Negotiating Sliding Scale

Negotiating Sliding Scale

Curt and Katie chat about the pros and cons of sliding your fee for therapy services. We look at the theories around fee-setting, sliding fee scales, and conversations around money. We discuss what actually makes a difference in determining if clients are invested and will benefit from your services. We also dig into the laws, ethics, and practicalities if you choose to offer sliding scale in your practice. 

It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.

In this episode we talk about:

• Feedback from our conversation with Tiffany McLain
• Clinical theories on how fee impacts the clinical relationship
• The different ways that people enter into therapy, different financial situations, etc.
• A more nuanced conversation about sliding scale fee
• Freud’s views on having direct conversations with clients on fee
• How clinical orientation can impact how therapists view fee-setting
• The idea that fee must be set at an “uncomfortable enough” that clients invest in therapy
• How fee paid impacts attending the last session
• Different types of investments that might impact how much people benefit of treatment
• Practical ways to assess what fee would be in the sweet spot for sliding scale (e.g., written out scale, financials, etc.)
• Do therapists show up differently for clients who pay more or less?
• How fees average out among larger caseloads
• Incorporating outcome measures and practice-based evidence to assess whether you are showing up differently for clients who pay more or less
• Mythology around what we have to do and what is best to do
• Laws and ethics, practical considerations
• Usual and Customary fees
• Advertised fees
• Philosophy related to how you set your fees
• The impact of insurance on our profession related to sliding scale
• Ethical codes on fee setting related to services provided and client ability to pay
• Models of subsidy for mental health services
• The need for a standard justification
• The risks for insurance fraud related to fee-setting and accepting copays
• The ability to adjust usual and customary fee as needed as long as it doesn’t violate state law
• What we have to do and what the softer, virtue ethics might recommend
• The importance of accurate billing and justification
• The tension between the equity argument and the practicalities of business
• Are you unfairly treating clients who are paying less?
• The need for pro bono work, but not sliding scale work
• The need for clinician-led discussions and opt-in from the client
• Check your insurance contracts, advertise your fees correctly, written basis for a range of fees
• Options for sliding scale
• Other models for addressing access
• How to create a sliding scale practically
• Why you need to identify what you need to make on average per session
• Moving your sliding scale or pro bono work outside of your practice
• Our recommendations for Open Path Psychotherapy Collective and Give an Hour