I encourage my clients to pay their own fees, whenever possible, and I discount the fee I charge to clients willing and able to do so. About half of my clients pay their own fees, instead of asking me to bill their health insurance companies. Some of the reasons clients prefer this arrangement include:
- They have no health insurance, or no mental health benefits.
- Many people are extremely dissatisfied with mental health services provided by their HMOs.
- Some HMOs refuse to reimburse independent doctors in private practice. Kaiser Health Plan is a local example.
- Some health insurance companies have a very short list of "exclusive providers." Omni Health Plan has been a local example.
- Health insurance companies do not properly protect your privacy. Most health insurance companies require me to report a great deal of personal information about you. If I refuse, they don't pay.
- Many health insurance companies decide for the client what kind of treatment the client should get, and when treatment should conclude, regardless of the feelings of the client or the opinion of the doctor. Most health insurance companies base these decisions on the desire for profit, not the best interest of the client.
- Health insurance companies interfere with decisions that the doctor and client should make. For example, many insurance companies try to prevent me from making referrals to other doctors. Some try to prevent me from writing work absence excuses or putting a patient on State Disability or Worker's Compensation. Once again, these decisions are based on nothing else but the insurance company's desire for profit.
When therapy clients pay their own fees, and pay at the time of each visit, I reduce my fee to $75 per hour. (A visit is a "50 minute hour." Therapists need breaks between sessions.) When clients are very distressed, they generally need to come in about once per week. For less distressing problems, or when things start to go better, clients normally come in once every other week, once a month, or as-needed. Clients concerned about cost are more likely to opt for less frequent visits. This is okay, as long as my client is getting adequate care.
Keep in mind that my fees for other services, such as psychological examinations, or treatment under other circumstances, might be considerably higher.
To help self-paying clients avoid undue hardship, I employ treatment methods likely to produce the desired benefits in the smallest possible number of visits. I take particular care to help clients estimate the likely duration and cost of treatment. I also take particular care to advise clients about "homework" and self help efforts for use between visits, to shorten the needed number of visits as much as possible.
Some therapists offer a "sliding fee schedule." In other words, they charge affluent clients more, others less. I don't do this, because I don't think it is fair. If I call a plumber, he doesn't ask me how much I earn before he decides how much he will charge me for unplugging my toilet. Like a plumber, I provide a useful service for a fee.
Although I do not have a formal sliding scale, I am sympathetic to the concerns of low-income people. Therefore, when a highly-motivated, low-income client badly needs my services, I will negotiate a fee reduction on a case-by-case basis.