Should You Offer a Sliding Scale in Private Practice?

[@wsutherland]

I’m a dental student and considering implementing a sliding fee schedule. There aren’t many videos in my field that discuss this so thank you for sharing!

[@pbxh6740]

I offer a sliding fee scale on two conditions: Someone is already seeing me and has problems with employment or insurance after they're established, or someone wants to see me and we're waiting for insurance to kick in. Personally, I think a multimillion dollar insurance company would have a hard time arguing that they meet the income guidelines for a reduced rate, LOL. The rate is based on the income of the payor, and my very lowest fee is the lowest that will still give me the basic income I want.

[@PrivatePracticeSkills]

That's an interesting strategy!

[@JorgeMendoza-zm7ev]

This is a great topic! I had never thought of the percentage idea you mentioned and I can see how this would help maintain boundaries. I think also having resources of nonprofit counseling agencies/referrals can help clients who financially can't afford private practice fees.

[@PrivatePracticeSkills]

Yes that's such a great point! It's so important to have referral resources for clients who may not be able to afford our rate.

[@Ravenccs1]

You are the FIRST person I have seen who has addressed the insurance issue! Well done!! Insurance fraud also includes NOT ensuring correct copays and deductibles are collected. Therapists often don't check with the insurance companies they have contracts with and assume that because others do sliding scales, they can too. This kind of information is USUALLY in the contract that you signed with them. It is very important to remember one must follow ethics, state laws, insurance contracts and to sometimes even call your liability insurance attorney before you even consider making most decisions - not make decisions based on what other therapists do.

[@josephmartelmusic]

Hey I really appreciate this video! I'm not a therapist (though an avid therapy-goer) but I'm looking to implement a sliding scale for another business I'm starting. This video was very helpful! Thanks!

[@thedogshouterer]

I am a private tutor working with neurodivergent students and, with my recently increased fees, this is becoming a really sticky topic. I LOVE the percentage rate--this way the choice is mine rather than the weird, squishy "pay what you can afford." I also think that if someone is requesting sliding scale it is then reasonable to ask for basic proof, ie. front page of taxes. Anyone else's thoughts on proof? In my case I think I would also need to ask questions about tax filing too as some of my parents are split but both contribute to paying services.

[@sherrygreen5428]

This is great information. I have been doing it all wrong. Thank you so much for your help.

[@PrivatePracticeSkills]

I'm glad you found it helpful!

[@privatepracticeworkshop5045]

This is such great information!

[@LisaMarnell-c2f]

Thank you! So helpful.

[@WarrenRichardson]

Hi Dr Marie, really enjoyed this video. I'm currently seeing a psychotherapist that offers sliding-scale, and I did qualify but just from some initial emails and wasn't required to submit my income or related documents as you described. Does that mean it's purely "honor system" or I might need to show the math later to continue getting the lower / more affordable rate?

[@bruceburleson8664]

This is REALLY helpful!

[@juliaoverlinmslpccncc1982]

If I am OON w/ an insurance company would you say they still can have a say over whether I offer a sliding scale or not, or is it just if I am aligned and In-Network with an insurance company? Thank you in advance. This was alarming to learn, want to do things right.

[@CarlaDEllis]

Yes very helpful info! I love the song by way lol! May I ask where to find out if I qualify for offering a sliding scale? I am preparing for private practice in a couple of months. Thank you in advance :)

[@PrivatePracticeSkills]

The song 😅As far as finding out where you qualify, are you referring to your state jurisdiction or to insurance panels? As far as the state, I think you'd have to consult with your jurisdiction's laws directly. But I bet your local colleagues could likely point you in the right direction!

[@CarlaDEllis]

Private Practice Skills okay thank you!

[@SpeechTS]

Do you have a video about offering a profit sharing program to clinicians you hire, do you have to be a corp? Can LLC do this? Can you offer profit sharing with independent contractors,

[@bridgetnash638]

Do you have a suggested breakdown of rates based on income? (i.e. if someone makes 100k/year you charge x, if someone makes 75k/year you charge y, if someone makes 50k/year you charge z?)

[@PrivatePracticeSkills]

Everyone does this differently, but I've personally set mine up so that if folks were to attend therapy weekly, it would amount to 10 percent of their income (within the allotted scale range). Hope this helps!

[@bridgetnash638]

@@PrivatePracticeSkills It does, thanks!

[@soraiasakkaidou1588]

I’m looking forward to being a home owner and have at the same time had home owners, company owners tell me they cant afford my services... ( because their company’s are running on a negative ) - But their still spending, living as per normal ( i feel its a system thing in their business and the messiness vs not having the resources )

[@i.e.presents638]

I worked in a recovery treatment group where virtually every couple had 5 therapists between them. This is Silicon Valley, so who knows, but it seemed to me that most if not all were paying more in the neighborhood of 20-30%. Now the couples work was not weekly during the program, it it would be for years afterward in most cases, and both the individual work & group work was definitely weekly 50 or so session annually so a frequent situation was that they made a fair amount but the intensive nature of treatment took far more than they could manage. Or at least that is what some said and that made sense...any guesses which therapist ended up caving in and charging less? Yup, the one working with the wives and some couples work where they were priced out of working with the male therapists. In the end I felt ill used and so did the wives. It impacted the way we collaborated on cases at times. Never again. Having said all that, it FELT different because these were not stories, we knew for a fact they were spending nearly $2K monthly on therapy and these people were probably not making $200K annually. Heading out into the private practice world doing the same work will mean collaborating with several separate practices now and I have to admit this feels like a good reason to slide. I’m just no longer willing to be the sacrificial lamb.

[@PrivatePracticeSkills]

Yikes! Well that certainly would be an investment - $2,000 a month for a whole year?? I can see the issue there. But also, at least in my area, $50 a session would allow me to pay my overhead and that's it. Sounds like a situation where both clients and therapists are bound to be incredibly frustrated!

[@rosiegarcia7562]

Love it

[@Viorinx]

Yes yes so much yes. You’ll lose out on clients if you don’t who are in need!

[@PrivatePracticeSkills]

Glad you agree!

[@theawakenedheart8783]

Such a great topic of discussion! I guess it’s important to know right from the start the target clients you’ll be catering for - goes right back to branding and then policies for having some room to wiggle. Thank you again 😊

[@johnfudala128]

Give me the short answer.

[@laloarr]

There needs to be a better compromise. Telling the person who's making fair money and seeking therapy to get their shit together and "budget" to afford your attention sounds pretty counterintuitive