How much money do you make and transparent salary/job offer thread?

[texanpsychdoc]

This thread has been so helpful as a recent postgrad! Follow up question (Since I don't think this has been discussed explicitly) - does anyone work as an independent contract therapist?

I'm looking into doing some group practice work on the side of my primary hospital job, and they asked me my rate per patient. I was curious what people charge for a standard therapy session PER patient (for a large, urban area)?

THANKS

I wouldn't accept anything less than $170 an hour for therapy

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[smalltownpsych]

This thread has been so helpful as a recent postgrad! Follow up question (Since I don't think this has been discussed explicitly) - does anyone work as an independent contract therapist?

I'm looking into doing some group practice work on the side of my primary hospital job, and they asked me my rate per patient. I was curious what people charge for a standard therapy session PER patient (for a large, urban area)?

THANKS

I charge 175 in a more rural area but I also have a lot of experience and some contacts with expensive private pay residential treatment that provides me with good referrals with resources. I also don’t contract with insurance.

 

[psychedaboutpsych123]

@smalltownpsych and @ohiopsychdoc - THANK YOU. This is really helpful for context!

 

[calimich]

This thread has been so helpful as a recent postgrad! Follow up question (Since I don't think this has been discussed explicitly) - does anyone work as an independent contract therapist?

I was curious what people charge for a standard therapy session PER patient (for a large, urban area)?

THANKS

My cash rates:
175 for standard therapy 50 min hour
215 50 min intake
225 65 min couple session
~250 hr assessment

Private practice, solo practitioner, small caseload on side of tt career, mix of therapy and assessment. I accept one niche insurance for therapy and about 1/3 of clients use it. Large metro area, I’ve been surprised how easy it’s been to fill cash spots and I see folks charging even more in the area.

 

[Justanothergrad]

This thread has been so helpful as a recent postgrad! Follow up question (Since I don't think this has been discussed explicitly) - does anyone work as an independent contract therapist?

I'm looking into doing some group practice work on the side of my primary hospital job, and they asked me my rate per patient. I was curious what people charge for a standard therapy session PER patient (for a large, urban area)?

THANKS

yes. I contract for 150 in a non urban area with low COL. this is 50min therapy only. in an urban area or high COL, it would translate to 200-250. this is a small practice 5-10 hrs weekly and not my primary gig.

 

[psychedaboutpsych123]

@calimich and @Justanothergrad - thank you! In grad school, you never get this context for fees, and now here I am, license in hand, and negotiating salary with no idea of what's good. I will go in more informed, I appreciate you sharing! I'm sure this will be helpful for others too

 

[WisNeuro]

@calimich and @Justanothergrad - thank you! In grad school, you never get this context for fees, and now here I am, license in hand, and negotiating salary with no idea of what's good. I will go in more informed, I appreciate you sharing! I'm sure this will be helpful for others too

If you are negotiating salary, you need to know your payer sources for the job. If you are working for a hospital system or practice that accepts insurance, they are not getting anywhere near those rates for reimbursement.

 

[PsyDr]

@calimich and @Justanothergrad - thank you! In grad school, you never get this context for fees, and now here I am, license in hand, and negotiating salary with no idea of what's good. I will go in more informed, I appreciate you sharing! I'm sure this will be helpful for others too

1) Google "psychotherapy CPT codes". Write those codes down.
2) Google "CMS fee schedule search".
3) Open up the CMS fee schedule search tool. Put your location into the search tool. Then put the CPT codes into that search tool.
4) Determine how many patients you can REGULARLY see PER DAY (e.g., 6 pts per day). Maybe allow ~20% less than that for slow times, no shows, etc.
5) Usually, professionals work about 46-48 weeks/yr after vacation, sick time, professional education time, etc.
6) Hourly CMS fee for your work X Hours works per year= Gross.
7) Determine the free market value of their benefits (e.g., health insurance, 401k match).
8) Substract benefits from gross.
9) Now figure out how much they usually profit off of workers. You want them to do so. Your job depends on it.
10) After you have gross-benefits-usual profit, you should have a range to negotiate with.
11) Make sure you know exactly how you profit the employer. EXACTLY. Have some stuff to sweeten the death (e.g., I can run one group a week, increasing my gross billables by $40k/yr). Have some things you want to ask for.

 

[Sanman]

1) Google "psychotherapy CPT codes". Write those codes down.
2) Google "CMS fee schedule search".
3) Open up the CMS fee schedule search tool. Put your location into the search tool. Then put the CPT codes into that search tool.
4) Determine how many patients you can REGULARLY see PER DAY (e.g., 6 pts per day). Maybe allow ~20% less than that for slow times, no shows, etc.
5) Usually, professionals work about 46-48 weeks/yr after vacation, sick time, professional education time, etc.
6) Hourly CMS fee for your work X Hours works per year= Gross.
7) Determine the free market value of their benefits (e.g., health insurance, 401k match).
8) Substract benefits from gross.
9) Now figure out how much they usually profit off of workers. You want them to do so. Your job depends on it.
10) After you have gross-benefits-usual profit, you should have a range to negotiate with.
11) Make sure you know exactly how you profit the employer. EXACTLY. Have some stuff to sweeten the death (e.g., I can run one group a week, increasing my gross billables by $40k/yr). Have some things you want to ask for.

I know this was a typo, but it is hilarious in the context of negotiating a deal.

 

[Justanothergrad]

@calimich and @Justanothergrad - thank you! In grad school, you never get this context for fees, and now here I am, license in hand, and negotiating salary with no idea of what's good. I will go in more informed, I appreciate you sharing! I'm sure this will be helpful for others too

I make my students look up CPT codes and then calculate how much they 'made' in the Department clinic across different insurance bill rates. I wish this was more normative. let me know what else I can answer

 

[Pragma]

I make my students look up CPT codes and then calculate how much they 'made' in the Department clinic across different insurance bill rates. I wish this was more normative. let me know what else I can answer

I’m doing similar things with trainees. Don’t want them having to figure it out later like I did.

 

[AbnormalPsych]

My cash rates:
175 for standard therapy 50 min hour
215 50 min intake
225 65 min couple session
~250 hr assessment

Private practice, solo practitioner, small caseload on side of tt career, mix of therapy and assessment. I accept one niche insurance for therapy and about 1/3 of clients use it. Large metro area, I’ve been surprised how easy it’s been to fill cash spots and I see folks charging even more in the area.

How do your cash patients tend to find you?

 

[medium rare]

How do your cash patients tend to find you?

For me, it’s almost entirely word of mouth at this point. I run a completely self-pay, full-time practice and am busier than I can handle.

I get referrals from a variety of sources including physicians, mid-levels, other psychologists and therapists, residential treatment centers, attorneys, dentists, dieticians, other health professionals, realtors, financial planners, corporate/business professionals, collegiate and professional sports teams, interior designers, teachers, clergy, CHADD, NAMI, cosmetologists, dog trainers, governmental agencies (FBI, CIA, Border Patrol), the military, and self-referrals - a decent number of people still find me online though their own internet searches.

Some of these referral sources I know; some I know well. Most, however, are folks I do not know or have only heard of in passing. I’ve found if you do good work and treat your practice like a business in addition to your vocation, the referrals will come so long as you are competent and can communicate your expertise and the ways you are able to benefit them.

 

[smalltownpsych]

How do your cash patients tend to find you?

My cash patients find me through Psychology Today and my company website. About 50/50 where the inquiries originate from. I think a good web presence is helpful and I think having a “team“ show up lends a sense of stability and credibility to my practice. People can read about us and our backgrounds and see our photos and I think that helps some in the decision to call. We also list our fees and a brief description of philosophy of treatment for various conditions or situation. I also get referrals from a handful of professionals who I have worked closely with in the past.
Many of my patients state a clear preference for an experienced psychologist over midlevel counselors as well. Especially if they have had some negative experiences prior. In this area there are some really good midlevel therapists with experience and skills that could compete to a degree with a newly licensed psychologist, but they do tend to be a minorit and hard to find. Majority of midlevels are recent grads from online schools with poor training and limited experience and a psychologist with standard training and experience will stand out pretty easily as people sift through these people that aren’t really ready for independent practice.

 

[calimich]

How do your cash patients tend to find you?

My experience sounds similar to @medium rare, although scaled down by an order of magnitude. I'm only in clinical practice 1.5 days/week, bankers' hours, 8-noon and 8-4, during which I typically see ~6 clients (individuals and couples, in English and Spanish) the other hours are for assessment, report writing, and admin tasks. Following is the evolution of the practice:

I started 1day/week summer 2018 accepting insurance and literally was 100% full within a few days of being paneled. The insurance (Anthem Blue Cross) was the one used by the local university where I interned & postdoc'd. By serendipitous timing, all my original clients were graduate students using insurance; most undergrads were still away for summer. I was naïve to market conditions and had applied to a 2nd panel (Magellan, which handles Kaiser outpatient) and by early 2019 I was also receiving Magellan referrals. Fun fact -- I was 1 of only 5 Spanish-speaking male psychologists on the insurance panel within a 100-mile radius (population ~12.5 million people Big Radius Tool: StatsAmerica) and at that point I was turning away ~a dozen clients/week. Around the same time, I also joined a local professional niche group of therapists with whom I share aspects of identity and values around diversity and inclusivity. Within a few weeks, referrals began coming from there too, mostly all cash, but I had no space. Fall 2019 I added a 1/2 day to my clinical schedule and began the process of negotiating a higher rate from Magellan. It took about a year before they raised the rate, but it didn't stop me from resigning from the network summer 2021. Jan 2021 an acquaintance recommended me for an all-cash assessment gig and by Spring 2021 I had my first assessment case.

Currently, I still have a few grad students as clients. The full fee spots have been filled by folks who returned/stayed after they graduated, referrals from the niche professional group, assessment cases, and by stroke of luck, a former client added me to Psychiat-list and I've gotten a few cash referrals from them over the years. I also have personal connections to a local midwifery organization and before I was licensed I offered workshops for new dads; that group continues to send me referrals for individual therapy. I recently made the decision to resign from the final panel, and submitted paperwork effective 1/1/23, so next year and beyond will be all cash only, about 50/50 assessment & therapy.

I’ve found if you do good work and treat your practice like a business in addition to your vocation, the referrals will come so long as you are competent and can communicate your expertise and the ways you are able to benefit them.

I think this is the gist of it. I do have a personal website, but no psych today site. I've done essentially zero advertising and just focused on doing good work and identifying how my strengths & skills can serve particular populations/organizations. I also have the huge privilege of having a stable full-time job.

 

[medium rare]

I think this is the gist of it. I do have a personal website, but no psych today site. I've done essentially zero advertising and just focused on doing good work and identifying how my strengths & skills can serve particular populations/organizations. I also have the huge privilege of having a stable full-time job.

A thing about Psychology Today listings: I have one and find that it does generate referrals although at a lower rate than word-of-mouth. Mostly, I use it as my web presence since PT has excellent search engine optimization and anytime someone searches for me, they can quickly and easily find my information at or near the top of the search.

I don’t allow patients to schedule online or email without first being established as a patient so I’ve found a PT listing provides what I need in a web presence without having to pay more for the creation and maintenance of a personal website.

 

[medium rare]

… I recently made the decision to resign from the final panel, and submitted paperwork effective 1/1/23, so next year and beyond will be all cash only, about 50/50 assessment & therapy.

Congratulations! A big step and I think you’ll be very happy with your decision.

 

[AbnormalPsych]

My experience sounds similar to @medium rare, although scaled down by an order of magnitude. I'm only in clinical practice 1.5 days/week, bankers' hours, 8-noon and 8-4, during which I typically see ~6 clients (individuals and couples, in English and Spanish) the other hours are for assessment, report writing, and admin tasks. Following is the evolution of the practice:

I started 1day/week summer 2018 accepting insurance and literally was 100% full within a few days of being paneled. The insurance (Anthem Blue Cross) was the one used by the local university where I interned & postdoc'd. By serendipitous timing, all my original clients were graduate students using insurance; most undergrads were still away for summer. I was naïve to market conditions and had applied to a 2nd panel (Magellan, which handles Kaiser outpatient) and by early 2019 I was also receiving Magellan referrals. Fun fact -- I was 1 of only 5 Spanish-speaking male psychologists on the insurance panel within a 100-mile radius (population ~12.5 million people Big Radius Tool: StatsAmerica) and at that point I was turning away ~a dozen clients/week. Around the same time, I also joined a local professional niche group of therapists with whom I share aspects of identity and values around diversity and inclusivity. Within a few weeks, referrals began coming from there too, mostly all cash, but I had no space. Fall 2019 I added a 1/2 day to my clinical schedule and began the process of negotiating a higher rate from Magellan. It took about a year before they raised the rate, but it didn't stop me from resigning from the network summer 2021. Jan 2021 an acquaintance recommended me for an all-cash assessment gig and by Spring 2021 I had my first assessment case.

Currently, I still have a few grad students as clients. The full fee spots have been filled by folks who returned/stayed after they graduated, referrals from the niche professional group, assessment cases, and by stroke of luck, a former client added me to Psychiat-list and I've gotten a few cash referrals from them over the years. I also have personal connections to a local midwifery organization and before I was licensed I offered workshops for new dads; that group continues to send me referrals for individual therapy. I recently made the decision to resign from the final panel, and submitted paperwork effective 1/1/23, so next year and beyond will be all cash only, about 50/50 assessment & therapy.

I think this is the gist of it. I do have a personal website, but no psych today site. I've done essentially zero advertising and just focused on doing good work and identifying how my strengths & skills can serve particular populations/organizations. I also have the huge privilege of having a stable full-time job.

Thanks!

Do either of the insurance panels you've been on require a certain amount of days/hours available in their contacts? They sound flexible. I am looking at finally getting a small one day, bankers hours, private practice launched after much delay. I really want to do my best to keep that boundary around that day and amount of F2F hours.

 

[calimich]

The branch of Anthem I was with was very flexible, no such requirements. Magellan had more of those requirements and was one of the reasons it was easy to leave.

If you're in a metro area and not dependent on the income, I imagine you could start cash only from the beginning. The demand is nonstop.

 

[WisNeuro]

Thanks!

Do either of the insurance panels you've been on require a certain amount of days/hours available in their contacts? They sound flexible. I am looking at finally getting a small one day, bankers hours, private practice launched after much delay. I really want to do my best to keep that boundary around that day and amount of F2F hours.

I only panel with a few, but they don't require anything in terms of certain availability. I pretty much only see clinical pts for evals one day a week at this point.

 

[texanpsychdoc]

My cash patients find me through Psychology Today and my company website. About 50/50 where the inquiries originate from. I think a good web presence is helpful and I think having a “team“ show up lends a sense of stability and credibility to my practice. People can read about us and our backgrounds and see our photos and I think that helps some in the decision to call. We also list our fees and a brief description of philosophy of treatment for various conditions or situation. I also get referrals from a handful of professionals who I have worked closely with in the past.
Many of my patients state a clear preference for an experienced psychologist over midlevel counselors as well. Especially if they have had some negative experiences prior. In this area there are some really good midlevel therapists with experience and skills that could compete to a degree with a newly licensed psychologist, but they do tend to be a minorit and hard to find. Majority of midlevels are recent grads from online schools with poor training and limited experience and a psychologist with standard training and experience will stand out pretty easily as people sift through these people that aren’t really ready for independent practice.

I think the new PC term is "Advanced Practice Professional." Evidently "mid-level" is too negative. Oh, and my hat is off to you with your practice, congrats!

 

[AbnormalPsych]

Advanced Practice Professional.

Interesting. And news to me. Where does the advanced come from and supposed to imply?

 

[texanpsychdoc]

Interesting. And news to me. Where does the advanced come from and supposed to imply?

To be honest, I have no idea who coined it, but hey...it seems like every week there is some new PC term being sent out from somewhere (Hogwarts?) that magically makes its way into the lexicon of psychologists and academics alike. It's the new flavor of the month until that becomes associated with something negative, and then it will most likely be changed again...and again....and again, etc.

I think the intent is that "mid-level provider" had a connotation to it to basically imply that their practice was sub-par and below that of a doctor, thus, "advanced practice professional" is supposed to change that image I guess...

 

[WisNeuro]

It's midlevel. I'll die on that hill. And, after I die on that hill, I'll haunt it.

 

[texanpsychdoc]

It's midlevel. I'll die on that hill. And, after I die on that hill, I'll haunt it.

Hey - I am just saying what was told to me by someone who felt inclined to correct me one time. On a different but somewhat similar note, I am really bummed that Michigan grants a limited license psychologist credential to folks with a master's. That convolutes everything for folks there. Here I am telling folks "yes, psychologists are doctors too" now I will have to say "yes, a statistical majority of psychologists are doctors too, except in Michigan where you can have a master's degree."

 

[WisNeuro]

Hey - I am just saying what was told to me by someone who felt inclined to correct me one time. On a different but somewhat similar note, I am really bummed that Michigan grants a limited license psychologist credential to folks with a master's. That convolutes everything for folks there. Here I am telling folks "yes, psychologists are doctors too" now I will have to say "yes, a statistical majority of psychologists are doctors too, except in Michigan where you can have a master's degree."

Michigan isn't the only one. There is at least one other state that used to license midlevels as psychologists, and now a sizable chunk have been grandfathered in to the license.

 

[texanpsychdoc]

Michigan isn't the only one. There is at least one other state that used to license midlevels as psychologists, and now a sizable chunk have been grandfathered in to the license.

Yeah I was thinking there was at least one other. In Texas, at least they differentiate it with LPA...but then there's the whole aspect of LPAs being able to practice independently at a certain point. I wonder if there is a provision where LLPs can't call themselves "psychologists" as that term would be only for those who are LPs.

 

[calimich]

somewhat surprising, I received an email from Anthem about my resignation letter with an offer to raise the reimbursement rate in exchange for staying in-network. new rates offered:
90834 131.53
90837 146.48
90791 166.32
90847 145.28

not too bad, still about 25% below cash rates...I'm pretty much done working for 3/4 of market value
terrible that the threat of resignation prompts an offer of higher rates. I guess it makes sense from the business side.
Still resigning.

 

[Sanman]

somewhat surprising, I received an email from Anthem about my resignation letter with an offer to raise the reimbursement rate in exchange for staying in-network. new rates offered:
90834 131.53
90837 146.48
90791 166.32
90847 145.28

not too bad, still about 25% below cash rates...I'm pretty much done working for 3/4 of market value
terrible that the threat of resignation prompts an offer of higher rates. I guess it makes sense from the business side.
Still resigning.

Kind of like arguing with the cable company about your paycheck.

 

[WisNeuro]

For 90791, that's a lower reimbursement than Medicare NF rate. Definitely walk.

 

[calimich]

The system is strange and somewhat mysterious, imo. Were I to stay with Anthem it’d be the 2nd time they increased rates in response to a query. First one I actually asked for higher rates, this time I just emailed a resignation letter, no ask. In both instances they replied within 24 hours with first a 20% bump and now a 10% bump.
Compare that to Magellan: It took weeks just to get confirmation that my request had been received and was being processed. I sent copies via fax and email and somehow it kept not appearing in my file. When they finally confirmed it was being processed and even though I provided evidence I was receiving higher rates elsewhere, the request still had to wind its way through layers of bureaucracy. It took almost a year to get approved. I seriously had the thought that my wife was able to grow a human faster than they were able to process the request. It’s hard for me to understand.
I’ll also note that Magellan’s billing was easy and they paid fast, a few days. Anthem was more difficult to bill and much longer to pay.

 

[smalltownpsych]

The system is strange and somewhat mysterious, imo. Were I to stay with Anthem it’d be the 2nd time they increased rates in response to a query. First one I actually asked for higher rates, this time I just emailed a resignation letter, no ask. In both instances they replied within 24 hours with first a 20% bump and now a 10% bump.
Compare that to Magellan: It took weeks just to get confirmation that my request had been received and was being processed. I sent copies via fax and email and somehow it kept not appearing in my file. When they finally confirmed it was being processed and even though I provided evidence I was receiving higher rates elsewhere, the request still had to wind its way through layers of bureaucracy. It took almost a year to get approved. I seriously had the thought that my wife was able to grow a human faster than they were able to process the request. It’s hard for me to understand.
I’ll also note that Magellan’s billing was easy and they paid fast, a few days. Anthem was more difficult to bill and much longer to pay.

It’s not too hard to understand, they are in the business of collecting money up front and paying it out slowly. Meanwhile, they can still cash in on the long term growth immediately. I saw this first hand back in the 90s when I was doing loan refinances for a mortgage broker. The details of how they do all of this and how everyone gets a cut is a bit more difficult to understand, but it is really all about skimming money out of the system and playing a bit of a shell game. For a minute back then, I thought maybe I could play the game and get rich. Little did I know that I was just a sucker in a grand pyramid scheme with the banks and regulatory agencies and I would never get in on the real game. It almost all blew up in 2008, sort of, but did any of them really lose money or did they just keep on rolling and playing the student loan and ”healthcare” game?

 

[Justanothergrad]

I guess I caused "existential dread" for students today when I outlined and discussed billing, credentialing, reimbursement rates, debt impact, etc. When I offered each of them a $60k job to do 25-30 hours of billable therapy per week they said yes... until I made them calculate how much gross they were giving up. Hopefully this helps them grow substantially in earning knowledge

 

[Sanman]

I guess I caused "existential dread" for students today when I outlined and discussed billing, credentialing, reimbursement rates, debt impact, etc. When I offered each of them a $60k job to do 25-30 hours of billable therapy per week they said yes... until I made them calculate how much gross they were giving up. Hopefully this helps them grow substantially in earning knowledge

Congrats, you either caused them not to get ripped off or got the VA several new applicants.

 

[PsyDr]

Psychologists are midlevels. It's why you have to have a physician referral for Medicare patients.

 

[texanpsychdoc]

Psychologists are midlevels. It's why you have to have a physician referral for Medicare patients.

....the hell we are mid-levels. lol

 

[WisNeuro]

....the hell we are mid-levels. lol

In terms of how we are defined by CMS, he is correct.

 

[Sanman]

Psychologists are midlevels. It's why you have to have a physician referral for Medicare patients.

More specifically, it is because we are not classified as physicians (which is not the normal definition of the word).

 

[texanpsychdoc]

In terms of how we are defined by CMS, he is correct.

This is sad. Well, luckily, in PP, I didn't/won't accept medicare/medicaid.

 

[PsyDr]

In terms of how we are defined by CMS, he is correct.

And with the DEA.

....the hell we are mid-levels. lol

I don't like it any more than I like Ohio's weird chili on spaghetti, but I'm not wrong.

 

[texanpsychdoc]

And with the DEA.


I don't like it any more than I like Ohio's weird chili on spaghetti, but I'm not wrong.

OMG...you don't like Cincinnati Chili? It's okay, my spouse doesn't either and we would routinely make the 1.5 hour drive over there to hang out and have some chili.

 

[AbnormalPsych]

Ohio is a strange land. Aren't they super proud of their highway rest stops too?

 

[texanpsychdoc]

Ohio is a strange land. Aren't they super proud of their highway rest stops too?

It's funny you should mention that. the State troopers love to patrol those areas for "various reasons." We had one right by us where we lived (out in the farmlands).

 

[PsyDr]

OMG...you don't like Cincinnati Chili? It's okay, my spouse doesn't either and we would routinely make the 1.5 hour drive over there to hang out and have some chili.

It's not even named after your best city.

 

[WisNeuro]

It's not even named after your best city.

Dublin? Surely you don't mean The Mistake on the Lake?

 

[medium rare]

It's not even named after your best city.

You must mean Columbus - pretty nice city. Although I will say Cincinnati grew on me when I was in Ohio for grad school; Mt. Adams is a fun neighborhood. Never did understand the chili, though.

 

[erg923]

OMG...you don't like Cincinnati Chili? It's okay, my spouse doesn't either and we would routinely make the 1.5 hour drive over there to hang out and have some chili.

Now Look here son...ALL proper chili is ALSO.... spaghetti

We are only slightly south of there but also think these people should be put into a mental institution for such nonsense.

 

[PsyDr]

Dublin? Surely you don't mean The Mistake on the Lake?

You know it’s a great state, when your sports team tries to move… TO BALTIMORE.
They saw The Wire, and thought “that looks better than Ohio”.

It’s a pumpkin spice flavored chili eating state, responsible for Dr. Oz and Machine Gun Kelly. Thanks for that.

Sincerely,


Everyone.

p.s., The Cleveland Clinic’s best contribution was discovering that if you steam 5 tons of X-Ray film for several HOURS, it creates a toxic gas that kills people. Way to go, scientists.

p.p.s., It IS impressive that you convinced people to put the Rock N Roll Hall of Fame there, despite having nothing to do with the birth of the genre.

 

[Therapist4Chnge]

OMG...you don't like Cincinnati Chili? It's okay, my spouse doesn't either and we would routinely make the 1.5 hour drive over there to hang out and have some chili.

I really enjoy Skyline Chili a few times a year, as there is something unique about the ingredients all combined. Separate...they are weird, but spaghetti, chili, onions, cheese, & hot sauce.... 🤤. I forget the other big Cinci chili, but that's meh. I enjoy real chili the most, especially during the cold months.

 

[Therapist4Chnge]

p.p.s., It IS impressive that you convinced people to put the Rock N Roll Hall of Fame there, despite having nothing to do with the birth of the genre.

I never understood this, I just assumed someone bribed someone and/or lost a bet...and that's how it landed in Cleveland. The city of Cleveland is basically "The Sad Factory", Browns football, and the Drew Carey theme song.