Nobody likes asking for money! It’s one of the most uncomfortable conversations to have with current and potential clients. However, you can’t pay the bills with rainbows! This article should help get you the confidence to deal with getting paid for your hard work.
Ethics of therapy fees
All of the professional counseling and therapy organizations have ethical codes regarding fees. The Zur Institute is a great resource on the specific ethical codes for the various professional organizations. Be sure to check out their ethical codes page! For the sake of simplicity, I’ll quote from the American Counseling Association Code of Ethics and Standards of Practice, however most organizations have a similar idea.
Here are the major areas of the ACA ethical code regarding fees for service:
- Self Referral
- Unacceptable Business Practices
- Establishing Fees
- Nonpayment of Fees
- Receiving Gifts
The ACA ethical code prohibits referring clients to your private practice if you work for an institution unless the organization’s policies specifically allow for it. When you are allowed self-referrals, you should be very clear to the patient of other options available. Remember, when you are working for an organization, you should be a representative of that organization and not a sales representative for your own practice!
Unacceptable Business Practices
No kickbacks for referrals! No fee-splitting! A patient expects you to look out for their best interests — not your best financial interests. If there’s a financial incentive through fee-splitting, that leads to steering patients towards a particular practitioner because of your own self-interest and not the best interests of the client. The appearance of impropriety is enough to shatter the public trust in the behavioral health profession. Hold yourself to a high standard and financially you’ll end up doing better than if you compromise those standards for a quick payday.
Be conscious of the locale and the financial status of your clients. If you’re in Laramie, Wyoming and you’re charging $250 an hour, you’re probably not doing it right. If you’re in New York City charging $250 per hour, then that might be more acceptable. The key point — be aware of your market and don’t exploit them (but don’t be taken advantage of either!)
Nonpayment of Fees
Are you prepared to use a collection agency? If that’s the case, you must disclose this possibility within your informed consent documents. You should clearly spell out the consequences of non-payment before the therapeutic relationship begins. Certainly be flexible, but you definitely want to collect the fees you have earned.
While I personally don’t like the idea of bartering for therapy services, it is permissible only “if the bartering does not result in exploitation of harm.” The reason I don’t like bartering is that it’s often difficult to equate the value of a good and your services. What that means is that you’re adding some complexity to the arrangement. However, that being said, in many communities, bartering is an accepted practice. Just be clear on the exact terms of the barter and don’t allow it to be open ended. For example, if you’re bartering for web design services, establish what the price of those services would be if you were to pay cash, then “pay” for those services in an equivalent amount of your therapy services. Be clear, get it in writing.
In many cultures, small gifts are a token of respect and gratitude. However, it’s important to take into account the motivations for the gift, the monetary value and your motivation for accepting or declining the gift. Be culturally sensitive, but I would advise you to avoid large gifts. Use good judgment.
Your therapy fee structure and cancellation policy
Every client should have fees disclosed before they begin a relationship with you. If you chose to offer a sliding scale, be transparent about how that fee is determined. If you collect cancellation fees, make those crystal clear, including the cancellation policy. The upcoming iCouch, due out this summer, is going to make it really easy to both set a cancellation policy as well as enforce it. We know this is an uncomfortable subject for many therapists!
It’s highly recommended that you treat cancellation fees as non-negotiable and consistently apply them within the context of your policy. If your cancellation policy is clearly defined, unambiguous and fairly applied, your clients will respect it. However if you inconsistently apply the cancellation policy, you will lose money, but you’ll also be faced with the uncomfortable task of explaining how you can’t waive the fee “this time.”
Cancellation fees serve several purposes:
- They compensate you for your lost time; you run a business and you have bills to pay (including your salary.)
- They provide an incentive to not miss appointments (thus improving patient treatment outcomes.)
- They establish the seriousness with which the patient should take their treatment.
If you devalue your services by not collecting the appropriate fees (including the cancellation fees,) the patient will devalue the importance of their treatment.
In later posts we’ll dive deeper into fees and therapy practice management, however hopefully now you have a bit more clarity as to how you should ethically approach your compensation as well as best practices on disclosing your fee schedule and cancellation policy.