To my knowledge psychotherapy is the only professional service where one can spend $100 or more in a session where instead of discussing the problem that brought you into see a professional, you will discuss the symbolic meaning of the payment. This fee discussion process could take a good part of a session, the whole session or even several sessions while at the same time you are charged by that therapist for talking about your feeling for being charged a fee.
My position on the matter of fees may differ from many of my colleagues but, here is my view on the meaning of the fee in therapy. It’s no different then it is in any business relationship. The therapist has something you want or need, hopefully anyway and you have something the therapists wants or needs, money. Like any other business relationship money means money. It buys things. It’s not that complicated. When anyone has enough money, they do not give it too much thought. The problem comes up when we do not have enough or we perceive we do not have enough. In that situation most of us can hardly not think about it all the time. But, I submit that is true for just about all our business dealings. If we have enough to pay our mortgage, we write a check and go about out daily lives. If not, we worry about it constantly.
If you find your therapist has a notion of the meaning of money that you don’t share or if he or she is spending a great deal of time talking to you about money in a therapy session and charging for it, here is a test. Offer to pay him/her in Monopoly money or poker chips. If your therapist is only interested in the symbolic meaning of money, it should not matter what specific symbol is used. It could be beads or beans. However I am willing to bet that if you did that your therapist no matter what their theoretical orientation will tell you they want real money, legal tender, coin of the realm etc.
If that happens it could be a true clinical breakthrough. You and your therapist can stop endlessly discussing the meaning of money in therapy sessions. Deep down it means the same to both of you. It buys things as said above. Negotiate the fee in a brief business like manner and decide if the deal is worth it to you. If not, explore other realistic options.
Negotiate did you say? Can I actually negotiate a fee with my therapist? Why not? You negotiate and shop around when you buy a car and a house don’t you? You don’t always pay the asking price. My e-book contains an article called All Things Are Negotiable. Please check it out.
Here are some negotiating hints.
Standard and usual or customary fee – That is the fee that your therapist claims they charge. However in most cases it is neither standard, usual or customary. A more accurate description would be standard and usual/customary fantasy or wish fee.
Look at it this way. My practice is my business. I can charge $1,000 an hour if I choose. The question is who in their right mind will pay that much? So, if I want to stay in business I have to come down to some amount that the market will bear. I must be willing to bargain.
If I have insurance, can I bargain on the co-pay?
Probably not and I don’t recommend that. If you have insurance your insurance company or managed care company has negotiated a discounted fee with a participating therapist already. That fee is substantially lower than the wish or fantasy fee. You can bargain if you can get one, but it’s no bargain if your therapist can’t make a fair living. They will become so preoccupied with money matters there will be not much energy for much less, including you. You don’t want to kill the proverbial s goose, just collect the golden eggs.
In addition your insurance company may prohibit your therapist from waiving or reducing the co-pay except for the most serious of hardships. You see their concern is that if you don’t pay at last something out of pocket there is a danger that you would be tempted to have therapy whether you need it or not because it appears free. Economist call this concept moral hazard. I don’t like the term but that’s what they call it. Also, if you spent any time discussing the meaning of money with your therapist they will tell you that for therapy to work you have to invest in it. So in principle anyway therapists and managed care companies agree.
But what if I lose my job and or insurance can’t pay?
That’s an all too common situation these days. And, there is no simple answer. It depends on many factors but probably most of all whether your therapy is something you absolutely need for your safety or that of others i.e. medical necessity or something desirable but not essential.
If your therapy is not essential, you will need to make choices as in all other things we would like. When things are tight, do we put off re-doing the kitchen or the vacation trip? Sometimes we need to make difficult decisions. Since fees are negotiable perhaps we can renegotiate the fee with the therapist.
If however, your treatment is truly necessary, your therapist has some responsibilities. They cannot simply abandon you. That would be a serious ethical breach and can result in action being taken against them. They have to find you someone to take over your care or keep treating you at least until you are stable. That is one difference between a professional therapist or health professional and your auto mechanic.
I have known therapists who paint themselves in a corner. They work real hard at convincing you and or your insurance company that your therapy is absolutely essential. But some have been known to drop you like a hot potato if your or your insurance company’s money runs out. Suddenly, you are miraculously cured. That scenario will only fly if you let it. If you absolutely needed the therapy when you could pay what changed except you can’t pay now. Make sure they have an answer that not pure psychobabble.
What is a sliding scale fee?
Basically it is a discounted fee but promoted in a way that is unique to Psychotherapy. It works like this. Your therapist tells you his/her standard and customary fee. You tell the therapist you can’t afford it. You therapist then reduces the fee to something you can afford. What you are doing is claming hardship or poverty and if your therapists believes he/she is being charitable. And, most therapists are genuinely sincere that they are being charitable. But there is another way to look at it.
Suppose you went to an auto dealership and bought a car for $20,000. Now suppose that same day someone else got that very same model for $15,000 because they came in and said they were poor or looked poor in the eyes of the dealer. How would you feel? Well if it were me, I would march on into the dealer and demand the same break that the other guy got. Business people discount all the time. However it is not based on how poor or wealthy their customers look but rather they have too much inventory of a product or they have services going unsold. True, a therapist that offers you a sliding scale fee is giving you a break. But odds are they are doing so because they have empty hours in their schedule. It’s like the airlines selling discounted tickets at the last minute so they won’t take off half empty. You are doing them as much of a favor as they are you. If they really wanted to be charitable, they could simply offer services to poor people pro bono and be done with it.
Why is it that therapists standard and customary fees at least for the same discipline are more or less the same?.
I t’s a coincidence or at least it should be. Non affiliated therapists are by definition competitors in the same market. Federal anti-trust laws prohibit competitors from engaging in price fixing and or restraint of trade. Even discussing or sharing fee information among competing therapists could get then in big trouble with the law. The same laws that restrict big corporations from price fixing also apply to solo practicing therapists. It does not seem fair to us but that is the way it is. The laws are to protect the consumer.
If my therapists refers me to some other non affiliated therapist can they get a cut or percent of the fee
No. That is called fee splitting and that is an unethical and illegal practice. All therapists should know that but a small few seem to forget.
Should my therapist give me credit?
It’s not a good idea for many reasons. A therapy bill can mount fast and when that happens you could really have all kinds of issues and feelings that interfere with your therapy. It’s much better to pay the fee or your co-pay as you go. If your insurance is managed let the company and your therapist work out the details of collecting the rest.
If your therapist balance bills you, check with your insurer. Balance billing is when the therapist bills you for the difference between what the insurer pays, your deductible and co-pay and his/hers standard usual or customary fee. In many cases in order for your therapist to be accepted on your insurance companies panel, they contractually agreed not to engage in balance billing. If that is the case confront your therapist and if they don’t back off report it to the insurance company immediately.
Again in special circumstance your therapist may let bills run up a bit, but usually not for too long or too much. If that is the case pay what you can as soon as you can. Your therapist has bills to pay too. However wise, compassionate or empathetic therapists should be prepared to write off the debt if you really can’t pay.
Can my therapist resort to aggressive collection methods?
Often this means taking you to court or using collection agencies. If done in accordance with federal and state laws it is legal and they can do it. However that does not make it any less despicable and onerous. I could go on and on about what I think of this practice and therapists who would do this except as the last resort in the most exceptional of situations. But we are running out of space so see what I said about it in Therapists To Stay Away From With A 10 Ft. Pole
Comments positive or other wise are welcome. Suggestions for future columns are also welcome. click hereto contact me.
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