Setting aside some session hours to see people who are uninsured or inadequately insured and who can’t afford your usual fees can help you strike a balance between your social justice beliefs and your own need to make a living. You can fill in some of the service gap in your area by using one or more of these ways to make your practice affordable for more individuals.
Yes, there are downsides. That will be discussed in Part 2. For now, let’s just look at some of the options for providing services to low income and/or uninsured clients. Here are options for providing services to low income and/or uninsured clients:
1. A Sliding Fee Scale
Setting a sliding scale where the fee is adjusted according to income and number of people who are supported by it is one option. Set up a grid. Across the top are income levels. On the left axis is a list of the number of people in the family who are supported by the client’s income. Fill in the grid with your fee per session.
What you set as the fee range depends on the cost of living in your area and what other therapists have found to be a reasonable rate. Many social service agencies use such a scale and would share it with you.
Sliding scales are generally non-negotiable. During the first phone call or first session (before starting a billable hour), share the grid and ask the client to identify his or her fee. If someone can’t afford the fee the grid specifies, it is a courtesy to provide the prospective client with a list of the names of other therapists or community services who will negotiate a lower fee.
2. Negotiating Fee on Individual Basis:
Some therapists negotiate fees individually. The sliding scale may seem concrete and easy but it doesn’t take into account the expenses the client is already managing. A young adult who lives with his parents and makes $30,000/year, for example, is in a different situation than a single person who is totally self-supporting on that same income.
There are individuals who are between jobs, who are in crushing debt or who have had a major medical expense. You may have on-going clients who have hit a rough financial spot who need a fee reduction to continue to work with you.
These conversations are difficult. Don’t be shy about asking for specifics. If you later discover they, in fact, could have paid your usual fee but chose instead to go on an expensive vacation, you’ll end up resentful. If, out of shame or lack of assertiveness, the client sets a figure they really can’t reach, they are likely to drop out.
3. Keep A Set Number of Hours at a Low Rate
Set aside a certain number of hours per week at a set low fee – say $10 or $20. Let referral sources like the local service agencies, clergy and family practice physicians know that those hours are available in your practice. Remind them to screen people’s financial situation appropriately and to call ahead to make sure you have an opening before referring.
4. Offer Group Therapy at a Lower Rate
5. Extend credit
Another option is to extend credit up to a stated amount. The client pays a portion of the fee each session and the remainder goes on their account. The client contracts to continue making regular payments after termination of treatment.
6. Do Pro Bono Work
Another way to “give back” without lowering fees is to volunteer your services at a local agency. One therapist I know offers parent consultations at a local parent drop-in center. Another therapist offers family meetings at the senior center for elders and their adult children who are providing care. Still another therapist facilitates a group for Parents Anonymous. None of these women characterizes their work as free therapy. Instead, they see it as providing education and support to people in the community who are already financially stretched. They avoid the potential problems of fee reductions in their practices by contributing to their communities in another way. (For further information, see Pro Bono Work Matters.
Setting fees is complicated. Setting fees while trying to accommodate those who can’t afford our usual rate is even more so. The solution is to be intentional about it. By thoughtfully choosing one or more ways to give back we give ourselves the satisfaction that comes with doing good in our community while doing good work.