79 How to Ask for Payment Professionally In Your Private Practice

Ever felt that twinge of awkwardness when the topic of money arises in your therapy practice? Join us as we strip away the discomfort with my insightful guest, Jennifer, guiding you through the complexities of financial discussions in the counseling room. We're tackling the big questions head-on: How do you introduce your rates with confidence? What's the smoothest way to handle declined payments? And how do you maintain the integrity of your practice while being compassionate to those facing financial hurdles? Our conversation is a treasure trove of strategies for any private practitioner seeking to balance ethical considerations with the bottom line. 

This episode isn't just about the numbers; it's about fostering respectful, clear-cut relationships with your clients from the get-go. We'll share our combined wisdom on setting, discussing, and sticking to your fees and policies, including the sticky situations of no-shows and rate increases. Discover how to apply sliding fee scales ethically and fairly, the potential perks of pro bono work, and the value of mentorship in offering affordable services. Whether you're a seasoned therapist or embarking on your private practice journey, our exchange is designed to equip you with the tools you need to navigate these waters with ease and professionalism. With Jennifer's expertise, we're shining a light on the path to a financially and ethically sound practice.

Get your step by step guide to private practice. Because you are too important to lose to not knowing the rules, going broke, burning out, and giving up. #counselorsdontquit.

Transcript

Speaker 1: 0:10

Hey everybody, it's Dr Kate Walker. This is your Tuesday training and we're going to talk about money. And my special guest is Jennifer, that many of you know and love, and she's going to ask me tough money questions because she's going to be in her own private practice soon. And I thought, well, who better than to kind of talk about the icky money stuff, the uncomfortable money stuff, than somebody who hasn't really gotten a lot of experience taking money with clients? I mean, jennifer, you know everything to do with supervision and you're in a doc program, but what? What do you think about when it comes to accepting payment from client? And to be clear, we're talking about taking payment, not insurance payment, because that's a whole other animal right. So what kind of comes to your mind when you're thinking about taking money or accepting payment from clients?

Speaker 2: 1:09

For me. I think about. You know, we go to the grocery store and the we scan an item and it tells us the item's $5 and we don't, we don't question it, we don't think anything of it, we just pay it. I mean, it's not a personal interaction but as a therapist it's a very personal interaction. It's a personal relationship and money's. You know, I was taught growing up we don't talk about money at the dinner table. So I think money, addressing money, is a really great topic and I wrote down some questions. So how do you tell a client that you don't take insurance, that you're just a cash pay practice?

Speaker 1: 1:49

That's a really good question. And when? And I want to go back to what you just said a minute ago, because so many of us are raised not to talk about money, and so when you have something that you don't talk about, it puts shame onto it, like you know. It's like we're not supposed to talk about sex, we're not supposed to talk about whatever right. So if we put it in that sort of category or box of stuff of not supposed to's, we've got to untrain and retrain our brain when it comes to talking about it with clients. So the way I teach it is you broach in your 10 minute consultation. Now, if you don't know what a 10 minute consultation is, I've got another episode on that, but briefly, it's the appointment that you set.

Speaker 1: 2:39

Before the appointment, it's the screening call. It's the call that you talk to the client and you let them know sort of what therapy is all about and what the first few sessions look like. And it's not like you're leading with my rate is $500. Can you pay that Right? We're not doing that. We're simply saying here's what I do, here's what you'll get, here's what you can expect.

Speaker 1: 3:07

And, by the way, do you have any questions for me, and so prompting a client to ask a question is good because you know the answer. First of all because usually they're going to ask about cost and schedule and we know when anxiety goes up, cognition goes down. So your clients on the other end very anxious, like they don't know what to ask. They know money's probably important, but we're kind of trained in the medical model. As a client I'm thinking about. You know the person on the other end of the phone. They may have never paid for something like counseling with a check or a credit card. They're used to using their insurance. So when you prompt them and say, do you have any other questions for me? And they say, oh, yeah, well, how much does it cost? Well, you can give your rate and right. It's just like an improv Do something, say something and right. So you give the rate.

Speaker 1: 4:08

My rate is $150, and you can submit a super bill for reimbursement if you have those type of out-of-network benefits. So see, I didn't just say my rate, I said my rate and then I told them immediately how to recoup that money without letting them know. Like I'm going to do that for them. Like they might ask, oh, do you do that for me and then I don't. In my practice I would say no, but we can give you a super bill with the proper codes and my tax ID, so you have that and you can submit that to your insurance. And if you have those kinds of benefits and I'm always really careful about that to say if you have those benefits, then you may be reimbursed. So I mean, that's, that's how I teach people to broach the topic right and introduce them to this new concept of yeah, we're not taking insurance, it's cash payment. And, by the way, when I say cash, I don't mean like cash cash, I mean credit card, venmo, ivy Pay, whatever it is that you're going to use.

Speaker 2: 5:21

Just cash in general. Yeah, yeah, okay. So how do you broach the subject of somebody's card getting declined?

Speaker 1: 5:30

Yeah, that's actually a topic I noticed today in one of the groups. It was either Texas counselors creating badass businesses or the Texas supervisor coalition. And you know this is really tricky because if you look at HIPAA and you look at LPC and LMFT, getting your credit card declined or your payment declined is respond to a bad client review on Google. Right, there are certain conditions under which we can break confidentiality, like abuse, child abuse or elder abuse, or if you have to defend yourself in court. So I my my whole comment. There is consult an attorney. Right Number one consult an attorney, but be prepared to eat that cost.

Speaker 1: 6:28

I mean again, no, I'm not an attorney, but most of the time when you have to dispute a payment, you have to submit proof. And if you can submit proof with the client's name redacted yes, I know the credit card company knows who it is and you know who it is and everybody knows what we're talking about but when you submit that proof, that's releasing protected health information. So nobody, ever, anywhere, ever said you have to work without getting paid and so terminating a client who isn't paying is absolutely appropriate and there are ethical ways to do that. You can refer to the ACA code of ethics, you can refer to the licensure code where it talks about termination and how to avoid client abandonment. But you're never supposed to work and not get paid for what your services are.

Speaker 2: 7:22

But yeah, it can be tricky get paid for what your services are. But yeah, it can be tricky, that's always a tough one. So well, and I guess you kind of touched on my next question Would you continue seeing a client if their card was declined.

Speaker 1: 7:36

You know I this is probably one of those other things like talking about money at the dinner table thing the program or the software that I use allows me to send out an automated email. It's a HIPAA compliant software, but I can send out an email that says, hey, your card was declined and here's how we can square that up. So I always start with the gentle tap on the shoulder and you know, because it happens all the time People's credit cards get declined or somebody gets compromised, I'm using something called IV pay. Now, iv like the plant, not like the intravenous fluid, so you'll know immediately if the payment's not going through. So I think as counselors we've, you know I've kind of talked a little bit about broaching the topic when you're having to work it into a client session.

Speaker 1: 8:35

I always teach to do it at the beginning of the session, right, the beginning of the session. Let's say, you're face to face, everybody's just kind of walked down the hallway, you're getting settled on the couch, you're putting your purse down, you're putting your whatever down and you can say hey, before we get started there's just a little bit of housekeeping. I noticed that your credit card didn't go through. Is there another card you'd like to leave on file with me? Same thing with virtual. At the beginning of the session is what I teach, and you guys know as well as I do if you've been doing this for a while. The reason why is because the end of the session is usually when they've dropped a bomb or they're in the middle of working through something very, very heavy.

Speaker 1: 9:18

You're trying to close. Maybe they're not ready to close and for you to be like oh yeah, by the way, your credit card was declined. You know let's just throw one more thing into the last five minutes that it's going to be tricky to try to. You know, talk about, hang on, I'm going to let somebody in. So yeah, if a credit card gets declined and or a client is showing that, you know it's sort of an issue over. You know that also comes down to your boundaries, right? You know and I talk about this with folks who are taking the supervisor training you know how long would you let somebody go in supervision without paying you for supervision, right? I mean, if you're having trouble collecting payment, it might not be. You know something with the client. It might be something with you right not be. You know something with the client, it might be something with you right.

Speaker 2: 10:18

So, yeah, it's a lot of what we counselors struggle with with money is up there, so very much so. Have you ever had a client dispute, a credit card charge?

Speaker 1: 10:26

Have I, yeah, I have A long time ago, yeah, and it was. It was shocking, you know, because you know, you're, you're kind of sitting there going wait a second, you're, I saw them right, like they were there and I remember, and you're kind of you're, you almost question. You know what happened and I work with couples and so you know, thank goodness this has only happened once, you know, in almost 20 years, but still it's that. What do I do? How do I get this money back?

Speaker 1: 10:58

Well, again, in the big scheme of things, that payment, that one payment that doesn't go through, that you're not able to recoup, you have to really ask yourself the time and the effort Small claims court, I don't know. Whatever you decide to do, is it really worth going after and maybe possibly risking the protected health information and flip it to say, you know, if you let that person come back and they still don't pay you, or it becomes a pattern, you know, and you're recouping $1,000 from them. That's kind of on you, if you I mean as gently as I can say it right, that's really something you got to work out.

Speaker 2: 11:42

Perfect. So do you ever offer like session packages?

Speaker 1: 11:49

Ooh, that is such a good question, and I hear that now because so many people are wanting to do coaching right, and so this brings in our codes of ethics and our licensure codes. So, code of ethics, just as a reminder. Code of ethics is from, you know, we think of that from our professional organizations like ACA, amft, apa, and those don't govern our license right. What governs our licenses are is LPC, lmft, social work, psychology, bhec, right, and then above that, we have federal laws like HIPAA. So when you have wait, tell me the question one more time. I just got totally lost into my Session session packages. Okay, oh yeah, I was like wait a second the question one more time. I just got totally lost into my session packages. Okay, oh yeah, I was like wait a second, that was so much, okay, yeah.

Speaker 1: 12:40

So LPC, lmft codes say you can only accept payment for services rendered, right, and that's.

Speaker 1: 12:50

You know, we don't want to bill falsely, right, you would never submit an invoice for something, a payment or a service that never happened.

Speaker 1: 12:58

So when we have packages, right, let's say that you're going to put a package together for three sessions. You know, I'm not saying that's good or bad or wrong, it's just you've got to remember those services haven't happened yet, so you might want to be sure that you have a refund policy. So if that person only comes to the first of three in the package, how long are you going to hang on to that money before you refund the money, right? So you give them a call, you say, hey, you know, you still have two sessions left. And they're like, hey, I'm feeling pretty good. I don't really think or we found somebody else who's a better fit, or the issue has resolved itself, whatever. Then, really looking at having something in your paperwork that describes your refund policy, and what that means is you'll need to have a cash kind of an account set aside, right, you won't want to spend that money right away because you're going to have to be ready to give that back if the services are never rendered. That makes sense.

Speaker 2: 14:07

And then my last question I had is how do you address when clients like you tell them your fee's $250 an hour and and they you know their life's falling apart and they're crying on the phone and they say I can't afford that.

Speaker 1: 14:20

Yeah Well, so this is a couple of answers here, right? So, first and foremost, counselor, I'm looking at you. You don't have to save the world, okay, it is not all on your shoulders, and there are ways that you can help this person out who can't afford your fees. So I'm gonna tell you a couple of ways. So, first and foremost, let's say it's you who wants to deliver those services. I have heard of business plans where you can set aside certain days of the week, certain times, certain slots in your schedule that are a sliding fee scale. So my only advice here is you must have something black and white to be able to determine who gets it and who doesn't. Right, it can't just be like oh, you look like you need a sliding fee scale, no, no, no, you drove a really nice car, so I'm not gonna give you a sliding fee scale.

Speaker 1: 15:20

So what I recommend are the federal poverty standards. If you're able to get some sort of documentation from this person you know, pay stub or some sort of letter from the unemployment office or something that satisfies you you as to the amount of money they have and their household number, right, like the number of people in their household who are dependent on them. Then you can go to the federal poverty standards and say, oh, okay, for a family of five making $36,000 a year, they yep, they fall under the poverty standards. Then you practice owner can come up with a rate, right. So if they make this much money, you might charge them $20 for the session, or this much money, $80 for the session or something along those lines. But whatever you choose, be consistent. Keep the same criteria in the same way for every single person who walks in your office and you don't have to dedicate half your schedule. You can dedicate two hours in your schedule, right? Giving pro bono work is in our code of ethics, right? We want to be sure that we're giving back to the community.

Speaker 1: 16:38

A second way is become a supervisor. Become a supervisor and have somebody you know amazing, like Jennifer here, once she gets her LPC associate license, who's able to see clients at perhaps a lower rate and you can pass those clients. And then, jennifer, you can decide what you want to charge them until you get the experience right. But my goal is to always create a raving fan, so someone who will leave the phone call with resources so they would be able to tell a colleague, a friend or a family member hey, that person, you know what? I couldn't pay their rate, but, my gosh, they did not let me off the phone until I had resources in my hand figuratively so I could take next steps with this problem.

Speaker 1: 17:29

So, whether that's a session at a lower charge or just referrals that they can, they can take, take you up on Awesome. Thank you so much. Those are my questions. That's it All right? Well, hold on, let me see if I have any. Uh, I think. Oh, you know, what I didn't talk about is within the session.

Speaker 1: 17:53

So I'm going to throw this out there here, because I do see this like OK, getting the credit card number right, charging for no shows having that information. That can be tricky as well. So I don't work for Ivy Pay. They don't pay me to endorse them. But one of the things I really like about Ivy Pay is you send your clients a notification through the app. They get the notification through the app. They enter in their own credit card information, so you never have to deal with that at all.

Speaker 1: 18:29

If you're doing it the old-fashioned way, then one of the things I would recommend in the 10-minute consultation is, if they choose to book with you then get the credit card information at that time.

Speaker 1: 18:41

But I, Kate Walker, never charge for a missed first appointment because in my philosophy of counseling, I have not established a relationship with that person yet. Even if they've signed all the paperwork, they don't know me, I don't know them, so I wouldn't charge them for no showing on that first session. But whatever your policy is, make sure, number one, you have it in your intake paperwork and, number two, if you ever change your rate rate, you got to do it in writing you have to update that consent form with your new rate and have that person acknowledge it and sign it. Um, I think I saw in one of the social media threads where somebody was texting their client that like, okay, this is written right. Like I'm texting my client letting them know that I'm raising my rate and it's like, well, maybe but how do you know that that's the person who got the text message Exactly?

Speaker 1: 19:41

How do you know it's them? Are they able to sign? Are they able to acknowledge in any way received? Take a picture and say, hey, yeah, I got through tech. No right, there's a way that you can get them to sign new paperwork or even just a form. Hey, I acknowledge that my rate has gone up 10% and I agree to it. That's. All we're looking for is consent to the new rate, and that is in the rules.

Speaker 2: 20:04

I did think of another question actually. Oh good, so a lot of people have a 24-hour cancellation policy and they'll say you know, if the client doesn't cancel within 24 hours, they have to pay you know X amount of dollars. And I guess I kind of struggle with that because, like myself, I have kids. What if? What if I wake up one morning and my kid's puking all over the place? You know, I, I don't know always know 24 hours before an appointment and that has deterred me from reaching out to some therapists because I don't want to be on the hook for $100. If you know, god forbid, somebody falls sick on the way to the appointment.

Speaker 1: 20:41

Right, and that's something I think in the interview, and if you know, if someone's listening to this who is going to ask for therapy, which should be all of us right, because therapy is good for us, that's a really good question to ask. Because we're back to the whole hey, I'm going to charge you a no show fee, but you know what? You're kind of my favorite over here, so I'm not going to charge you a no show fee. So, whatever you choose, you must be ruthlessly consistent, right? I mean it's yeah. I mean, it's just one of those things that if you're going to have a policy, you got to stick to it.

Speaker 1: 21:18

And honestly, I would actually, as you're saying that, and I've been there too, you know, I've had, you know, three kids at home under the age of 18, you know, and you never know what's going to happen. So I imagine that would be pretty cool for a therapist to actually market themselves as someone who is amenable to people with kids. And your no show fees are reasonable, and you have all of these different ways to reschedule and you have all these different ways to perhaps use virtual, and I just think I came up with a business.

Speaker 2: 21:49

Yeah, Like you could do so much, because that it is a deterrent and you know it's hard and people don't know you can't plan for illness and emergencies and so I like that.

Speaker 1: 22:05

It happens to the best of us, you know, and so maybe it would even be the solution like, okay, if somebody no shows once, okay, they no show five times in a row. You're like the solution like, okay if somebody no-shows once, okay, they no-show five times in a row. You're like, hang on, baby, and maybe therapy is not a good fit at this time for them either. Right, Maybe it's just not. But gosh, think of the business, think of the practice. If you two could brainstorm together and figure out a way to do therapy, I don't know, it just sounds right. Okay, we need to flesh that out.

Speaker 2: 22:39

So, those are all the questions I had, hopefully. I mean that was some really great information. I like the Ivy pay because taking people's credit card numbers you know, my previous background was law enforcement and I always cringed because I worked credit card, debit card abuse cases all of the time and somebody asked for my credit card number and I'm like, what are you going to do with it when you're done? Like, are you going to turn it in the fireplace? Did you take a match and light it on fire? So you know, we live in a day and age where it's very easy. So I really really like the the Ivy pay system where I don't even have to touch it. So there is no possibility that it's because of me that there, you know, was some sort of financial security breach.

Speaker 1: 23:21

Yes, yeah, I know, like remember ordering pizzas and be like okay, what's your credit card number, and I'm like oh gosh okay, here it goes Right over the phone.

Speaker 1: 23:33

All right. Well, let me double check over here in the Facebook group. We've got a couple of people attending live today and if either one of you want to ask questions, I will stop the recording and we'll dive into those. Hey, rosalinda, I'm glad you're here. All right, anybody have questions live about money, about talking with clients about money and I'm talking to supervisors now too.

Speaker 1: 24:17

I would love to know how you guys teach associates, your associates who have their own practice, how to broach this topic, how to set, maybe, a sliding fee scale, how that they, how they're going to consistently charge for no-show fees. Because for me, I've heard stories too about, yeah, I gave this person a sliding fee scale and then they drove up in a new car. Okay, what do you think that does to the therapeutic relationship? Right, because I mean, we're not big corporations. As the therapist, we're also the bank. Right, we are the cashier, we are the one you know sending out invoices for billing the accounting department. So that dual relationship in that moment, you know we really have to work through. Ah, okay, am I okay that I'm giving this person a sliding fee scale and they just drove up in a new car because I know they need the new car and they've been working really hard and and and right. So always consult If this is something that you feel like is negatively impacting you or the relationship, take it to somebody, talk to somebody.

Speaker 1: 25:23

We've got great groups right Texas Counselors, creating Badass Businesses and Supervisors, the Texas Supervisor Coalition, or tag me in this group. Just tag at Kate Walker and I'll see it and I'll answer your question. All right, I think that's it. It's funny. I just looked at your screen. I think that's it, kate Walker. All right. Well, thank you for asking such great questions and you're gonna come back and do this again because you're awesome, jennifer, thank you. Thank you, all right. Bye everybody. Have a great day.