I'm probably not going to be very popular for saying this but I'll go ahead and say it because I do feel strongly about it. It is an integrity issue regarding the billing for sessions when the client isn't there. A therapist who bills insurance when a client isn't there, whether by mistake or for fraudulent reasons, needs to be called on it and things need to get straightened out. But it also really isn't okay for a therapist to offer to allow the client to not pay the co-pay as a way of giving them a break. A therapist makes a contract for payment with the insurance company by saying, I charge $120.00 a session but I'm willing to settle for the insurance company payment of $50.00 and the client's co-pay of $20.00. It's a business agreement that is contractual.

It a therapist wants to give a client a "break", why not say, I'll give you a free session every four sessions or something along that line? Here in the U.S. we are really struggling with the whole issue of medical insurance and when therapists/doctors fool around with the payment of services, by stepping outside the contractual lines, it just throws another problem into the situation. I totally think it's fantastic that a therapist wants to help her client who is struggling financially, but it is an ethical issue for both the therapist and the client. Wouldn't we all be up in arms if we heard that a therapist was over-charging a client on the co-pay to make up for her stated service--ie. accepts the insurance payment of $50.00 but charges a co-payment of $70 instead of the agreed upon co-pay of $20.00?
How is not charging the correct co-pay okay but the overcharge isn't?

I do understand wanting a break on the cost. Therapy is expensive and at times it nearly broke me . . . literally, but it is an issue that needs to be played fairly on both sides of the fence. . . at least, that's how I see it.