Offering fee reduction of one type or another is a way to give back to your community and at the same time maintain professionalism. Whichever option you choose, reducing your fee or extending credit comes with clinical challenges.
Careful consideration of the following issues can help you make a wise choice for your practice. Any of these concerns can become useful material during treatment. Left unprocessed, such issues can hijack the therapy.
Clinical Issues
Ø There are clients who will resent paying a lower fee because it makes them feel like they need to be grateful to you. They may feel that in order to be your equal, they need to do something for you. That something could be gifts or referrals or sharing stories they don’t really want to share.
Ø There are those who feel dependent since they can’t afford to see someone else. It may raise other issues about dependency or co-dependency,
Ø There are those who are suspicious. Having grown up with a parent who gave them money but with strings attached, they question your motives and worry about what you expect in return. The same may be true of someone who was (or is) in a relationship with a partner who controlled them by controlling the money.
Ø There are some who feel entitled and special because they get to see you for less than what other people have to pay. That entitlement may be played out in other ways. They may be late for appointments or test you to see if you will keep them in treatment if they don’t show up on a regular basis.
Ø Some clients who have a personality disorder feel entitled in general. Knowing that doing so will result in a higher fee, these clients may not disclose that they got a better job, finished paying off a burdensome school loan or won the lottery.
Ø There are clients who make every attempt to pay the least they can in order to have more disposable income for items or experiences they see as essential. I’ll never forget negotiating a lower fee for a client who persuaded me that she was paid a barely adequate wage at her job, only to learn many months later that she was going on an expensive cruise. What followed was a very difficult conversation about her evaluation of the worth of her treatment and how she set her priorities.
Ø If not clearly discussed at the outset, a client may abruptly terminate if you move him or her out of a low income slot because their financial situation has changed for the better.
Ø Therapy is not like buying a new pair of shoes. There is nothing new to look at and touch to remind a person that they made a purchase for which they need to pay. Some clients who put some or all of their sessions “on account” may forget about how they benefited. If they feel they didn’t benefit or didn’t benefit enough, they may feel justified in not paying their bill.
Other Issues
Ø If you consistently charge fees that are below the market rate in your area, there are clients (and other therapists) who will see your work as worth less than the higher priced therapists. It may not be reasonable but it happens.
Ø Extending credit or being too liberal about lowering fees or collecting payment may have negative consequences on your cash-flow. You cannot keep a practice if you don’t have enough income to support it.
Ø You can only bill an insurance company for fees that accurately reflect the usual and customary fee you charge in your practice. Carefully read the contracts you have with insurance companies. Be aware of the consequences, if any, of setting fees for some clients that are lower than what you charge for those with insurance.
Ø Not so finally, you may find that you have some unresolved feelings about lowering your fee for some of your clients. A negotiated fee means you are voluntarily giving up a higher paid hour. You may find yourself resenting it. You may find that you are reluctant to do extra collateral work for a client who is paying a lower rate. Or you may be surprised and dismayed to find that you question your worth as a therapist when some clients pay less than others.
All that being said: It can be very gratifying to reserve some slots for low income members of your community. Self-worth is increased by doing things that are worthwhile. It is certainly worthwhile to provide treatment for people who could not otherwise afford it. If you deal honestly and responsibly with the issues listed above, you can make a major contribution in your community doing what you do best – good therapy.
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