Episode 234 | Transforming Out-of-Network Therapy Reimbursements with Mentaya

Maureen Werrbach (00:00:01) – If you’re listening to the Group Practice Exchange podcast, where the business development resource for group practice owners, where we talk candidly about business ownership and leadership. I’m your host, Maureen Werrbach. 

 

This episode is sponsored by Therapy Notes. Therapy notes is my favorite EHR, and it’s one that I’ve been using in my own group practice since 2014. They’ve got everything you need to be successful in your group practice, and they’re constantly making updates and have live support. If you want two free months of therapy notes, go to therapynotes.com/r/thegrouppracticeexchange. 

 

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Maureen Werrbach (00:01:20) – Hey everyone! Welcome to another episode of the Group Practice Exchange podcast. Today I have Christine Lee. She is the founder and CEO of Mentaya. This is this newest company that I have been sort of delving into and really enjoying. And so I’m really excited to have you on, Christine, to talk about Mentaya, what it does for solo and group practice owners when it comes to improving booking out of network sessions, and just sort of like the evolution of mentira and how it can support clinicians. So thank you for coming on.

 

Chrstine Li (00:01:45) – Of course. Thank you so much for having me.

 

Maureen Werrbach (00:01:47) – So start with just because I know you are new to my audience. And so my audience is just like starting to hear rumblings of Mentaya from me. Can you talk a little bit about it? Like what made you start with this? I know you were like in Google, right? You were a product manager or something like that in Google. And so in mental health now.

 

Chrstine Li (00:02:04) – Yes. So I come from the tech world. I’ll give you a quick backstory on myself. So I’m in San Francisco. I grew up in the Bay Area in California, and I’ve been interested in mental health for a long time. I went to a high school with a lot of mental health issues, and so I saw how much mental health had affected people’s lives at a pretty young age.

 

Chrstine Li (00:02:25) – And I think ever since then, I’ve realized the significance that mental health could have on people’s lives. And so I think that’s sort of where it all started. I was always a huge math nerd in high school and college, and I ended up studying computer science and doing my senior thesis on mental health and, you know, using technology to improve patient outcomes and mental health care, trying to support therapists and private practice, and ended up going to Google because I wanted to do product. And so I was a product manager at Google for several years. And then I left over two years ago now in 2021, because it was Covid. I think a lot of people were starting to talk a lot more about mental health. And I was like, I really want to make a difference in this space. And I wanted to figure out if there was a way to leverage what I learned from working at Google as a product manager, to see if there was something I could build in this space to help both clients and therapists at the same time.

 

Chrstine Li (00:03:21) – Because I know a lot of times in health care, the incentives aren’t always aligned. And so I wanted to see if there’s something that I could do that was a win win for both.

 

Maureen Werrbach (00:03:29) – So Mentaya, tell people, what does this business do for clients and clinicians?

 

Chrstine Li (00:03:38) – We help clients use their what’s called insurance out-of-network benefits to get up to 80% back on therapy. A lot of therapists don’t take insurance, as I’m sure we all know, because, you know, for various reasons you don’t get paid as much, etc.. And so a lot of people don’t realize that they can get anywhere from 50 to 80% back on private pay therapy sessions. And so obviously for clients, it’s like, here’s free money that you otherwise didn’t realize you could get back and save on therapy and on the therapist side and on the practice side, what we do is we’re kind of a marketing tool, almost, for you to attract more private pay clients, because if clients know that they can get reimbursed, they’re much more likely to start private therapy with you and stay in therapy for as long as they need instead of, you know, stopping or reducing the number of sessions because of financial reasons.

 

Maureen Werrbach (00:04:30) – I love this, and I obviously have a small piece of knowledge about your business from the perspective that my own group practice uses your services, but we accept insurance, so we use your services in a very specific way. I would love for you to share what are all of the different ways, the different tools and resources that you have that support out-of-network reimbursements for private pay clients?

 

Chrstine Li (00:04:57) – Yeah. So we have two main tools that practices and therapists and clients can use. The first one is this instant benefits calculator, which I believe that you’re using as well.

 

Maureen Werrbach (00:05:09) – I love it.

 

Chrstine Li (00:05:10) – Awesome. I’m so glad to hear that. This is basically a cool little widget or tool that you can either use an app you can put on your website, but what? It does is all you need to do is get the client’s name, date of birth, and insurance ID, and we can automatically calculate what their benefits are. We can see if they have these out-of-network benefits, what their deductible is, how much they can get reimbursed for therapy just so the client is fully informed on, you know, the amount that they can save.

 

Chrstine Li (00:05:36) – And it’s not just like, you know, I don’t take your insurance. Here’s my private pay fee. That’s it. They actually know what their insurance benefits are. And so this has really helped a lot of practices get a lot of clients who are maybe on the fence about paying their private pay rate for therapy. And so that’s kind of the first part.

 

Maureen Werrbach (00:05:52) – And I want to add to that, is that you can set it up so that you can put in the CPT codes, the different CPT codes that you bill as a practice like initial session, follow up sessions, family couple therapy, and put your out-of-network or full fee rates in there so that when the client or, you know, in our case, we have a person who does our billing and benefits checking if they go in there and look because they’ve been testing it out and they’re like, it is accurate because I’m like, I always am very skeptical of tech being inaccurate. Our therapy notes is what we use for our EHR, and they have like a benefits checker.

 

Maureen Werrbach (00:06:26) – And it is like always a mess. For years it’s been we don’t even use it. And so I’m always like a little skeptical. And when the person who’s in charge of our administrative team is like it is accurate, I’ve checked my benefits, I’ve checked these people’s benefits, and the network benefits are always very accurate, which is great as a business owner. But clients can see because you can input what your out-of-pocket rates are. So when they type their stuff in, it’ll tell them exactly if it’s 50%, what they would owe for a 937, which is really cool.

 

Chrstine Li (00:06:56) – Yeah. So we have different I mean, first of all, it’s awesome to hear just that it’s been accurate. That’s obviously something we care a lot about. We don’t want to be giving false information obviously. And so that’s something that we work really hard on. But it’s great to just hear that validation.

 

Maureen Werrbach (00:07:09) – What my issue with therapy notes has been with their benefit checker is that it doesn’t all just the benefit information for a therapy session.

 

Maureen Werrbach (00:07:20) – It gives us like 40 pages of all their benefits. And we’re like sliding through like, you know, seven size font to like find where mental health is, where this. And it’s like, I don’t need to know about radiation and what the rates are for this. It’s like they haven’t been able to make it really concise and you guys really have. It’s so clean and simple and accurate.

 

Chrstine Li (00:07:41) – Yeah. Well I appreciate that. That’s something that we definitely put thought into with the design. Because basically what we’re saving people on is time. And just the confusion and frustration from having to call insurance companies or deal with insurance companies or have the practice do it on their behalf. Yeah. And we’re also helping simplify things so that you only really see the information you need to know, which is what is the, you know, private pay fee, that as a therapist or practice you can input yourself, you know, as you said, like individual therapy, group therapy, etc. and also what the deductible is and what the co-insurance.

 

Chrstine Li (00:08:14) – Otherwise the amount that you could, you know, be reimbursed is. And we want to simplify it into language that’s easy for anyone to understand because insurance is complicated and no one wants to deal with that.

 

Maureen Werrbach (00:08:24) – Right? Okay. So this one I know about what other tools or resources do you have?

 

Chrstine Li (00:08:29) – So the second part of our core product is this automated claim submission tool. And so let’s say you have private pay clients and they’re like okay great I know my benefits now what a lot of therapists traditionally are like, oh well I can give you a super bill. You know, you can just submit it to your insurance, which is fine. That’s better than nothing, obviously. But I think the issue with that is a lot of clients don’t really understand what a super bill is. They don’t really know how to submit it. Sometimes you have to fax it in, you have to fill out a form, all these different things. And a lot of times therapists are surprised that clients don’t even submit it.

 

Chrstine Li (00:09:02) – Yeah, I.

 

Maureen Werrbach (00:09:03) – Know I’ve done it as a client myself. My therapist is out of network and my kid’s therapists are both out of network, and I just I never asked for super Bill. It feels like extra steps in my life personally that I seem to just be like, oh, I’ll just pay the full rate. Yeah.

 

Chrstine Li (00:09:20) – And that’s what I think a lot of people say. They’re like, I just, I can just pay the full rate or like, I’m never going to submit or I don’t know if I’m going to get money back or even I’ve submitted it and I haven’t heard back for like a year, like what’s going on. But obviously if you’re saving hundreds or thousands of dollars a year on therapy, like, who wouldn’t want that? And so we have a tool that automates this whole process so that as a practice, you sync your calendar or we, you know, can send you HIPAA compliant texts to just verify if a sessions happen. And if your client wants to use mentira, they can and will automatically submit claims for them so that you don’t have to send them super bills and they don’t have to submit super bills.

 

Chrstine Li (00:09:57) – We just need to know from you as a therapist or as a practice that it wasn’t a no show, that the session actually happened because, you know, we don’t want to be accidentally committing insurance fraud. We just have to assume that the sessions always happen. So it’s super easy.

 

Maureen Werrbach (00:10:11) – That’s really cool. So you were saying it’s like as simple as getting a text notification that. A therapist can respond to and say, yep, we had the session and that would be it.

 

Chrstine Li (00:10:21) – Yeah. So all you have to do is you do have to, you know, have your clients sign up, put in, you know, their date of birth. You have to sign up and put in your NPI, your tax, you know, things like that and your license type. But aside from the one time setup, all we need on a recurring basis is you can either go in the app and click a button, or we can send you a HIPAA compliant text, for example. It’ll be something like, we see that you had a session with client, you know, TJ from 11:00 to 12:00 on Monday, December 11th.

 

Chrstine Li (00:10:54) – Please reply yes to confirm the session has happened and we’ll, you know, automatically submit the claim for your client and all you have to do is just text back. Yes. And we will automatically submit the claim with all the right information and make sure it gets routed to the right insurance company.

 

Maureen Werrbach (00:11:08) – That’s really cool. What are what is the pricing look like for both the website tool, the network benefit checker and the claim submission? Oh, and I want to say that the prices are based off of December 11th, 2023. Because obviously if someone listens to this in five years from now. Costs always go up. So I just want to preface that for anyone listening that these are prices as of today, December 1123. Sounds good.

 

Chrstine Li (00:11:34) – So the pricing is on our website. We are very transparent with their pricing, which is something we’re proud of because I know that not every company is. And so if you go to our website, there is literally a section at the top that says pricing. So you can click around with it.

 

Chrstine Li (00:11:47) – But on the therapist side, the only thing we charge a therapist for is the benefits calculator, the first tool that we sort of talked about and that is optional, that is an optional $29 a month per practice. So right now it’s a really good deal for group practices. It is unlimited benefits checks per month. You can put all your therapists on the widget and it’s just $29 a month, month to month. And that is something that is optional. So if you’re like, I don’t really need this, you don’t have to pay for it. The claim submission piece you can still do for your clients, and that is entirely free for the therapist to do. Now, on the client side, the benefits checker is free for them, but we charge them for the claim submission and we charge clients a 5% fee per claim. So if it’s a $100 session, we charge them $5 per claim, and on average we get clients around 62% reimbursed after meeting their deductible. And so for most clients, it’s a no brainer for them to pay, you know, 5% to get, you know, anywhere from 50 to 80% back on therapy.

 

Chrstine Li (00:12:53) – And that is also on the client side that’s optional for clients right now. Every single client needs to do it. It’s something that a lot of therapists choose to offer their clients and tell them, like, hey, I’ve partnered them and I had to offer you the service. It’s fully optional. You can use it if you want. If you don’t want to, that’s fine as well. But in general, a lot of clients love using it. And, you know, it’s very little work for a therapist to just confirm a session has happened. And on the therapist side, it helps you with client retention, which is awesome as well.

 

Maureen Werrbach (00:13:21) – Yeah. Tell me a little bit about what you’re seeing with that. That was going to be my last question.

 

Chrstine Li (00:13:27) – Oh okay. So for a lot of therapists we’ve noticed that the benefits calculator tool, it’s a really useful marketing tool to get clients in the door in a sense where instead of saying, hey, my fees, you know, $200, I don’t take your insurance.

 

Chrstine Li (00:13:44) – You know, that’s pretty much it.

 

Maureen Werrbach (00:13:46) – Yeah, you can call your insurance, which puts your work on their end.

 

Chrstine Li (00:13:49) – Yeah, exactly. So instead, with Montoya’s automated benefits calculator, you can say, hey, if you have your insurance card ready, I can, you know, I’m happy to run your information through the system right now and see if you have these benefits and how much you get reimbursed. And a lot of clients are really surprised because people don’t realize they have these benefits and can get reimbursed. And so that’s really helped. A lot of practices get a lot more clients in through the door. And then the second part is we have seen that help with client retention. Because obviously if your clients are saving, let’s say like $100 per session on a $200 session, they’re much more likely to stay as long as they need to for therapy instead of being like, ah, can I go once every other week? Can we do once a month? This is really adding up. It’s getting really expensive.

 

Chrstine Li (00:14:34) – And so it’s just it’s at a different point. The first one is for sort of getting clients in the door, and the second one is sort of keeping those clients and making sure they stay for as long as they actually need to.

 

Maureen Werrbach (00:14:44) – I really love that, especially as someone who is very like, affordability minded and wants to make sure that there’s access for everyone to mental health support, while also understanding that the insurance world makes it difficult for practices or clinicians to be able to be in network with every insurance. It’s a great sort of middle space and a support tool for both practices and clinicians and clients. So I really appreciate you bringing this thing into fruition.

 

Chrstine Li (00:15:16) – Yeah. Thank you. I mean, we are all about accessibility while making mental health care more accessible for clients, but also really supporting therapists. And if they choose to be being private pay and not feeling like they have to choose between accessibility and, you know, their own wellbeing, right?

 

Maureen Werrbach (00:15:32) – So to wrap up, so if people are interested in learning more about Mentaya, where should they go? And also I think we have a little code right for clinicians.

 

Chrstine Li (00:15:42) – Yeah. So if you’re listening, the easiest way would be to go to Mint.com. It’s Mentaya.com. That’s our website. From there you can see our pricing, you can sign up. It’s super easy. And we have a special code with all the listeners. The promo code is literally TGPE. And when you create an account, you’ll see a spot to add a promo code and to be able to try out our platform entirely for free. The claim submission is already free for therapists, but we with the code, allow you to try out our automated benefits calculator for 30 days for free. You can try it with your own insurance, test it out, see if you like it, and and then make a decision for yourself if you want to continue using it.

 

Maureen Werrbach (00:16:25) – Well, I totally appreciate you coming on, Christine and sharing this really amazing resource for solo and group practice owners alike. And I look forward to seeing your business grow a ton.

 

Chrstine Li (00:16:37) – Thank you so much.

 

Chrstine Li (00:16:38) – Thanks for having me on here.

 

Maureen Werrbach (00:16:39) – Yeah. Thank you. Thanks for listening. Give us five stars on whatever podcast streaming service you use and I’ll see you next week.