Ethics and money: Raising the subject of money and payment for services with patients

Tips on pro bono treatment, payment plans and when to involve a collection agency.

By Sherry Delaney

Money is an uncomfortable enough topic for many mental health professionals under the best circumstances, but when the topic turns to large, unpaid balances, the conversation is both uncomfortable and potentially damaging to the patient relationship. Proactive management strategies can head off large client debts and minimize the clinical impact of the business side of mental health practice.

“You are in a dual relationship that is difficult to resolve if you are creditor and clinician,” explains Mary Gresham, PhD, of Atlanta.

She recommends that the intake process should include a discussion of policies concerning payment, insurance and missed appointments. Psychologists in private practice should decide before intake how much pro bono work they will accept, and have an appropriate referral ready for clients who cannot afford to pay the required fee.

“If a client is getting behind, that needs to be addressed right away,” says Jeff Zimmerman, PhD, ABPP, of The Practice Institute.

In broaching a timely, direct conversation about an outstanding debt, you might discover an unknown stressor that is clinically significant. You might choose to offer a payment plan or reduced fee to a financially stressed patient who is eager to do the hard clinical work. You might find that it is time for a patient who is not valuing treatment to move on.

“If a patient hasn’t paid for two sessions, we contact them and find out the circumstances,” says Mary Alvord, PhD, psychologist and director at Alvord, Baker and Associates, a large group practice in Rockville, Maryland. Alvord Baker does not use a collection agency in the rare cases when the practice’s proactive policies fail to resolve an outstanding balance.

Collection services are expensive. Most take a large percentage of any debt collected. Many psychologists in private practice avoid credit cards because the fees are burdensome, but credit card payments provide a convenient solution to avoid large balances.

Zimmerman notes another reason to establish proactive policies to avoid large debts and collection agencies altogether. It is not uncommon for clients in collections to retaliate with a licensing board complaint.

When engaging a collection agency, research is essential. Local Better Business Bureaus and Chambers of Commerce can help identify collection agencies that adhere strictly to state laws and the Health Insurance Portability and Accountability Act. Check for complaints or legal judgments against an agency. Your agency’s professionalism and reputation will reflect on your own.

You can read more about navigating the complex world of money and practice in the Fall 2016 issue of Good Practice magazine.