[AllHeart]

My 22-year old niece just started therapy with my therapist’s colleague. This therapist does not take my niece’s insurance so my sister offered to pay the fee for the therapy.

I made the initial call to the therapist for my niece. The therapist told me that she charges based on a sliding fee scale range from $80-$150. My sister was to call this therapist to discuss the amount to be paid. Well, that didn’t happen in time so the therapist had my niece make out a check for the max of $150, plus $30 for set up of a new account and file.

My sister called the therapist to discuss the fee, finally. The therapist told my sister that she charges a standard fee of $150 but a sliding fee scale option is available. Different than what she told me initially. Her sliding fee scale ranges from paying $80/session if annual income is $20,000 or less, up to $150/session if annual income is $85,000 or more.

I read the therapists payment fee info sheet and she sounds money hungry the way she charges for every single thing but that’s not really the point of this post. Ok, seriously though, who deducts time from session in order to run a credit card through a cell phone card reader?

Back to the point… whose annual income should the fee be based on – my niece’s or my sister’s? I think my niece’s. She’s an adult client. It doesn’t matter where she gets the money to pay for her therapy, does it?

[atisketatasket]

Originally Posted by AllHeart

My 22-year old niece just started therapy with my therapist’s colleague. This therapist does not take my niece’s insurance so my sister offered to pay the fee for the therapy.

I made the initial call to the therapist for my niece. The therapist told me that she charges based on a sliding fee scale range from $80-$150. My sister was to call this therapist to discuss the amount to be paid. Well, that didn’t happen in time so the therapist had my niece make out a check for the max of $150, plus $30 for set up of a new account and file.

My sister called the therapist to discuss the fee, finally. The therapist told my sister that she charges a standard fee of $150 but a sliding fee scale option is available. Different than what she told me initially. Her sliding fee scale ranges from paying $80/session if annual income is $20,000 or less, up to $150/session if annual income is $85,000 or more.

I read the therapists payment fee info sheet and she sounds money hungry the way she charges for every single thing but that’s not really the point of this post. Ok, seriously though, who deducts time from session in order to run a credit card through a cell phone card reader?

Back to the point… whose annual income should the fee be based on – my niece’s or my sister’s? I think my niece’s. She’s an adult client. It doesn’t matter where she gets the money to pay for her therapy, does it?

ETA-How the heck does one create a poll?

I agree. Your niece’s income seems the relevant one to me.

A list of every fee doesn’t really surprise me, DBC had that. But this one deducts session time to run a card through a reader? Yeah...shady.

[WarmFuzzySocks]

Your niece is the client, so the fee should be based on her income.

[healinginprogress]

Definitely your nieces. Like you said, she's the client. But I'll also add my hesitation over a therapist that deducts time to run a card.

Sounds like she's trying to encourage cash payments so she doesn't have to pay the credit card fee. But at that point, just don't take credit cards.

[stopdog]

This just shows me how a client can be too honest with a prospective therapist who exploits it.
I also think the whole thing, while completely well-meaning, is a bit too group involved and messed up from the get go. I think the adult niece should find her own therapist and work out arrangements with them without it being a family affair. If after choosing her own therapist and making her own arrangements, her mother wants to give her money - great. But I would not make the call/choices/decisions/hiring of a therapist for an adult for them.

[dSou9]

I completely endorse the point healinginprogress has made above

[InnerPeace111]

I agree with stopdog...the adult niece should find her own therapist and make her own financial arrangements directly with them. This whole arrangement needs to be kept as clear and simple and clean as possible.

[AllHeart]

Originally Posted by stopdog

I also think the whole thing, while completely well-meaning, is a bit too group involved and messed up from the get go. I think the adult niece should find her own therapist and work out arrangements with them without it being a family affair. If after choosing her own therapist and making her own arrangements, her mother wants to give her money - great. But I would not make the call/choices/decisions/hiring of a therapist for an adult for them.

Sometimes the young adult needs a little help finding support, especially when anxiety, depression, and addiction has taken over their life. My niece requested the help because she was striking out on finding a therapist she liked on her own. The decision was hers to hire this therapist.

If your niece and sister live together, the sliding scale fee should be based on total household income.

I was thinking back to college, where some other students got a free pass but were rich because they lived with boyfriend or wealthy parents. Not cool at all.

[ScarletPimpernel]

The fee should be based on your niece's income. My husband paid for my therapy when we weren't married. I qualified for sliding scale, so my T based it off my income.

[MessyD]

I didn't even know they charged by income.

[lucozader]

I also think it should be based on your niece's income, and I don't see anything wrong with her getting help from you and your sister with setting it up, if that's what she wants to do.

This though:

Ok, seriously though, who deducts time from session in order to run a credit card through a cell phone card reader?

Is completely ridiculous...

[NP_Complete]

Originally Posted by lucozader

This though:

Ok, seriously though, who deducts time from session in order to run a credit card through a cell phone card reader?

Is completely ridiculous...

I don't know. How long does it take? 30 seconds to a minute? I pay at the beginning of my session and it doesn't take any longer than that. I like paying at the beginning because it's like a small ritual to start our session. I can come sit down and don't have to speak for a small window. It gives me the space to settle in to the couch, so to speak. It seems like a lot of people here pay at the end of session though.

Really surprised at the answers.

Using this logic, Melania Trump, who lives in a house made of gold, would get the lowest rate, while a single mom making $25k would not (and if head of household would not have enough disposable income to pay her rate.)

Since the mom is paying and it is very apparent and obvious she is doing so, it should be based on the mom's income. If down the road the daughter starts paying for her own therapy, she can negotiate a reduced rate based on her own income at that time.

[healinginprogress]

Originally Posted by Rayne_

Really surprised at the answers.

Using this logic, Melania Trump, who lives in a house made of gold, would get the lowest rate, while a single mom making $25k would not (and if head of household would not have enough disposable income to pay her rate.)

I don't understand this.

Melania is paying for Ivanka's therapy? She would pay full price. Mainly because Ivanka can afford to pay full price.

Also, why would the single mom not? I'm really, honestly, confused by your logic here.

Most seem to agree the sliding scale should be based on the income of the person receiving the therapy, rather than the person paying for the therapy or household income.

I was assuming Melania isn't employed/doesn't receive a salary as first lady, so with zero income and her husband paying for the therapy with his presidential income, she'd be eligible for the $80 discounted rate.

The single mother would not be eligible for the $80 rate because she earns more than $20,000. She'd have to pay more than Melania.

I didn't think sliding scales were intended to work that way, but maybe I am wrong.

When I had therapy and a sliding scale was applied, I had to divulge all sources of income before a decision could be made about what my fee structure would be.

[atisketatasket]

This might help. Between the blog post and the link to federal poverty guidelines, it looks like it should be household income that determines a sliding scale. So if the niece lives with her mother, household income, but if the niece lives on her own, niece's income (= her household income).

According to the blog post, if therapists offer a sliding scale, they're supposed to offer it to everyone. Which is the not the impression I've gotten.

[lucozader]

Originally Posted by NP_Complete

I don't know. How long does it take? 30 seconds to a minute? I pay at the beginning of my session and it doesn't take any longer than that. I like paying at the beginning because it's like a small ritual to start our session. I can come sit down and don't have to speak for a small window. It gives me the space to settle in to the couch, so to speak. It seems like a lot of people here pay at the end of session though.

Yes, exactly - charging for an extra thirty seconds to a minute of their time is pretty ridiculous!

I also always pay at the beginning of my sessions. At the end I'm often all wrapped up in whatever we've been discussing, sometimes very emotional, and I tend to be distracted by it and forget, which can lead to awkwardness. I like to get the practical stuff done first so I can relax into the session.

ETA: I've just realised that perhaps you misinterpreted me as saying that AllHeart's statement was ridiculous, when in fact I was intending to agree with them that charging for the time taken to process a card is over the top!

[NP_Complete]

Originally Posted by lucozader

Yes, exactly - charging for an extra thirty seconds to a minute of their time is pretty ridiculous!

I also always pay at the beginning of my sessions. At the end I'm often all wrapped up in whatever we've been discussing, sometimes very emotional, and I tend to be distracted by it and forget, which can lead to awkwardness. I like to get the practical stuff done first so I can relax into the session.

ETA: I've just realised that perhaps you misinterpreted me as saying that AllHeart's statement was ridiculous, when in fact I was intending to agree with them that charging for the time taken to process a card is over the top!

I got your original meaning. And I can see that some or even most people would be annoyed at having to pay for the time it takes to pay. I guess in my mind, it's such a miniscule amount of time, I don't feel bothered by it. I use that time to settle in, take a look around the room, think about what I'm going to say, etc. It's not wasted time for me is what I'm trying to say. And I agree with you about getting the practical stuff out of the way. At the end of the session, it would feel more uncomfortable emotionally to conduct a business transaction.

Originally Posted by atisketatasket

This might help. Between the blog post and the link to federal poverty guidelines, it looks like it should be household income that determines a sliding scale. So if the niece lives with her mother, household income, but if the niece lives on her own, niece's income (= her household income).

According to the blog post, if therapists offer a sliding scale, they're supposed to offer it to everyone. Which is the not the impression I've gotten.

She gives some bad advice though, telling people it is "illegal" and "insurance fraud" to charge a different rate for cash paying people. I think that's a myth.

I recommend not reading that blog if you are currently having anger issues.
For those on a sliding scale, she recommends just giving them a certain number of sessions and transferring them to another provider. I don't think it's a good idea to expose someone to therapy than try to brush them off to someone else. The client has a breakdown and so seeks a therapist. The therapist sees the client for 2 months, the client stabilizes, so now its time to transfer the client? That itself could bring on repressed trauma. But it's a win-win for therapists, she says.

Just beware of this practice if you are a sliding scale client.

It is also reasonable to not offer life-long therapy to an individual client at a rate significantly lower than your Usual and Customary Rate. With that in mind, offering brief, time-limited, solution-focused therapy or crisis stabilization for these same clients can certainly fill a much-needed service gap in most communities. Just make sure that you are ethically meeting your clients’ needs and provide appropriate transitional support to another care provider when needed. What’s not OK is to simply fill your designated low-fee slots for 6 weeks and then to boot those clients out without proper support.

This sounds like a win-win for a lot of therapists. Assuming you can afford to offer reduced-fee time slots, I would certainly support this as a healthy business decision that also serves to ethically and compassionately meet some individual’s needs.

Originally Posted by MessyD

I didn't even know they charged by income.

Apparently some may charge according to the therapist's self worth:

How do you know if your lower fee is, at least in part, a reflection of your own self worth? Consider how it feels to ask for the full Usual and Customary Rate. (In Colorado, that is $85-125 / hour for licensed therapists.) If you find yourself hesitant to ask for that full fee, then the question becomes “Why?” If the answer you get back is something along the lines of . . . “I’m brand new , I just don’t have any experience, I’m only getting started, no one will pay me that much, or I’m not worth it,” you can bet that the lower fee you are thinking about charging for your professional services is not about the economy OR your concern for your client. It’s about your own self worth and FEAR. How to Create...

[AllHeart]

Thanks, everyone, for the input. The t based the session fee off of the client's income (my niece).