's incredible. And for them, you know, even though the patient isn't paying, their time
is valuable. They're taking time out of their calendar to get in their car and drive to you,
and, you know, be invested in the conversation. So they are, you know, they're showing up,
and you have to give them a reason to do that, which, which clearly you do. So, yeah, and,
you know, cultivating those long, longer term relationships, those were always my favorite patients,
right? Patient, you know, you are always going to have the patient who comes in, so my doctor has
told me that I need to be here. Okay, well, then let's lean on our motivational interviewing a
little bit and say, well, how do you feel about being here? You know, I know, I don't want to be
here. Well, tell me a little bit more like about that. Like, why don't you want to be here? Like,
I'm here to help you. And then all of a sudden, you become their ally, right? And it can be a really
amazing experience. So it, I think too, like the key piece, and I think a lot of us forget this,
or like in the beginning of our practices, the beginning of our businesses, our ability to be
successful, however we wanted to find that is probably going to be more or less defined by our
ability to sustain relationships with people, right? And so like, when I hire into my practice,
I often get dietitians. I had somebody that I run in for an interview last week, and they're like,
oh my God, the dietitian on your team wrote this book or this dietitian. And I'm like, yeah,
yeah, yeah, yeah, but that's like not important to me. Like your ability to learn and be a good
communicator, be a good, I always see just be a good human. Like to me, that's the most important
thing. If you are a good human, I can teach you clinical skills, but I can't teach you how to
be a good human. And I think my success is predicated on the fact that I want to be a good human.
And that, to me, is like one of my values, you know, I can't stress that piece enough,
because you and I probably constantly get dietitians that are like, why am I not successful?
And I think for most people, they're looking for like a hard skill when
the reality is a lot of our success is built on these soft skills, like people's skills and
being a good human and treating people how we want to be treated. I know that sounds so silly,
but like, you know, it's like, I run a seven figure business and it's based on being a good human.
Like if you were to ask me, like, what do I think got me to where I am trying to be a good trying?
Like I said, all day, not all days am I successful, but I do. Right. Right. And that all things that
you try are successful. Right. And again, going back to, you know, dietitians kind of being
risk averse and really battling, like, do I take insurance? Do I not take insurance? Yes,
it is a risk to make that decision. But then once you make that decision, you lean into it and
you get the support that you need to, to help you be successful. Just because you take insurance
is not mean you're going to be successful. Like if you're just, let me tell you something,
it's really exhausting because I see this happen where you're bringing in a patient and they're like,
you know, it was okay. Like it was, it was okay. I didn't get a ton of value. And then they don't
come back and you have to constantly recruit new patients. Even if you take insurance, that is
exhausting. And that is not sustainable. So like you're saying, showing up and being a good
human and finding support that enables you to do that, you know, one of the reasons why I started
my company was because I, I like to think I'm a good human. Then I always tried to show up for
my patients. Yes. What was happening was I was so busy trying to, I opened up the practice I
needed to recruit new patients. I needed to attract people. I needed to serve them. I was creating
all the content, right? The cooking classes, the curricula, the handouts, the cooking videos,
the recipes that I just burnt out. And that's a fear, right? Like that's the fear of every
private practice register dietician. There is, like you said, like we should have a, you know,
university, right? Just like how to run a practice. Because when we're studying to be a registered
dietician, nobody tells you all that stuff, right? Now, they teach you like how to be an evidence-based
counselor, but there are so many other things that you need to learn and that you need support with
in running a successful private practice. Whether, again, you're looking to earn $2,000 a
month as a side vessel or whether you're learning to build a six-figure business, right?
I think if anything, it's discouraged. And I, and I speak to this a lot is like in my undergrad,
my two undergrads and in grad school, you know, people thought that I was crazy, you know, people
thought that I was somewhat crazy wanting to go the direction that I ended up going. And it was
really interesting. I was at Fencey in Denver and it was a whole like kinetic hit-based plane and
it was really funny because somebody who didn't support me, it was just, it's very ironic. It was
like just happened to be sitting in business class and this person that did anything but support me,
you know, I'm waving to her as she's, you know, as she's going to the back and it was just like
you never forget who doesn't support you. And so it's like that's where I think it's so important
to find your people and not to let that noise because if I let all the noise, you know, and my,
you know, throughout my career, like, you know, I mean, I wouldn't have ended up where I was.
And that, my everybody's going to be happy for your success. Yeah. And you know, you just have to
be a little bit resilient, which I think in general, you know, register digestions, and we're just,
we're such a community-oriented profession that you will always find your people. You'll always
enjoy it. Okay, so let's talk about, let's say you're speaking to a dietician or a certified
nutrition specialist or somebody who can speak, and sure, do you actually support any other health
care professionals because, you know, because I try to like slay in my own lane. That way, you know,
I know what you've got your niche, but I think that's it.
this is probably relevant to physicians as well like anybody.
Yeah, it's, but this is really interesting and so this is something that I've done
different in 2024. So while I work with registered dieticians and CNSs,
I get, you know, historically in the past, I've done a lot of consulting for, you know,
sizable physicians, um, practices. So how to recruit and, you know, set up an
insurance-based practice, right, gyms, health centers, wellness centers.
And it's really interesting that I decided for 2024 that I'm not interested like even though
there's a lot more money to be had in that space and I'm able to charge a pretty insane amount
of money when I'm working in those consulting roles. I'm not, I, I want to work with dieticians
like that's where I enjoy when I would have, you know, like corporate executives or individuals
in those spaces in my schedule. Like, like, I would be like, oh man, but like now all day,
like it doesn't mean, and it doesn't matter that they were paying me a thousand dollars an hour.
It doesn't matter. Like and so, you know, I've turned down a lot of opportunities already where
February 8th, I think I've gotten three and I'm just like, it was weird. I was like, I won't,
like, I'm not interested, like, dear someone, so I'm not interested in working with you. Like,
I work dieticians are my people. Like, that's where I belong and, you know, do you have any recommendations
for somebody? No, I don't, but I'll be over here working with you know what I mean? So, yeah,
yeah, you know, I don't, I just didn't enjoy that piece. And I think you had mentioned trying
to explain to somebody who's not a registered dietitian, you know what I mean? It's, it's,
there's a lot of pieces removed from that. It's like a lot easier working with partners who
get you. Yeah. And I just love it. Like, I would be so, yeah, I don't know, it was like a lot of
dollar signs in there. Like, making that decision, I was like, oh, like life is so much better.
Exactly. Exactly. Just kind of letting those things go. Yeah. So, if you were speaking to
any registered dietitian who is looking, who's thinking about taking the insurance, what,
what would be their first steps? Yeah. So their first step is, so their first step is they want to,
I kind of call it like the pre credentialing step. So, like, they need to get an NPI. So, like,
a natural, a national provider number, um, that's free. They would do that on the website npps.com.
That's where they would apply. It's free. I'm a big believer, you know, I do a lot of screening
before I accept people into my practice is I want them to have a business entity set up. So, like,
I want them to be an LLC or a PLLC depending upon their state or an S Corp. So, I think what I see,
or at least what I can tell you what I did and I don't recommend it was, I became a sole proprietor
and I went right into my, you know, into my practice because I didn't know any better. And I didn't,
I didn't, you know, I always say to my clients, like, slow down to speed up. And, you know, and so that
created a lot of issues when I did switch to an S Corp down the road. I went from a sole proprietor
right to an S Corp, which is not something that I would recommend. So, I want you to have your
business set up. I want you to have an NPI. I want you to have an EIN, which will be associated
with your business. And then I need you to have liability insurance. Now, in EIN, just for those of
you who don't know, is an employee identification number? Yes. And you don't have to have employees
to have an EIN, but the government will assign that to you. Yeah. And that's free. And I want to
repeat that that's free because I've had three dietitians, like in the last month, applied in my
program, they played like a company to apply for their EIN. And I'm like, no, you just go to the
IRS website and it will come via email like within like instantaneous. So those are the main
steps. And then you would fill out what's called the CAQH. Um, I like to refer to that as like,
it reminds me, I can't see it reminds me of like when I applied for my internship because everything
was like my application was written out by hand. Um, but DICAS right now, it's almost like a data
suppository where you put out information or like I would equate it. Maybe it's not even a thing,
but when I applied to college in the 90s, like we had the common app, right? And so like we put all
of the same information in that application. So we only had to do it once. Um, and so once you have
the CAQH completed in its entirety, it's in its just basically like your history, like if you have
a license in your state, your liability insurance. So by creating that profile, the insurance
companies only have to circle back to that and check that to see. So it was nearly almost as a
common app for all of the insurance companies. Yes. Right. So Blue Shield, Etna, Sigma, they're all
going to go to CAQH to say, okay, yes. There's Amy's profile, you know, we're either going to accept her
or Noah. Yeah. Yeah. And most of the time, yeah. And as long as it's accurate, like, you know,
no need. Um, and so then once that's complete, then you can reach out to the insurance companies.
And so I used to think it was like such a mystery, like who, like who are the providers,
but the reality is that there's only really five big ones in all that state. So it's Etna,
Sigma, your state's Blue Cross Blue Shield product, United Health Care, and then Medicare,
you know, um, certain states there is Medicaid coverage and the academy is working really hard
to come up with almost like a unit. There's nothing universal about Medicaid, but what the academy
is doing now is they are trying to find information on each of the states. So we can see where, you
know, where there is breakdown and what each state has, but right now Medicaid is not always covered.
But okay. Yeah. But those are the major ones. And so you apply to them. Um, and I think the hardest
part for dietitians is that waiting period because it can be, you know, the credentialing process
where they are looking at your information, that can take like 30 to 60 days. And then once they
look at your information, they send your application to contracting, that can take another 30 to 60 days
as well. So I'm talking about three to four months. Yeah. Yes. Exactly. Exactly. I'm sorry. Yeah. So,
so in certain, in certain states, I mean, the good, the good or the bad thing is because I've
worked with dietitians in every single state, I can, if you have questions, I can tell you like
North Carolina, you're going to wait seven months for your, you know, your Blue Cross Blue Shield
products, New Jersey. It's going to go much quicker. It's going to be like two months.
Connecticut is probably going to be six months. So, you know, so certain states will go quicker
in terms of what their credentialing boards look like. But on average, I would say you can expect
a contract within six months. Yeah. Yeah. So this, so this is something that you can do as soon as
you are credentialed like you're, you're already or CNS, right? As you have that. And as soon as you
have insurance coverage, because it's mandated, right? That we have malpractice insurance.
Then you can start this application process. So if I'm working part-time in clinical, can I
start this process? Absolutely. And if you're working for somebody else, I just did an Instagram
story today on that because I'm seeing a lot of dietitians working for some of these like telehealth
companies like Fay and Barry Street and Nourish or working for like another institution like I did.
I worked at Yale for seven years and they, they credential, you know, I was credentialed under them.
Right. And I was very clear with them, you know, that I would be starting my private practice
someday. So I did sign like a non-solicitation and non-compete. That wasn't an issue. And I had built
my business while I was working there. And it wasn't like, it wasn't like under the rug. I wasn't
promoting it while I was at my job. But because it comes back to my why of being a good human,
I feel like I would not be being a good human if I wasn't, you know, clear with my intentions.
Like brain eyebrows is like clear as kind. And once again, I always say like choose kindness
whenever you can. So it, that's why I did it that way. And I have seen a lot as of lately,
dietitians who are working for other practices doing this. Like they're, so they can credential
themselves, but they are not all you so transparent. So at the end, it becomes, you know, rough rolling.
Yeah, great. Just, just asking the question, I think it's important if you're working for another
practice or you're doing virtual counseling, understand, I mean, some of the, these companies,
they have rules. They have non-compete, which says, yeah, you can do, yes, you can do employee
ones. There's so many other things that you can do. Yeah. You can contact work and play
wellness programs, but you can't offer medical nutrition therapy. And you can't solicit our,
you know, right? You know, at the same time, like, you know, I'm not adverse to that, you know,
especially because I think that, you know, I, and maybe you, you could probably comment on this too.
But I want to be very clear that while I, you know, I have a successful private practice,
and I would consider, you know, myself full time, you know, between that and the coaching work,
full time and the coaching, I often feel like it's the wizard of Oz that we, like, I love my job
as a private practice dietitian, but I feel like sometimes, you know, in our space, we put private
practice or working for yourself on this pedestal that sometimes, like, I don't know if it's always,
you know, it's like, you can define success whatever way you want it to be. Like, sometimes people
feel bad if they're working clinical and their side hustling, or they're like, they have a
couple different jobs. Like, to me, that's not inferior. That's just, you know, like, you know,
you need to be an adult and you need to make money and you need to do whatever way works for you.
Exactly. Because you're not in full time private practice, whatever that means or looks like for you,
it doesn't mean that you're any, like, I, you know, I mean, it's like this concept of working
for yourself is like, the be all end all of life. It's like the wizard of Oz, and then you pull
back the curtain. It's like this little, you know, this little guy with like, you know, you know,
But it's like from like
I feel like we've done that and I know and I always say to myself like am I part of this
problem by being a coach and but I want people to really understand that like your version
of success is going to look different than my version of success yeah and it's just like
I feel like we we need to do a better job like you know it's like it doesn't have to be
full-time you don't have to go all in if you do like I got you boo but like if not like
I still love and respect everything you do because we need dietitians in long-term care
we need dietitians in the hospital like so I just want to be very clear while I have
no regrets about doing what I did you know if I couldn't continue to do what I was doing
I might go work at Target versus you know what I mean like I would do it right right
right so just like ripping your toe into the water of private practice to see if it's
for you and you may not like so many things to me like the other day they're like you
know it's like you inspire me I want to be like you know like most days I don't want to
be me like I like like not like it is not all like you know like rainbows and unicorns
but I do I don't have any regrets because I think that's when we grow is when it's messy
but it's not it's not it's not this in I hope that we're able to do a better job at
gaining the realistic version of running of business of right whether it be insurance
fees or cash fees like right it is it is it is kind of it's kind of hard now I think you
know if I were starting a private practice now there's just a lot of mixed messaging
so a lot of noise and yeah a lot of noise and kind of making you feel bad like oh if
you're not hitting them $10,000 a month it's like what is that you know with a cash
based practice like you're you know you're not successful and that's just not the case
or you know it takes a long time to get to that point right and also going back to your
values like what are your values and for some people they just want to contribute or
a lot of I give a lot of dieticians like they've been out of the work you know they were
like a full-time stay at home mom which is amazing and now they're coming back and they
just want to contribute or I work with a lot of retired dieticians like in their 60s
they just want to like hone their clinical skills like they're retired some of them even
have these crazy pensions because maybe they work for the VA right they want to see some
patients on the side so I love what you said it's like we see all of these screenshots
of everybody making like $10,000 a year but the reality is like they got a month a month
a month. I'm sorry. I'm making not a round of money. Exactly. But they may be spending, you know,
like, you know, you know, it's like 9,909. That's not that these business coaches aren't showing
that side as well. So, you know, I think that's one of the things we can do better as coaches
as is to coach our, you know, our clients about finances and not there's two sides to that.
Yes. I'm running running an efficient practice, right? A profitable practice. Exactly. That's very
different like that. What let the messaging go? You can absolutely achieve a six-figure practice,
but it's not going to, it's not going to be overnight. Number one, and it is a process,
right? So paying attention to the process. One of the things that I wanted to talk about today was
the idea of a hybrid model in a private practice because that is probably the number one question.
And your name always comes up. That is a number one question I hear in private Facebook groups.
Like, yes, I take insurance. I want to serve my patients, but insurance is limiting. It doesn't
cover a lot of things, right? So for me, for example, Amy, when I was in, I'm a culinary
dietician. I have a teaching kitchen that I'm standing in now. I wanted to offer a group,
you know, culinary nutrition education classes. And we did, but insurance paid $8 per hour, right?
Like, wasn't right where we were going to go with that. And so we ended up being self-pay for those.
I want you to kind of share your thoughts around that. Yeah. And I'm only laughing because when I
first started my practice in 2007, well, yeah, 2007, you know, I exclusively focused on eating
disorders and division one athletes. And I very quickly found that that was not bringing me
any joy. And I actually pivoted it and now we see everything but eating disorders in my practice.
But I started a PCOS clinic when I was at Yale in 2010. And so as I was building out my practice
before I knew really like the ins and outs of insurance, I was still learning, right? I was
selling high ticket packages and integrating them with insurance before I really knew exactly
what I was doing. And so if you fast forward now into 2024, I started my practice selling
programs and packages. And I'll talk about what that includes. But I don't want to say I was doing
it before it was cool. I was only doing it because I wanted to get the best outcomes in my patients.
And during it from a service person to do my service. And so, yeah. And I'm sure you see that
is like, and I think like I always want to serve for a cell second. And so like if I can deliver
extra value or value and my clients feel that, you know what I mean? They're going to want to
continue working with me. So I don't have to worry about the selling. Yeah, you don't have
anything, right? If you're serving with integrity, oh, showing up with a shaman, you will never
have to worry about selling. But on the flip side, I'm going to be very clear is that in our space,
a lot of times, people will seek me out because like they're looking to make like passive income
or they want to make more money. And I'm like, but does this model, you know, does this hybrid
model, which we're trying to, but like does this fit your population? Right? Because like you don't
want to be selling to get you shouldn't have to sell something that they already know that they
need. If you've done your homework and you've created these products and services that align
perfectly with your ideal client, their hands should be going like they should be asking you about
it before you even tell them about it. So in if they're not, then we have to go back and refine
that. So I was selling PCOS, you know, programs. And so what that entailed was like a meal plan.
Back in the day, like we didn't have a ton of, you know, meal planning software. There used to be
like Kaisen or something, that maybe it was an EMR, like stuff was so old back there. So I was using
Dietmaster Pro, which was at the time, like the only program. So I would do customized meal plans
as part of the service. I do metabolism testing. We do dexatesting. You know, we do a lot of
body fat because I was working with women with PCOS and we were recording the data. I was selling
like some supplements, which I had private labeled on, but not like not like that burner. You know,
no need like this that work truly like they needed to buy a vitamin D because they, you know,
they had like a vitamin D of like four, you know, right? Like some it's like, they might as well
buy them for me. So with the way that it happens with programs packages, whether you be a functional
dietitian doing like GI mapping or all of dutch testing, all of those things, you can bill insurance
for the face to face time you spend with the client. So, but you, you can charge the client
for anything that is non-MNT. Okay. So if you're running a culinary program, you know, I always
tell people with culinary programs, like eating disorder, meal supervision, you can kind of decide
from an insurance based standpoint, like where you want that to fall because sometimes there is,
you know, there is MNT or is it really education? You know, I'm not here to, you know, define the
difference, but you always want to ask yourself as you are building out these hybrid products. Like,
are these high value to my clients or are these things that I just want to make some money on?
And I'll give an example because this one kills me every time. It's like, everybody is like, oh,
you know, I use like practice better. I use this and like, I do like email check-ins. And I'm like,
oh, that sounds so painful for me. Like, you're writing these, like, these manifestos. Like,
why not just bring them in for a visit? Oh, I want to try. I'm like, no matter what amount of money
you charge for that, like, it's never going to be worth your time. So a hybrid model can be amazing
if it is always serving first. You know, it's not like a shiny object, like, memberships, right?
Like, everybody wants to run these memberships. And I'm like, like, are you, like, does it serve
your people? Like, you know, and me and see you're working with eating disorders? Like, are they
going to really show up? Like, you know, and that's a whole, you know, so you have to, as you teach
everyone, you have to know your audience and you design products and services in response to them.
You don't develop them because you think they're really cool and they're going to make you a lot of
money because those are the ones that fail every time. So like, so say I would sell like a six-month
package. I would be meeting with that patient probably every two weeks. I'd be billing insurance
for those sessions. And then they all occur services like the metabolism, texting, the dexos,
the meal plans. All of those things are communicated to be, you know, off the clock. So I would charge
them. I would also make sure, because I'm a very transparent person, that I wasn't selling somebody
like a bag of poop. And so like, when we sit down, I'm like, okay, this is what your insurance
covers. And I would create a liability for them. So like, I can't bill insurance for these things.
And these are the reasons why, you know, are you okay with that? It wasn't like, hey, like,
PS, like, you know, like two weeks later, like, you know, you're going to wire me the two great,
you know, no, I mean, it's all about like that integrity, right? Because, yeah, you know,
because sometimes dieticians don't want to sell. They're like, oh, I'm just going to send them an
you know, with a link to buy and I'm like, oh, this is so crazy and messed up. You know, I would,
I would offer a bit of advice there. You know, I'm really envisioning myself in my counseling room
upstairs, which I'm not in much anymore. I'm usually in the kitchen. But, you know, having a client
there and trying to communicate to them that insurance will cover this, the best way
for me to help you meet your health goals
is with the other, you know,
these other valuable interactions
that we can have outside of the insurance payments.
So, and then just lay it out.
Like you're not, it's not like,
hey, why are we $2,000 a month right?
Exactly.
Yeah, and I see you use the language like, you know,
'cause people ask me all the time,
like how do I sell these products?
You say, you position yourself as the expert,
not in a sleazy way.
You say, in my professional experience,
metabolism testing is effective
because of X, Y, it's not like you, you know,
and I mean like you're coming from a place
that like you want to help them on the flip side, right?
You also don't want to sell somebody something
that's not going to be helpful.
Like, if I know one of my clients needs to move,
move more and eat less,
there's no value in me selling them on a $200 metabolism test
because then I'm focused, you know,
and I mean like, they don't need that.
And so, digestion needs to recognize
that these are all tools that you have in your toolbox.
That can be very helpful, but you're the professional
and you need to decide who,
it's not like your patients come in
and they're like, I want this package
or I want that package.
You tell them, right?
You see to them, like in my expert opinion,
based on what you're telling me,
I think this is the best.
And a lot of times,
and I think that's maybe also even in a coaching,
some people will come to me and they're like,
I know, I'm like, no, no, no, no, no,
you're not a candidate for this.
I mean, you know what I mean?
Well, I want it.
No, no, no, no, you're not a candidate for this.
This is what I mean.
It's not going to be helpful for you, right?
You're not going to get the value that you are hoping.
It's interesting that that was a conversation I had
and I was saying about meal plans.
Now I'm in the meal planning business.
I buy a special package and people will come in
and say, I want a meal plan.
I'm like, okay, well, why?
Why do you want a meal plan?
And they would, you know, tell me the reasons why
and those reasons were not going to be solved
with a meal plan.
And so we would pivot to something else,
say the meal plan might be appropriate in about a month,
but let's work on this first, right?
And I just, I'm offering up this phrase
because it's in my head and it's something
that I learned from one of my mentors
and business coaches, Colin Boyd,
that serving, if you're serving with all of your heart,
that is your selling.
Like you're never going to have to quote unquote sell, right?
And you'll kind of icky about it.
You know, really saying that in order for me to serve you
as best as I can and to support you with meeting your health
goes, this is what it looks like.
I'm really just laying it out.
And, you know, people can say, no, if they say, you know,
if you're afraid of the no,
you're going to be in really big trouble
because you are going to hear no.
And then that's that kind of patient.
But, you know, I would say there are going to be a certain
percentage, it's a numbers game, right?
A certain percentage of patients who are sitting in front
of you and if you're serving the way that you need to
and adding huge value, you know, it's the same
with the memberships too.
I like that you brought that up too, Amy,
because I think that that fits really well
into insurance base because especially if you have clients
who are coming in regularly because they have what,
you know, 28 visits a year or unlimited, right?
They're coming in to see you.
And then in between, this is what, whatever, you know,
the $99 a month is going to go through.
These are all, this is all the value
that I can support you with, right?
We're going to have group council, you know, group calls.
We're going to be cooking demos together.
I'm going to give you meal plans.
And, you know, that that's an easy yes, right?
But, would you want to 10 times that value?
So, like what I do in my memberships,
I'm like, you get X, Y and Z.
And then I give them the whole rest of the alphabet.
I'm like, I'm bringing in like a CPA.
And like, we've got, you know, I mean,
it's like, you always want it 10 times deliver.
So, it's like, you promise them,
you know, I mean these three things.
And everybody's like, oh my God.
Like, and you have to ask them what they want.
So, I survey them, you know, the way that my membership
was literally like the OG, the OG team of the original people
that did the, like my original program, which I smashed.
And it's like, you know, incarnation, like one million,
whatever, they told me they wanted.
More.
And I was like, like, give me a couple of weeks.
Like, let me figure this out.
And I am sincere when I tell you the original OGs from 2019.
They are still in the membership.
I think like all but one, you know, I mean,
and there's 192 people in there.
So, I think if you, if you do best by your people
and you ask them what they need,
I always say like our job as mentors, coaches,
dietitians, we give people a little bit of what they need
and a little bit of what they want, right?
So, it's our job to figure that out.
- Yeah.
- But yeah, it tends to be shiny objects.
But if you do it, right, it can like, oh, I love it.
I love my member.
Like I love that, it's great.
And you know, this, what Amy is really alluding to
for people who have listened to the podcast before
been on any of my workshops,
it's this idea of an irresistible offer.
- Yes.
- New hands name offer, right?
You, you, you have to make it.
So, they actually, it's Alex Hermosi who said this, right?
Like the person who was looking at your offer asked this,
he's like, oh my gosh, like why wouldn't I do that?
Like look at all of the support and the stuff
that I'm going to get as part of it.
And the great thing about memberships is that you can put them,
you know, on, on repeat.
Like it's rinse and repeat, right?
You're delivering the same kind of service
every single month, but with different content, right?
That's why living platarics makes so much sense
for private practice dietitians.
I literally, I give you content not only every month,
but you now have four years behind you,
where you just go into the library and say,
okay, what am I going to, what, you know,
what cooking today is I'm going to provide this week?
What, what this month?
What meal plans?
What education, you know, this is so much
that he had the expense of a lot of hard work.
And not so far as, of course.
- Of course, of course.
- Yes, you rinse and you repeat,
but like you, you have been nurturing this thing
from the time it existed in your head.
And so like, you know, it's like a membership,
I think sometimes people just think it's like,
if you throw enough stuff at the wall, it's going to stick.
Well, it's only going to stick for a short period of time
until people, you know, you have a very high chart,
you know, but like, right, I think it's important
that people know if they are thinking
or contemplating memberships is that like,
it's your blood, sweat and tears.
It's like, you know what I mean?
It's hours and hours of content and you know, you mean,
sorry, I just want to make sure that,
'cause it's like, what you just said,
it's like, it's to me, I'm like, oh my God,
it's like so much work.
Like, I will pay anybody for like done services like that.
Like, you know, since idea of concierge medicine
and so, you know, for you and I,
we're using the language of memberships,
but in private practice, it really is concierge care.
And you, you know, you could even position it,
you know, if you have even clients
who are using insurance for your practice services,
differently with concierge doctors
and kind of what that looks like.
So how cool is it that they can use their insurance
to pay for part of your services?
And then you have this whole concierge thing on the side, right?
And you have limited enrollment,
which kind of, you know, makes it a little bit more,
you know, if you limit enrollment to your membership,
you can show up at a point back to the original point,
that Amy was making was served with all your soul,
served with all your heart,
show up as a good human.
It's kind of hard to do that if you're,
you know, if you don't have the infrastructure
to support large membership, right?
So, so you can start, so the answer then is yes.
You can have a hybrid practice model.
You can accept insurance for the face to face,
MNT care, and then all of the other services.
And honestly, again, practitioners who are listening,
you absolutely can justify those additional services,
because we all know that better outcomes are going to happen
with those added services and with that added support.
And that's what you lead with, right?
And, you know, when you're sharing this with your patients,
like, you know, my patients who are in my concierge program,
they're the ones who get the best results.
And here's why, right?
So, filming doesn't have to be, hey,
you don't have this membership, do you want to buy it?
Nothing you would say that way,
but, you know, just don't be afraid to experiment
with that a little bit.
And Amy, I think the best way to start a membership,
kind of like a hybrid program,
is to do the limited enrollment.
Say, look, I'm cooking on 10 new clients.
I think you're a really good candidate.
Is this something that you think you might want to go?
But then just what you said, Amy, once you have buy-in,
that's actually where the real work begins,
because you have to continue to show up
and deliver value every single month to retain those clients,
because a membership is only as good as its retention rate.
Yes, of course.
If you've got a churn rate of 40, 50%,
that's not a membership.
No, no, no.
You need to keep your retention, you know,
really high in your attrition really low.
Absolutely, absolutely.
But that takes a lot of work.
And that's okay.
It can be, Mama, comma, and that's okay.
But, you know, like, yeah.
So it's like, yeah, that's like very,
I take my job very seriously, like as a coach,
and I think that's, you know what I mean?
That's like, that's where I want to over-deliver.
So, but I see so many people like shiny objects,
and it's funny when I serve in my membership,
I'm like, what do you guys want more help with?
They're like, growing a membership.
I'm like, really?
I don't know, trust me.
It sounds, you know, it sounds great, right?
Because, but there is no passive income.
And that doesn't really exist.
No.
I've had Facebook ads and, you know,
the money comes in from the Facebook ads,
and you stop to pay attention.
Like, it's not, there really is no passive income.
But, you know, it can be a better trade-off,
like, hours for dollars, right?
Yes, of course.
And so the membership can make sense.
And, again, diversifying your practice
and having different streams of income.
So you'll have the membership.
You'll have the insurance base.
Now, your insurance based practice,
that's going to be your solid.
Sure.
That's your bread and voter.
That's it.
Right, yeah.
And then everything else.
And this, the memberships are extra.
And that's gravy and that's great.
But we also don't want to, you know, a lot of times,
like we don't want to, like,
you want to focus on the things that are important.
And sometimes things that are important
get a little muddy.
And that's why coaches like us are able to, like,
okay, like, this is, you know, okay,
you know, bring you back to reality.
And those things are great.
But to me, they're always insolary.
I have a question for you that just came up.
So, I'm credentialed with the insurance companies.
I start my membership program going really well, right?
So, I have clients and now it's getting to be a bit much.
And maybe I can't take as many clients who are coming to me
from the insurance companies.
Yeah, I can see that that is a problem because from what I remember,
if you are credentialed with insurance, you cannot turn somebody away.
You can't say, "No, I can't help you, I can't serve you."
You can refer them out.
You can refer them out.
Yeah, so that's why it's good to network.
So, we don't do intuitive eating.
I know who to send them to.
Somebody comes to us and we can't service them.
You do have to refer them out.
But if it's general, right?
If it's down there, yeah.
So, you need to be a little bit careful there.
So, again, having a limited enrollment membership
or a limited enrollment program might be a good place to start
until you find your sweet spot.
And it's always going to be a balancing act, right?
You're always going to have to be figuring it out.
But this conversation has been so great.
And I hope that those who are listening
who are thinking about taking insurance
or those who already are credentialed
and taking insurance are thinking about, you know,
how can I leverage insurance to not just, you know,
grow a practice to X amount of dollars,
but really create a life that you want, right?
In your practice, right?
One where you can show up, you can serve, love, you know,
what, having your clients come in, have success
and then also, you know, have a family life too
and a personal life outside.
So, please share with our listeners, Amy.
You can reach out to you.
I know you're going to be for our content cure this week.
You have so generously offered to give us
a bunch of resources, which I'm going to have a link
for everybody, absolutely.
But if you could just share with us
and give us your social location.
So, yeah, for sure.
So, I had a website.
It's called reimbursementdientition.com.
When I, when I made it, my dad was like,
"That is an awful name."
And I'm like, "Dad, SEO."
And I'm like, "Yeah, that's my diet mission.
It's not like we all know our reimbursement."
Exactly.
I'm like, "It's, so it's reimbursementdientition.com."
"Okay, you need to find me."
And I have tons of blogs, resources.
I'm embarrassed to say this,
but I have a YouTube channel as well.
I can't blog.
Why are you embarrassed?
Well, it's just like so.
Because I'm so not like cool.
Like, I feel like cool people have like social media.
Like, I'm like, you know, I'm not really super hip.
But like, my YouTube channel is like, really good.
Because I see the questions that are out in the community.
And then I just show up and I answer them.
So, maybe YouTube channel under the same name,
so reimbursementdientition.
And then where I am, the most active,
which is also really funny,
because I didn't have a social media account
until I started reimbursementdientition is on Instagram.
So, every single day, I show up and I do a story
that's contemporary.
So, like, if I saw something in the public Facebook page,
and then I saved them to the highlight.
So, if you have a question on something
that happened in California,
or you have a question on Etna,
you can go and kind of. Yeah, so I like to continue them of resources,
meaning like, if you can never ever, ever afford my services,
I want you to be able to consume them anyway.
So, you know, there's probably more free ways to consume.
Yeah, and so that's where I'm the most active.
I run a coaching program for dieticians
and CNS is looking to accept insurance.
My membership is invite only or if you've graduated
from my coaching program.
So, you're not. It's not open to the public.
So, but sometimes people are more advanced
and they're a better fit for that, you know?
Yeah, just like I'm always happy to help.
And I think that, you know, I started my business,
like with no products or services,
just showing up to help dieticians.
And like, that hasn't changed, you know what I mean?
So, I want more people, you know,
I want to be more. I want to be the forward-facing as dieticians,
the nutrition experts, you know, making it impact.
So, yeah, and I just. I love my job.
It's very, very clear.
Thank you so much for sharing your passion,
your wisdom and all this great information.
And I'm looking forward to seeing you in person.
Yes, that happened.
Thanks, Amy.
Awesome.
And now for your content cure for this week.
Amy has put together a bundle of resources
to support you with exploring insurance-based
and hybrid payment models in your practice.
Amy's reputation is stellar.
With every colleague review I have read noting
that whatever investment was made in her programs
was earned back tenfold.
If you are looking to be insurance-based,
I strongly encourage you to go through this
to content cure bundle and consider her programs.
That's it for today.
Thank you for joining me.
I trust that you found value in this episode.
Be sure to follow this podcast
and remember to download your resources in the show notes.
Visit us at livingplateRx.com
for complete show notes and access
to all the evidence-based nutrition content
you need to create a thriving practice
that serves up the most delicious
and irresistible content your clients are looking for.
And don't forget to tune in again next Tuesday
as we continue to explore the latest trends
in nutrition content marketing.
Podcast Summary
Key Points:
Amy Plano, the reimbursement dietitian, helps dietitians build insurance-based practices to make money and increase care accessibility.
Accepting insurance allows dietitians to make an impact while earning good money, as patients prefer providers who accept their benefits.
Doctors are more likely to refer to dietitians who accept insurance, which can open up a floodgate of referrals.
The credentialing process involves getting an NPI, setting up a business entity like an LLC, obtaining an EIN, and securing liability insurance.
Dietitians must complete a CAQH profile, which acts like a common application for insurance companies, before applying to major insurers.
Credentialing can take three to six months, with waiting times varying by state and insurance company.
A hybrid model allows dietitians to bill insurance for face-to-face medical nutrition therapy while charging for non-MNT services like meal plans or testing.
Success in an insurance-based practice depends on retention, showing up as a good human, and delivering high value to patients.
Dietitians should avoid shiny objects and instead design products and services based on their clients' needs, not just to make money.
Serving with integrity and transparency is key, as serving with all your heart is your selling.
Summary:
In this podcast episode, host Jeannie Patrucci interviews Amy Plano, the reimbursement dietitian, who advocates for insurance-based private practices for dietitians. Amy shares her journey from working at Yale to building a multi-six-figure practice that is almost exclusively insurance-based, proving that success doesn't require a self-pay model. She emphasizes that accepting insurance makes care accessible, allows dietitians to make an impact while earning well, and attracts referrals from doctors who prefer to send patients to in-network providers.
Amy outlines the initial steps for getting started, including obtaining an NPI, setting up a business entity, getting an EIN, and securing liability insurance. She explains the CAQH process as a common application for insurers and notes that credentialing can take three to six months depending on the state. She also discusses the hybrid model, where dietitians bill insurance for medical nutrition therapy sessions but charge for additional services like meal plans or metabolism testing, always ensuring transparency and value.
Throughout, Amy stresses the importance of retention, serving with integrity, and designing products based on client needs rather than chasing trends. She encourages dietitians to define success on their own terms, whether full-time or part-time, and to focus on being a good human as the foundation of a thriving practice. The conversation highlights that insurance-based practices can be profitable and sustainable when approached with the right mindset and support.
FAQs
Accepting insurance makes care more accessible to a broader range of patients, allowing you to make an impact while earning good money. Many patients have insurance benefits that cover nutrition services, and they are more likely to see a dietitian who accepts their insurance. It also opens the door for referrals from doctors who prefer to refer to insurance-based dietitians.
The first steps include getting a National Provider Identifier (NPI) for free, setting up a business entity like an LLC or S Corp, obtaining an Employer Identification Number (EIN) from the IRS, and securing liability insurance. Then, you complete a CAQH profile, which serves as a common application for insurance companies.
The credentialing process can take about 30 to 60 days for review, followed by another 30 to 60 days for contracting, so on average, you can expect a contract within about three to six months. The exact timeline varies by state and insurance company.
Yes, you can absolutely have a thriving insurance-based practice. Amy Plano's practice is almost exclusively insurance-based and easily generates a multi-six-figure salary, proving that success is possible without relying on self-pay or high-ticket programs.
Yes, you can bill insurance for face-to-face medical nutrition therapy (MNT) sessions and charge clients separately for non-MNT services like meal plans, metabolism testing, or group classes. Ensure these add-ons are high-value and serve your clients' needs first, not just as money-making schemes.
Absolutely, you can start the credentialing process while working part-time or for another employer. However, check your employment contract for non-compete or non-solicitation clauses, and be transparent with your employer about your intentions to avoid conflicts.
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