Thrown Into the Fire: Maggie Block on Pivoting a Private Practice to Teletherapy Overnight

Maggie Block had been meaning to explore teletherapy. It was on the list, somewhere between updating her website and taking new professional headshots. Then a global pandemic moved it to the top of the list overnight.

Within about a week and a half, Maggie and her team of seven therapists at Metro East Therapy went from 100% in-person sessions to 100% virtual. No prior teletherapy experience. No roadmap. Just a shared understanding that if they didn't figure it out fast, families would lose services and the business would lose revenue.

She joined Kadie on Clinic Chats to talk through the transition in real time, while it was still messy and uncertain and very much in progress.

When "Eventually" Becomes "Right Now"

Maggie started noticing other states shutting down schools about three weeks before her office closed. She sent letters home to families, warning them that changes might be coming. Most people thought she was overreacting.

A week and a half later, she was deep into researching teletherapy platforms. By mid-week, sessions were live. By the following week, the office was fully closed and every session was virtual.

None of her therapists had done teletherapy before. One or two took the lead, diving into research and testing platforms, and the rest followed. That willingness to jump, even without a perfect plan, is what kept the practice running. As Maggie put it, "You just have to jump and trust that you're going to land safely."

Insurance Chaos Is the Quiet Crisis

The technology pivot was the visible challenge. The billing side was harder and a lot less photogenic.

Roughly 70% of Metro East Therapy's caseload is insurance-based. Illinois had issued an executive order requiring coverage for telehealth services, but insurance companies weren't keeping up. Representatives gave conflicting information call after call. Some told Maggie's team to use modifiers. Others said not to. Some said teletherapy was covered. Others said it wasn't.

"You can call one day and be told one thing and call the next day and be told something totally different, just depending on the representative that you're talking to," Maggie said. "That is just insurance in a nutshell."

Her team submitted their first claims and waited. The billing person was following up daily. Some families paused services entirely until they could confirm coverage. Others pushed forward, knowing their kids needed consistency even if the financial picture was murky.

For practices trying to bill insurance for teletherapy sessions, the coding question alone was a moving target. Maggie's team used the telehealth option in Availity and hoped the claim forms would route correctly. That was the best anyone could do at the time.

Running a Business When the Ground Shifts

Maggie was honest about something a lot of practice owners feel but don't always say out loud: she can't afford to provide free services and keep the lights on.

Some providers were telling families they'd eat the cost if insurance denied the claims. Maggie understood that impulse, but she wasn't in a position to absorb it. Her therapists were putting in extra hours learning new platforms, redesigning sessions for virtual delivery, and troubleshooting tech issues with families. They deserved to be paid.

"As the person who's running the business, I don't have the luxury of continuing to pay them while not being paid myself. I'm not going to be able to sustain for very long."

That tension between wanting to serve families and needing to stay solvent is one of the hardest parts of owning a small practice. The timing made it worse. Maggie's husband had just resigned from his university coaching position to become a stay-at-home dad so Maggie could focus fully on growing the business. They made that decision three weeks before everything shut down.

No insurance policy covers a pandemic. No disaster plan anticipates this. Every private practice owner was, in some form, doing the same math Maggie was doing: how long can we keep going like this?

Teletherapy as a Long-Term Play

Here's where Maggie's story shifts from crisis to opportunity.

Even in the middle of the uncertainty, she could see that teletherapy wasn't just a stopgap. It was going to change how families access speech therapy long after the pandemic ended.

Parents were discovering that their kid could sit at the kitchen table and do a session while dinner was being made. The sessions were interactive, backed by research, and more convenient than loading everyone into the car for a 30-minute drive. Maggie predicted some families would ask to keep virtual sessions even after offices reopened.

She was already updating her website to include a dedicated teletherapy tab and posting daily on social media to educate families about what virtual sessions actually look like. Not just FaceTime calls, but structured, evidence-based therapy with real tools and interaction.

"This is, in a lot of ways, a little bit of a blessing, because it's going to open up so many avenues for the girls in my office, for myself, for the business, for us to be able to expand without having to move physically to a physical location."

The SLP Community Showed Up

One thing that stood out in Maggie's account was how the speech pathology community rallied. Free resources, free continuing education, shared information across social media groups. A live teletherapy conference drew 45,000 attendees in a single day, with eight hours of free CE content.

Colleagues who had invested time and money into creating materials were giving them away. Therapists who had experience with virtual platforms were walking others through setup. It wasn't organized in any formal way, but it was effective.

For Maggie, that generosity made the difference between feeling like she was in freefall and feeling like she had a parachute.

"I think I'm still in free fall, but maybe I feel like maybe I've got a parachute now, whereas before I didn't."

Pivoting to teletherapy means rethinking how you schedule, document, and bill. ClinicNote is an EMR built for private practices and university clinics, keeping documentation, scheduling, and billing organized in one HIPAA-compliant platform so you can focus on serving families, whether that's in person or on screen. See how ClinicNote works.

Transcript

Kadie: You are listening to Clinic Chats. Clinic Chats is a multidisciplinary therapy podcast that was created for students, professionals, clinic directors, and supervisors. Clinic Chats is bridging the gap between graduate programs and professionals, sharing personal journeys of the smallest of private practice startups, large and expanding practices, as well as university clinic triumphs and tribulations. We hope you'll find our podcast informative and helpful in your career endeavors. Clinic Chats is sponsored by ClinicNote, an electronic medical record company for private practice and university clinics. ClinicNote was designed to make scheduling, documentation, report writing, and billing effective, efficient, and HIPAA compliant. Our featured sponsor this week is Therapy Marketing Kit, the perfect solution to creating professional marketing materials for your business.

Kadie: So today I have Maggie Block, a returning guest. She is a neighbor of mine in our town. She has joined me before on the podcast from Metro East Therapy. Hi Maggie.

Maggie: Hi Kadie.

Kadie: It's good to have you back. I thought you were a good person to bring on because I'm fully aware of everything that your private practice is going through and I think a lot of private practices are going through.

Maggie: Well, I'm going to try my best to answer any questions and just be kind of honest about our journey, which is very uncharted.

Kadie: Right. And I think we should just get right to it. People have questions and it's okay if either one of us know the correct answer to that or what's next to come. At what point did you have to pull the plug on in-person therapy and make this drastic switch to teletherapy?

Maggie: You know, my days are just running together. It must have been about three weeks ago when I started noticing that other states were shutting down their schools. I started to become a little bit concerned and so I sent home a letter to parents just saying, look, we're taking extra precautions in our office, but there may be a time where you're going to have to make some decisions. And I know people thought that I was crazy because we never thought that it was going to come to this, but ultimately, probably a week and a half ago, maybe a little bit more than that, we started really looking into teletherapy and by middle of last week, we were really up and going. And so this week, our office is completely closed down and all of our sessions are virtual.

Kadie: Right. And then we are in Illinois, for those that might not know, and Illinois, what was it last? Friday. Like you said, days are running together. Friday, we went on a shelter-at-home order. So basically, at that point, you had to fully make that transition if you hadn't already.

Maggie: Yeah.

Kadie: Had any of your therapists that are beneath you done teletherapy before?

Maggie: No. None. None of us had, and this was something that, you know, I had been wanting to get into teletherapy and I was sort of thrown into the fires of it all and we had to figure it out really quickly, but none of us had ever done teletherapy. So I had one or two therapists that really jumped on it and spent a lot of time researching and sort of said, okay, this is what I'm doing. And then everybody kind of has chipped in, but nobody knew anything about it other than we know that it exists and there's a lot of platforms, but we've always just done in-person therapy and that's just the way that it's been.

Kadie: You know, I think our profession has experience in providing such quality therapy, and I know your therapists do. And so, you know, you're lucky that they could make this transition, probably quick learners, and hopefully things just continue to run smoothly. What was that communication like with families, though, who are really uncertain during this time?

Maggie: It's a really loaded question. So we have, I would say probably half, maybe even 70%, upwards of 70% of our clientele are insurance patients. And so there has been a lot of stress with, is insurance going to cover this? And so we did ask families to reach out to their own insurance providers, just because as most people know that take insurance, you can call and be on hold for hours and hours. And so we knew that if parents could call and ask those specific questions, then they would maybe get a little bit more information if they heard it for themselves, and that would be reassuring to them.

Maggie: So that has been a struggle for parents. And we have, you know, in the state of Illinois, there was an executive order that was released, and a lot of insurance companies are really not maybe up to speed with that executive order. And it seems like every time somebody calls, there's a little bit of conflicting information. So some of our families have just said, until we know for 100% sure that this is going to be covered, we are going to be putting services on hold. And then there have been a lot of parents who have said, you know, my child doesn't have good attention. And so what is this going to look like for me as a parent? Our Wi-Fi is kind of dicey. So what are we supposed to do about that? And, you know, there's just a lot of parents wondering what it's going to look like.

Maggie: And so we've tried our best to do as much educating as possible. But in all, most parents have said, yes, we're going to continue. What do we need? I think that parents know that this is important for their child and having the routine and the consistent structure for them has been really important. And I think that they also, there's a part of them that we're a small business and they want to support us as a small business.

Kadie: Yeah, you're right. That was a loaded question. And you did a great job explaining all the different obstacles. You know, once you get therapists on board, there are so many things for a family to worry about, not to mention your severe kiddos. That is really, really uncertain and scary for families to try to implement good therapy, whether it's AAC, whatever.

Maggie: Well, I mean, regression is something that is, unfortunately, common with a lot of the kids that we see. And parents know that. And they know that also there are a lot of kids that just thrive on the routine and the consistency. And so parents are making shifts and adjustments the same way we are as therapists.

Kadie: Exactly. And I think maybe this week still is kind of an uncertain week. Like you said, you might see some numbers fall off, which is scary for a small business. But hopefully, as this becomes what I'm afraid might be our norm for a little while, hopefully you get more people jumping on board when they realize, okay, we still need therapy. We need to work this out somehow.

Maggie: We're crossing our fingers and our toes. I think right now we're in the position like so many Americans where we don't know how long this is going to last. We don't know what to expect. There's a lot of uncertainty. And so I think that there are some parents who are sort of saying, let's just ride this out a little bit longer and see what happens. If the inevitable happens, which I think might be that schools might be out a little bit longer, then I do think that we're going to have some parents say, okay, this is the reality of the situation. So what do we need to do?

Kadie: Exactly. I know, like you said, a large part of your caseload and your therapist caseload are all Blue Cross Blue Shield of Illinois. And we can't speak for Blue Cross Blue Shield of Illinois across the board. I know every plan is so different, but you are finding that some are paying.

Maggie: Well, we are. Yes, we are finding that some are paying and they actually had those teletherapy benefits prior to even all of this happening. And again, this was just never anything that we would have, you know, billed insurance for. So we do have some families that already have this in place. And then it's the confusion, really. What I have found and speaking just to other therapists that take Blue Cross Blue Shield of Illinois and other insurances as well, is that the insurance representatives, they are confused on, you know, telehealth versus MD live versus, you know, we're being told just bill it as an in-home visit. And of course, you can't do that because that's insurance fraud. We're being told it's not covered. We're being told it is covered. I mean, it is just, quite frankly, a mess right now.

Maggie: I do feel strongly that this executive order, that it's going to be enforced with insurance companies. I just don't think that right now they have started really enforcing that on their end. So I do know that I'm working really hard to tell families like we're going to appeal it if they deny it. But also being honest with them that insurance companies right now are just maybe as confused as the rest of us. And, you know, that's all I can say is that we're just daily checking and following up. And there's a large group of therapists that are on social media sort of sharing the information that they have heard. But it's not very well organized right now on the insurance end.

Kadie: Yeah, you're probably right. It depends on who you're speaking to on the other end of the phone when you call that insurance company and if they actually know what they're talking about and they might be just as confused as us.

Maggie: Well, as always with insurance, you can call one day and be told one thing and call the next day and be told something totally different, just depending on the representative that you're talking to. I mean, that is just insurance in a nutshell, right? So now we've added this element of teletherapy, which is confusing, I think, for the insurance company representatives who this is not something that they probably field a lot of phone calls on. So I think that they are not always sure what they're looking up and what they're looking for. And of course, as speech pathologists, we always get confused for behavioral health and for medical billing. And what do we even categorize this as? And so it's just another layer of the fun of insurance.

Kadie: Yeah, and I think you have a hired billing person, so maybe they would only know this. But do you know as far as the different coding that they're having to use to show that it's teletherapy?

Maggie: So there have been a lot of different ways that therapists are billing. And it's all based on what Blue Cross has told us. So some have told us to use a modifier. We use Availity. And there's actually a telehealth option that you click on. So we've just been using that. So last week, the big push that we were hearing was to use a modifier. But now we're hearing don't use a modifier. So we just submitted some of our first claims on Friday. And I know Stephanie, who does my billing for me, she'll be following up on those claims today. So it's either going to be a really busy day with me calling insurance, or if a lot of them went through, then we'll sort of have peace of mind. So we're still kind of on pins and needles to see if some of those claims went through.

Kadie: Okay. Yeah, that's helpful, though, because I read the same thing. Like, oh, you need a modifier, which I really, truly don't understand modifiers at this point. But then I've also...

Maggie: We've never really used modifiers either, because we've always done everything, you know. I know that with evaluations, if you do your evaluation over multiple sessions, then you would want to use a modifier. But we have never done that. We've always done our evaluations in one session. Our therapy sessions are the same amount of time, you know, 99% of the time. So we've never really had to mess with modifiers. So that was going to be new and different for us. But we're also finding that Availity has that feature. So we're wondering if maybe Availity is just going to be, you know, with the claim forms that they send over to Blue Cross, maybe that will just sort of go where it needs to go. I don't know. I just don't know.

Kadie: Yeah. So you're talking, it might be just simply marked as the place of service. Click on teletherapy. Okay.

Maggie: Right.

Kadie: That makes sense. Well, fingers crossed for you guys, because we've talked a lot on this podcast about the difference of a charity versus a running business. And it's hard to continue being a running business for a lot of people right now.

Maggie: It's really difficult. And other providers have said, you know, that we've just told families that if insurance doesn't pay for it, that we're going to appeal it, but that they won't be charged for it. And I wish that I was in a position to be able to do that. But I just, unfortunately, I'm not. You know, the therapists that are working are absolutely going to get paid for their time, especially now they're putting so much time and are really, really working hard to make sure that these teletherapy sessions are interactive and that things run smoothly. And that, you know, on the family side of things, that they are just reassured that everything is just going to continue to go. So they're absolutely going to get paid for their time.

Maggie: As the person who's running the business, I don't have the luxury of continuing to pay them while not being paid myself. I'm not going to be able to sustain for very long. And like a lot of small business owners, we're anxiously awaiting the stimulus package that hopefully will be announced in the next day or two to find out a little bit more about what options are going to be available to us. But it is a really anxious time. And it's almost surreal in a lot of ways to just sort of be jerked into this other world of teletherapy.

Kadie: I know. I've definitely been thinking a lot about you and really everyone that I've made connections with with their businesses, just because I know how successful things were going. And, you know, hopefully everyone makes it through. But it's just really, really scary. And like you said, you want to pay your employees. And it almost seems like the bigger or more successful you had been, it's almost like the bigger hit you are going to have to take because you want to pay all of your employees.

Maggie: Well, any business owner wants to take care of the people that make the business what it is. I mean, the girls that I have in my office are just phenomenal. They are absolutely phenomenal. They are moms and wives, and they have to be able to support themselves and their households. And so I want to make sure that they're taken care of. But I also am a mom and, you know, I'm a big contributor to my household income. So I also have to think about what does that look like for myself and my house?

Maggie: And, you know, even your different insurances that you have, the natural disaster insurances and liability insurance and all of those different things that you get. I mean, I felt that I had enough insurance to cover me in any event. But this is not something that any plan covers. So unfortunately, I don't have the ability to file some type of a claim to get some type of relief. So that's why I said I think we're all just anxiously waiting to see what options are going to be available to us via the government.

Kadie: Right, right. So my husband, actually, we are pivoting. So he works for a university, but his contract is up July 1st, and we have decided that he's going to be a stay at home dad and that I'm going to focus on the business. Because I was really trying to juggle being a stay at home mom and running a business. And I love them both dearly, but I cannot do them both. And my husband, with the nature of his job, was traveling a lot. He's a coach. And so he's gone recruiting and at meets. And he's gone for a very, very long time. And so we decided that it would maybe make sense for him to be able to stay at home. And we just made that decision about two weeks ago. Well, really about three weeks ago. So right before all of this unfolded, we made that decision.

Maggie: And so we are, I think that's probably a little bit of the anxiety of all of this, is that my husband has resigned from his job to be able to stay at home. And now we've kind of got all of this unfolding. It just makes for just a lot of sleepless nights. But all I can say is that this teletherapy, assuming that it all falls into place, and I really feel like it will, this is, in a lot of ways, a little bit of a blessing, because it's going to open up so many avenues for the girls in my office, for myself, for the business, for us to be able to expand without having to move physically a physical location, but to be able to do this remotely. This is really a blessing. So that's what I'm focusing on right now is how can I capitalize on this? That's the right word. How can I turn this into something really great?

Kadie: Yeah. Well, I appreciate all of that honesty and vulnerability. And, you know, I was thinking your husband's job might just take a hit because universities are closing. And I had no idea that, you know, also you have this extra weight on your shoulders as of the last few weeks and come summertime. So fingers crossed. Like you said, stay positive. And then maybe it'll all work out to your advantage, hopefully, in the end.

Maggie: I do think it's a good opportunity for the business. It's a great opportunity. And I think sometimes that life will sort of just pivot you where you need to be. So I try to not fight it too much. I try to, you know, cautiously, but yet optimistically pivot with where life is taking us. And I think that this, like so many people, this is a major adjustment, but I'm going to say I think that this is happening for a really good reason. I'm going to blindly kind of just keep walking and know that there's probably going to be a really, really good, big, bright light at the end of this tunnel.

Kadie: Absolutely. Yes. Do you have a plan for marketing the teletherapy side after all of this blows over?

Maggie: So I have been working on updating my website for probably the last month or two. I've been working with my website team, and I also had a lot of professional pictures taken. That was something that I always wanted to do to really spruce up my website. So the timing of that is good. And so we're definitely going to be adding a teletherapy tab on my website. So that way, this is an option for people.

Maggie: I have been trying every single day to put out information on social media. As much as possible, not only saying we offer it, but explaining what it looks like. So people understand that there's so much that you can do via teletherapy. And it's not just like a FaceTime session, but it's interactive. And there's a lot of research and efficacy behind it. But this isn't just something that we're just doing just to try to make ends meet. This is a real solution to a problem for a lot of families. And so that has been the approach that I've been taking. But as with anything, it's just going to take constant putting it out there into the world that this is what we're doing, and this is what it looks like.

Maggie: I don't remember where I read this. I might be making this number up off the top of my head. But I think it's upwards of seven or eight times somebody has to see something before they actually make a decision that they like it or that they don't like it, or that they're going to be doing something with it. So I always have to remember that when I'm marketing something, that I have to keep putting it out there. People have to continue to see it to be able to make a decision.

Kadie: That actually reminds me of an awesome way I found for private practice beginners to create their marketing materials quickly and getting their brand known in the community. Therapy Marketing Kit creates custom marketing materials such as brochures, flyers, postcards, and more that are unique to your business. With professional templates and content written by an SLP, you can skip the exhaustive back and forth part of the design process. Listeners can use code CLINICNOTE and get $20 off any of the kits on Therapy Marketing Kit's website. That's therapymarketingkit.com.

Kadie: I feel like teletherapy was really an up and coming thing anyways. So it's kind of just pushing everyone towards that model, maybe just a little bit sooner than it may have eventually gone anyways.

Maggie: Well, and I think that there might be a handful of parents that say, can we keep it? This works really well for us because I can make dinner while they're sitting at the kitchen table getting their therapy. My other child can be home working on their homework and they can be there working. I can hear what's going on. That's really helpful for me as a parent. I think that this is going to be something that parents, once they get used to it, are really going to embrace.

Kadie: Yeah. I mean, ASHA backs it. There's research proving it is successful. And like you said, just getting out the door with more than one child or even one child is enough work in itself. So people might end up loving it. And you all have chosen the teletherapy platform, Doxy. So all of us are using Doxy except for one of our therapists who likes Zoom. So she's using Zoom.

Maggie: There's seven of us. So six out of the seven are using Doxy. One is using Zoom. I think that she just used both of them and she found that she just liked Zoom a little bit more. And right now, most of us are on a free trial to kind of give it a go. And then I think that we will make a decision as a team which one we all like that we can use.

Kadie: You know, I personally, using Doxy, found it to be very user friendly for someone who gets intimidated pretty easily by technology. I felt like I can do this. Like this is pretty easy. And can you, do you schedule an appointment in Doxy or you have your pre-made schedule and send clients a link, I believe, and they come into like a virtual waiting room? It's kind of cool.

Maggie: Yeah, that's right. So you send a link to them and then they click on that link. The big thing that we found is that they have to make sure that they say yes, that they can access their microphone instead of just kind of bypassing that, not even paying attention that they clicked don't allow. I think we just kind of are in the habit of like, don't allow, we don't want any intruders, but that's not like your microphone, hit allow. But then we can see that they're in our waiting room and we can send them a little message, you know, I'm 10 minutes behind or be right there or whatever the case is. It's really neat.

Kadie: That's awesome. Well, I'm happy for all of these teletherapy platforms who are surely doing very well. Their time has come.

Maggie: I think that they've all been waiting for the apocalypse. And here it is.

Kadie: Yeah. Well, is there anything that you wanted to add? You did a great job just kind of relaying the struggles, but also maybe the potential that go along with all of this.

Maggie: Oh, gosh. Well, I think that as a community, speech pathologists have been so generous and so helpful, and I have seen more free resources and more continuing education than I have ever seen. And so to my colleagues who are doing that, thank you so much for just putting out information that you either took the time to create or that you paid for or you're just volunteering your time for free. That for me has been such a relief to be able to get access to that information.

Maggie: So like I think that they said there was 45,000 people that tuned in to the live teletherapy conference yesterday. It was all day. That was so, you know, one, to get continuing education for free for any speech pathologist is amazing. I mean, it was eight hours of continuing education, but it was fantastic information. And people just, I'm assuming, donated their time to be able to put that together. And there's so much of that going around. So for my colleagues that are hesitant to do the teletherapy, there is a lot of stuff out there. You just have to jump and just have to trust that you're going to land safely. That's what I'm doing.

Maggie: I think I'm still in free fall, but maybe I feel like maybe I've got a parachute now, whereas before I didn't. But I just want to say thank you to the community of people that have been so grateful and giving us so much information.

Kadie: Yes. Thank you so much for remembering to say that, because I totally agree. The community has seemed so wonderful through all of this. So thank you for your time. And I think our listeners will really appreciate that.

Maggie: Thanks, Kadie.

Kadie: Thank you for joining me and listening to Clinic Chats. If you have a moment, please leave a five-star review for Clinic Chats to help other SLPs find our podcast. Please email me kadie at clinicnote.com. That's K-A-I-D-E at clinicnote.com.