 |
The Mentors Corner |
||||||||||||
|
Student/Early Career Professional |
Jeffrey Barnett and Michael Murphy |
||||||||||||
 |
|
||||||||||||
|
Jeffrey E. Barnett, Psy.D. and Michael Murphy, Ph.D. are members of Division 42’s governance who are active on the MENTORS Listserv. This is a regularly featured column in the Independent Practitioner that will share some the discussions from the MENTORS listserv that may be of interest to Division 42’s student and young professional members. We encourage all members to participate on this listserv to share in the stimulating discussions had there and to share your experience and expertise with our new colleagues. Mary Ann Jones asks: I have recently started a private practice. I am seeing only fee for service patients and do not want to accept insurance. I have set my fee at $125 session. If a patient cannot pay my full fee and I want to offer a reduced fee. Do I need to have a written policy stating that I maintain a certain number of low fee slots? I don’t want there to be a problem if one patient finds out they must pay full fee and finds out that another patient pays a lower fee. Elaine Rodino responded: Since your practice is “independently” yours, you can do whatever you’d like. I see full feel patients and I have a sliding scale for those who cannot afford the full fee. That means I slide to whatever is comfortable for the patient...and me. I don’t have a policy, its very subjective from both points of view. Bottom line though is - You need to be comfortable with your approach. I am..and this puts my patients at ease about “negotiating” a fee. My co-authors and I deal with “Money Matters” in our book. This is always a tricky subject for practitioners...My guess of why its easier to have fees set by some outside agent. Miriam Adler contributed: I hear your real concerns and struggle as to what is right. However, I think that it is important to remember that the concept of sliding fees is very respectable. All mental health clinics I have ever worked at have had them. Also, an “intuitive” decision to slide isn’t purely “intuitive”. My “intuitive” decision is based on speaking with clients about their basic income and expenses, but in the end it is a judgment call about what feels right given numerous factor brought up by me and others (e.g. how sincere I believe they are, how much I need business, whether they are coming at “prime time” or a harder to fill hour, whether I believe I can be especially well suited to help, etc...). I disagree that this is not having a “standard”. A lot of my approach to psychology in general is humanistic and I believe that this a true and genuine exchange and that it is quite in line with professionalism to meet clients where they are at and take their financial needs and idiosyncrasies into account. Certainly, there is nothing wrong with not having a sliding scale of some sort, but it should be a personal decision up to the clinician. It’s hard for me to see why sliding fees would be anything but positive for those who are comfortable doing so. (In fact, psychologically I think having a higher fee that is sometimes slid down is better than having a lower fee, because it sends the message that our professional services are worth a lot even though we choose not to collect full fee in particular cases). Steven Walfish added: You do not need a written policy. If people find out that you have a differential fee schedule then indeed they may become upset. However, that becomes “grist for the mill.” You are in a business and don’t have to justify your fees to anyone, including your clients. However, I will preface this by saying that you have to be willing for clients to walk away from you and go elsewhere in order to adopt this attitude. If you are unwilling to take this risk then by all means develop such a written policy. However, please note that there will be clients who will want to be considered for these lower fees that probably, from a financial perspective, do not deserve the lower fee. They may just be looking for a bargain. You may possibly get into a debate with them about the fee and in the long run, my prediction will be that you will resent the process. Frank Cushing cautioned: This is only true if you do not accept any insurance reimbursement. If you do, you are subject to criminal penalties for fraud if you charge insurance-covered patients a higher rate than some cash (fee for service) patients.......the insurance company will state that your fee is the lowest you charged anyone--therefore, you should charge them only their Percentage (50-80? Or whatever) based upon your lowest fee. Otherwise, you are overcharging the insurance company and “artificially inflated” fee.... Steve Walfish concluded: In my 22 years of private practice I have turned down people for therapy based on fees less than I can count on my two hands. I have always worked out lower fees and have done this cooperatively with the client and responded intuitively. When dealing with people who need lower fees I ask, “I know that you can’t afford my usual fee. I have no problem sliding this fee at times. Given your circumstances, what is it that you think you could afford to pay?” I have found this to be one of the hardest questions for clients to answer. I think this is because they don’t want to insult me and at the same time don’t want to place an undue hardship on themselves. I have had people say $ 25 and people say $80, and all in-between. The times I have said no is when I knew they could afford more. Many years ago I saw a teacher who made $ 20,000 a year and I asked her if she could pay $25 (before I asked this question noted above). She said, no and would like to pay $ 10. I told her to call the local CMHC. I was always afraid that if I got a reputation that I would lower my fee at times that the floodgates would open and I’d have a sliding scale practice. Never happened. I have found that in the long run, “What goes around comes around.” That is, many of my sliding scale people have referred me full paying clients. |
|||||||||||||