Sit and Stay: Run a Successful Mental Health Practice

Parker and Tom discuss how patient-provider communication in mental health care has changed over the past 30 years, from pagers all the way to AI. Provider-patient communication outside of session can affect multiple sectors including the clinical relationship, patient experience, boundaries, and operations, so we found it extremely relevant to dive into how much the dynamic has changed as a resul...

When should a growing mental health practice start offering employee benefits? In this episode, Parker and Tom discuss how practice owners can think about PTO, health insurance, retirement plans, disability insurance, and other benefits without overextending the business. They also cover how benefits affect recruiting, retention, budgeting, and the shift from 1099 contractors to W2 employees. 0:00...

Nearly two decades after federal mental health parity law passed, why is access to care still so difficult? In this episode, we break down how insurance rules, low reimbursement rates, ghost networks, and weak enforcement continue to limit mental health care access. We also discuss Illinois’ new behavioral health legislation, including a minimum commercial insurance reimbursement floor tied to Med...

This week, we discuss why mental health clinicians should pay attention to legislation, insurance policy, and mental health parity laws. Tom explains how federal and state laws can directly affect access to care, reimbursement, authorization requirements, and a provider’s ability to deliver clinically appropriate treatment. We also cover the Mental Health Parity and Addiction Equity Act, state-lev...

We return for part two of our conversation on how insurance barriers affect mental health care. We discuss the fight for single case agreements, ghost networks, delayed approvals, and why these systems can leave patients without the care they need even when the rules are supposedly on their side. This episode also explores how insurers create friction for providers, why continuity of care becomes...

Insurance companies keep finding new ways to make mental health care harder to provide and harder to access. In this episode, we break down frustrating new tactics affecting psychiatrists, therapists, and patients, from stricter psychotherapy billing requirements to misleading out-of-network reimbursement practices. We also discuss why these changes matter, how they can push providers away from ac...

Tom breaks down the hard conversations friends and partners need to have before starting a mental health practice together. We cover ownership, leadership, profit, long-term goals, and how to handle disputes before they become real problems. If you’re thinking about going into business with someone else, this episode is a strong reality check. 0:00 Introduction 4:43 What are some expectations part...

How do you start a psychiatry practice and make insurance work? Child psychiatrist David Balyozian joins us to discuss how he built an insurance-based child psychiatry practice from the ground up. We cover negotiating reimbursement rates, building referral networks, managing multiple roles, and growing a practice while keeping access to care at the center. Along the way, David makes the case that...

Many mental health providers who accept insurance don’t actually know their contracted reimbursement rates. In this episode, we explain what a fee schedule is, why so many clinicians don’t know their rates, and how this can lead to underpayments, billing errors, and poor financial planning. 0:00 Introduction 2:41 What is a fee schedule, and why do they matter? 6:31 Why don't providers often kn...

We’re joined by Sarah Dosanjh (MSc, CTA, MBACP), a UK psychotherapist specializing in binge eating recovery, to talk UK vs US private practice, ethical self-disclosure, sustainable marketing through YouTube, and what GLP-1 weight-loss injections may mean for eating-disorder treatment going forward. 0:00 Introduction3:01 What inspired you to pursue a career in the mental health field?6:31 Do you fa...

Child and adolescent psychiatrist Tom Tarshis goes head-to-head with Alexa to answer real-world medical questions. What did she get right? What did she get wrong?--0:00 Introduction6:29 What are some scientifically proven therapies for treating depression in kids?12:24 What is the right dosing and time to take melatonin to help with falling asleep?17:20 I am taking 50 milligrams of Zinc a day. How...

Should your mental health practice be non-profit or for-profit? Your structure shapes your practice for years, so this week we break down the differences: taxes, salaries, grants, boards, loans, and control.

Insurance authorization is a major—and often underestimated—challenge in mental health practice management. In this episode, we unpack a real-world IOP authorization case and explore how insurers process these requests, where delays almost always occur, and what practice owners should be prepared for when offering higher levels of care. Hope you're ready for a clear, honest look at the process...

Insurance contracts can have major consequences for a mental health practice. In this episode of the Sit and Stay Podcast, we break down the insurance contract language clinicians should actually pay attention to: Common “gotcha” clauses, reimbursement rates, documentation requirements, and what to watch for when insurers change terms. If you’re in-network (or considering it), this episode will he...

Mentorship and supervision aren’t just for academic clinicians. We unpack how mental health providers can mentor students, supervise trainees, stay current on best practices, and build real community without overcommitting. Plus: what supervision actually means, how payment works in different models, and why being upfront with clients about training level matters. 0:00 Introduction 1:13 In what wa...

In this episode, Tom explains what credentialing actually is, how CAQH fits into the process, and why timelines can vary wildly. We cover the difference between credentialing and contracting, common mistakes that cause delays, what the upcoming 90-day California law means, and how practices can avoid getting stuck in months-long wait times.0:00 Introduction1:48 The Mental Health Business Moment Of...

Thinking about offering ownership or partnership at your mental health practice? In this episode of the Sit and Stay Podcast , we explore four ways to structure partnership tracks for clinicians — including profit sharing, phantom equity, traditional buy-ins, and sweat equity . Dr. Tom Tarshis, founder and CEO of RipsyTech, breaks down how each model works, what to consider legally and financially...

Recorded live at AACAP 2025 in Chicago, we’re catching up after another incredible year connecting with providers, fellows, and clinic leaders from across child and adolescent psychiatry. Parker and Tom share what stood out most at the conference—from the ongoing buzz around AI to the practical realities of running a mental health practice today. We also reflect on what keeps us coming back to AAC...

In this episode, we break down ownership and partnership structures for private practices: when to offer ownership, how to balance control and profit, and why options like “phantom shares” can motivate without giving up decision-making power. We also touch on legal considerations, attracting top talent, and avoiding pitfalls when adding partners.

Learn the scheduling strategies that keep your mental health practice clinically sound and sustainable. Tom explains how to set smart blocks for intakes vs. follow-ups, choose between 30/45/60-minute sessions, and protect after-school slots without burning out. We also cover when to split parent-only check-ins, why every-other-week therapy can expand access, and how AI-assisted notes change the ma...

In this episode, we break down how to offer reduced fees without risking the health of your practice. Tom explains the difference between sliding scale and other discounts, the pros and cons of income-based models, and alternatives like automatic discounts or referral credits. We also cover the legal and ethical guardrails every provider should know, from documenting requests to setting time limit...

What is a payer mix and why does it matter? In this episode, we unpack how the balance of insurance plans and revenue sources affects your practice’s financial health. Tom shares how he sets fair caps on low-reimbursing plans, explains why transparency with patients matters, and breaks down the pros and cons of accepting more insurers versus negotiating single-case agreements.

Building a budget for your mental health practice isn’t just about tracking numbers—it’s about creating a plan that helps your practice thrive. In this episode of the Sit and Stay podcast, we talk through the key components of a practice budget, how to estimate revenue and expenses, plan for seasonal changes, avoid common mistakes, and use data like payer mix and RVUs to make better business decis...

Running a mental health practice without a budget? You’re not alone—but it’s costing you more than you think. In this episode, we explore why every mental health practice—whether solo or group—needs a budget. From reducing stress to planning for growth, Tom shares real stories and practical insights about what most providers miss when they skip this crucial step. We also discuss the financial blin...

In this episode of the Sit and Stay podcast, we’re joined by therapist Ida Milani, LMFT, who recently transitioned from a group practice to running her own private practice full time. Ida shares how her early experiences shaped her passion for working with teens and young adults, and opens up about the realities of starting a practice from scratch. We talk about marketing, money, social media, aut...