Fees in Therapy
Clinical Update March 2016
By Zur Institute
Most therapists are more comfortable discussing their client’s sex life than their investment portfolio, mortgage or credit card debt. Money and fees present some of the more complex issues facing therapists and clients, especially at the beginning of treatment. Nevertheless, they tend to be ignored by many therapists who have neither the training nor inclination to explore these issues. In spite of our reluctance to address financial issues, money, like sex and time, often define people in this culture. Fees issues are one of the parameters that differentiate psychotherapy from friendship and other intimate or loving relationships.
In my many years of consulting with therapists on private practice and ethics issues, I have discovered large numbers of erroneous beliefs or myths regarding fees in therapy.
Following are some myths, faulty beliefs and misstatements about fees in therapy:
- Fees in therapy never have clinical meaning but are purely and only financial matters.
- Fees should not be mentioned in the Informed Consent that all client must signed at the onset of therapy.
- Discussing money issues with clients is tacky and unprofessional.
- Forgiving clients’ debt is unethical.
- Employing collection agencies to collect debts from clients can take the burden off the therapist and provides a sure way to recuperate the money.
- “You get what you pay for,” and therefore low fees often result in low client motivation and low therapeutic efficacy.
- Once an insurance company has paid a claim, they cannot require the therapist to return the fees.
- Fee-for-service therapy must have CPT and ICD codes in the records.
- It is permissible to bill an insurance company for direct reimbursement without requiring the client to pay the co-pay.
- It is permissible to bill an insurance company for more than your customary fee.
- Insurance companies do not reimburse for telemental health.
- HIPAA mandates that all therapists use electronic billing.
- Video conferencing and telemental health rates are always much lower than F2F.
- Not charging clients is unethical.
- Charging for phone calls in between sessions is unethical
- Therapists have the right to refuse requests from clients to release their records, if these clients refuse to pay their outstanding balance.
- Verbal agreement regarding fees is generally sufficient to comply with ethics guidelines and states’ laws. There is no need to document it.
- Billing records are not part of the clinical records.
- Sliding scale is below the standard of care.
- Regardless of a clients’ consent, it is unethical and constitutes a breach of privacy to send the invoice to a clients’ relative for payments.
- It is ethical to pay referral fees if the client stays in therapy.
- No-fee clients do not appreciate therapy as do full fee clients.
- No-fee agreement is always preferable to bartering.
- Bartering is always unethical.
- Bartering for goods (i.e., art, vegetables) is as risky as bartering for services (i.e., house cleaning, carpentry).
- All bartering arrangements involve conflict of interest.
- Allowing a client to accumulate a large debt is always unethical.