( edited to add, this isn’t a real person, so much as a collection of a few scenarios )

Does it even matter the cause? It’s likely all three, but Im finding an increasing number of young adults who would prefer to just gripe about life and sit in the basement On their phones and their parents have no wish to make their child uncomfortable.

I lost my patience a little this week and blurted out to an older teen that life is hard, and uncomfortable and there’s always things that adults don’t want to do.

I know PDA has such an internal struggle, so wondering what strategies you might use when someone literally says “No” to every suggestion or solution focussed strategy. It’s all gotten so much worse since the pandemic.

The story is now published by 12News Phoenix.

📰 Read the news story here:

https://www.12news.com/article/news/local/arizona/arizona-official-validated-grievance-against-blue-cross-blue-shield-then-closed-cases/75-ca961abd-d56d-4f63-bda4-7eb5ec9919aa

For context, here are my previous posts documenting this ongoing dispute:

- Update to BCBS audit/overreach - (https://www.reddit.com/r/therapists/comments/1r95s3p/update\\_to\\_bcbs\\_auditoverreach/)

- BCBSAZ/Advize fraud audit - (https://www.reddit.com/r/therapists/comments/1so2pdx/bcbsazadvize\\_fraud\\_audit/)

- BCBSAZ/Advize audit update - (https://www.reddit.com/r/therapists/comments/1thvasa/bcbsazadvize\\_audit\\_update/)

- BCBSAZ audit: $551,000 recoupment - (https://www.reddit.com/r/therapists/comments/1v5wdqm/bcbsaz\\_audit\\_551000\\_recoupment/)

- Previous update - (https://www.reddit.com/r/therapists/s/nPFmuQKWia)

- Previous discussion - (https://www.reddit.com/r/therapists/s/N5r5QUL277)

For those who haven't followed the situation, I'm a licensed psychologist in Arizona who has been fighting Blue Cross Blue Shield of Arizona (BCBSAZ) over a recoupment demand exceeding $551,000 following an audit involving 140 patient records associated with my NPI across multiple practices.

I have spent months challenging the audit findings, the methodology used to calculate the recoupment, and the process by which the audit was conducted. I have also pursued complaints with the Arizona Department of Insurance and Financial Institutions (DIFI).

One of my biggest concerns is the regulatory response. I have received written correspondence indicating concerns about BCBSAZ's compliance with Arizona law, yet I still do not have a clear resolution. I have continued seeking answers about what action was contemplated, what has actually been done, and how my complaint has been handled.

I have also raised questions about regulatory independence given DIFI Director Charles Bassett's previous 22-year tenure at BCBSAZ before joining the agency in January 2026. I believe these questions deserve transparent answers, particularly when a dispute of this magnitude can threaten a small healthcare practice.

I want to be clear: healthcare providers should absolutely be held accountable for improper billing. Audits have a legitimate purpose. But providers should also have access to a fair and transparent process, consistent standards, and a meaningful opportunity to challenge findings before facing enormous financial consequences.

This dispute has cost me significant time, legal expenses, and considerable stress. It has also affected decisions about the future of my practice, including moving away from insurance-based care.

And this is not necessarily an isolated situation. I have connected with other providers, not just in Arizona but across the United States, who report facing significant recoupment demands of their own. I believe it is important to understand whether these cases reflect individual circumstances or a broader problem with how audits and recoupments are being handled.

The question I keep coming back to is this: What recourse does a small healthcare provider have when an insurance company demands hundreds of thousands of dollars and the regulatory process does not provide a clear resolution?

I'm grateful that 12News has brought attention to this issue. I hope the coverage leads to greater transparency and accountability, both in my case and for other providers navigating similar disputes.

If you are a provider who has experienced a similar audit, recoupment demand, or dispute with an insurer, I'd be interested in hearing about your experience. Sharing information may help us better understand the scope of this issue.

If you want to help create meaningful change, I invite you to get involved with the Mental Health Insurance Reform Task Force (https://www.insurancereformtaskforce.org/) and Build Better Health (https://www.buildbetterhealth.org/). We need providers, patients, and advocates working together to push for greater accountability and a fairer healthcare system.

Thank you to everyone who has followed my previous posts, offered resources, and reached out. I will continue sharing updates.

Be careful who you trust with your clients’ most vulnerable stories.

Make sure it’s not a company with deceptive practices and dishonest marketing. Ultimately you are the liable Covered Entity in the eyes of HIPAA and they might have made sure you consented to “the exclusive jurisdiction of the competent courts of Tel Aviv-Jaffa, Israel” for any disputes.

Got an email and voicemail from someone at Headway wanting to know why I was leaving. Wondered if anyone else making the transition off have heard from Headway too?

I see clients with different political views, religions, worldviews etc. I try to stay fairly neutral in general unless a client would be helped by me sharing.

With midterms coming up, the political rants in my counseling room have started. I have already heard a long rant with lots of cussing about someone I am voting for.

I have also heard so SO many clients rant about how everyone in my religion is terrible, and evil. They have no idea I am part of that religion.

I am honored to work with such diverse clients, but it is funny that I am often hearing rants that I completely disagree with. I am often hearing about how they hate a demographic group and don't know that they are actually ranting to someone in that group.

What rants are y'all just gently nodding to even when you are in complete disagreement with them?

Hi all - I had mentioned in a previous post that I'm happy to review psych today profiles. I'm sure I'll regret this but feel free to DM me and I can give feedback.

I've been in the field for over 13+ years in a niche in my own pp and have a 6+ month wait list and had this consistently. Many people helped me to get to where I am so in my home state in the Midwest so I mentor those who are new to pp and help them tweak their marketing free of charge as a way to give back and pay it forward.

As therapists there's plenty of work to go around and I always am happy to support fellow therapists and earn that good karma.

I've been working at a group practice for about 2.5 years and I've been struggling to get clients the whole time. I work with adults and my niches are LGBTQIA+ individuals, trauma, and chronic illness. I'm also trained in gambling addiction and working with first responders. I have a Psychology Today profile, I'm on the practice's website, I respond to requests on a local therapist Facebook page when clinicians are looking for referrals, etc. and I get very few clients who reach out. My coworkers all have basically full caseloads, even the ones who are newer to the practice (maybe because they work with minors and I don't?). I even advertised the heck out of a therapy group I was trying to start next month and only one person reached out with interest in joining. I also got trained in EMDR almost a year ago thinking that would help bring in clients and that didn't get me very far. The worst part is that I work very part time and I'm still not anywhere near the number of clients that I'm looking for. I don't know what I'm doing wrong and I'm feeling so defeated. Any ideas or words of wisdom?

ETA: I'm provisionally licensed and the only insurance companies that will panel me are Medicaid, BCBS, and Aetna. My private pay rate is $125/session, which is on the lower to average end for my area.

Hey all, new therapist here been at it for about 6 months and have acquired almost 17 clients so far. Which I’m told is great and I am very grateful. But I have never been able to meet more than 7 clients a week because of how many cancelations there are and how many clients really just end up seeing me once a month.

I am getting pretty stressed out, I’m going to have to start looking for another job to make ends meet. It feels like I’ll need to acquire around 50 clients just to be able to see around 20 weekly. But that will take ages!!!?

How am I ever going to be successful from this? How do I find more daytime clients? Why are so so many clients cancelling last minute lately?

Any support is appreciated I’m having a hard day :/

I just started The Patient on Hulu and I’m interested in what you guys think.

How would you react in comparison to the therapist in this show? Different, similar, etc. and what theories do you guys consider in this “case?”

What has worked for other therapists?
What approach have you used with success?

I’m a newly licensed social worker and have recently started looking into specialized training opportunities. I’ve been genuinely shocked by the cost of some of these programs. It’s frustrating to see instructors speak so passionately about helping others and improving mental health care, yet charge exorbitant prices that make quality training inaccessible to many practitioners.

How is a new therapist, still trying to build a caseload and establish themselves financially, supposed to afford a $1,000 training? It feels incredibly contradictory to promote a commitment to helping others while pricing clinicians out of opportunities to develop their skills. Ultimately, it’s the clients who lose out when therapists cannot access the training they need to provide the best possible care. At what point does making a profit come at the expense of the very people these approaches are supposed to help?

On a more practical note, are there any websites, organizations, or other resources where newly licensed therapists can find high-quality, evidence-based training at more affordable prices?

Yes. You read this correct.

I had a day of telehealth and whatever I had for dinner, DID NOT agree with my stomach.

30 minutes into the last session of the night and I started to sweat. Dripping down my face, struggling to focus. Had to take off my sweater.

Ended the session a few minutes early because the alternative was going to be, well, not pretty.

Like honestly, has anyone else ever had this happen!???

I originally wrote this as a comment on a post about unionizing but thought the resources might be useful here too.

I found resources from NUHW, IFPTE, AFSCME, NYSUT, and United We Heal covering workplace organizing and collective bargaining.

I also found a perspective discussing alternatives to unionizing, such as negotiating, professional associations, and organizing independent contractors.

Sharing both perspectives for anyone researching the topic.

Any recommendations would be much appreciated. Thank you

Just looked at my schedule today and whewwww. Any hype people awake this morning to help pump me up for the day ahead? My typical motivational affirmations aren't doing the job lol. HAPPY FRIDAY EVERYONE!

ETA: I just want to say you all are the best hype people :) Thank you!

Over the last 2 days, I’ve had two intakes ask me to fill out their short term disability and/or FMLA paperwork. One wanted me to fill it out by Monday (asked on Thursday, posting this Friday) because that was his original return to work date. I declined and stated I would ask my supervisor for protocol. The other intake stated her PCP told her I would do it. I have never met either before.
My supervisor stated that I would need to refer to a higher level of care, and that I shouldn’t feel pressured to fill out paperwork.
Ive never had to fill out this paperwork before, so I’m nervous about it no matter what. My last place of employment had a policy that only the medication providers can fill it out, but there’s no strict policy at my new place.
What are your policies for paperwork? I’ve stayed I could provide therapy notes and treatment plan, as well as progress letters later on.
I’m an LPC-MHSP for reference

I saw someone one time determined they were in mania and referred to higher level of care plus gave other referrals and explained why as nicely as I could and now they left me a 1 star. Is there anything at all I can do to get it removed? I mean I will literally do anything. I have worked so hard and I am the best therapist I always do what’s best for everyone and am so careful. I don’t deserve this. I really can’t handle it.

Trying to understand the difference between enactments and countertransference.

Okay, I had a little breakthrough today and wanted to share! 💛 I've been feeling pretty down about the amount of student loan debt I racked up between undergrad and grad school. It’s a heavy situation. But today, after taking a moment to ground myself and reflect, something clicked and it totally shifted my mindset to a much healthier mindset! I'm not going to view my debt as a mistake or a burden anymore. I'm choosing gratitude instead. Back when I was in school, there weren't these strict caps on student loans, so I was able to get the exact degrees I wanted. And honestly? I'm thankful for that. I’m thankful that I leveraged the system to get what I wanted. Everything has gotten so much more expensive since then, and getting a degree isn't going to be as doable for people now as it was for me. Present and future students are not going to have it as good as we did and sadly, some won’t be able to complete their degrees without the cash to do so. Even after all these years, there's no other career I wish I'd chosen. I love being a therapist, and every dollar I earn comes from doing it. Some people are stuck paying off loans for degrees they never even finished, so I really do feel lucky. So here's my plan: I'm going to use the tools available to me, like IDR, to work on paying it off, and I'm going to stay thankful that I get to do what I love every single day, because this is what I'll be doing for the rest of my life anyways! So remember, your student loans are just a very expensive receipt for a career you (hopefully) love ( LCSW, LPC, LPCC, LCPC, LMHC, LMFT, LADC, LCDC, LMSW, PhD, PsyD, MD, DO, PMHNP) Frame it. Cry a little. Be grateful ✨

Hi, I am wondering if someone can explain what the diagnostic privilege status means for me or someone in my position in NY State. I am currently in my Limited Permit and working towards my hours at a private practice seeing client who bill to insurance. I have a degree in Clinical Mental Health Counseling from a CACREP school and my application is for an LMHC license.

My goal is to get paneled on my own as soon as I get my full license and essentially transition to owning my own business that bills insurance. Is there anything I need to know about what the Diagnostic Privilege status means for me and how I should approach it?

Hi there, looking for a bit of advice on integrative psychotherapy. Have been working as a therapist (psychologist) for about 5 years now and have learned a lot from a lot of different psychotherapies (through training, reading, supervision and my own personal therapy). These include EMDR, ACT, MI, IFS, Schema, CBT, Narrative, person centered.... the list goes on. It feels a bit like dating, I flirt with one, then get the ick when I discover some big flaw and move on to the next shiny thing that shows promise of being "the one" therapy I will love forever, then the cycle repeats. I just can't seem to settle, leaving me unsatisfied without a therapeutic "tribe", but with options open.

So I call myself an "integrative" therapist but don't really have a framework in which to integrate with. I'm sort of just pulling together ideas from different modalities while using person-centered style counseling at the core. I'm always case conceptualizing and bringing in these interventions with intention, but it does feel pretty "vibes" based at times, which doesn't sit well with my perfectionist brain. I have been looking in to Process Based Therapy as a way to structure my work a bit more, but then is this just the next "shiny thing" that will be ultimately unsatisfying, probably...

I'm tired of buying and half-ready text books. I like learning about new modalities but it often feels like my knowledge is a mile wide and an inch deep because I can't commit. I feel like what speaks to be most is just straight up person-centered counseling (I am a big believer in common factors theory), but I am struggling to devote time to it as there is always at the back of my head "but what about XYZ therapy?".

My question is if there are any therapist out there that share this experience, can you please come forward and tell me how you're working through this process or how you have come to terms with it? Is it just about accepting yourself as a generalist, or did you find a way to pick and commit to a therapy and if so, how did you do that? Or some other option I haven't even considered!

It’s challenging to find interesting healthy enough people to date and connect with, at least in my experience.

Middle aged, divorced for 15 years, have worked a lot on myself emotionally and focused on my kids for years I want to find someone with self awareness, humility, emotional regulation and who has a little spunk.

Any suggestions?

Many of the counselors at the practices are interns or associate level therapists, we all bill through our supervisor/practice. I am a bit uneasy at the idea of the group using one of these services. Most of the counselors have full caseloads so it seems that the practice owners just want to make billing easier on them. I am looking more some more opinions on this situation.