Should You Offer a Sliding Scale?
Should You Offer a Sliding Scale?If you’re looking for one guaranteed way to make a therapist cringe, ask about sliding scales. Specifically:
- Do you offer a sliding scale?
- Why don’t you offer it?
- Should you offer it?
- What is an appropriate minimum rate for a sliding scale?
- How do you decide who deserves reduced rates?
What is a Sliding Scale?A sliding scale is a flexible fee system. The fee that the client pays can “slide” up or down based on the client’s ability to pay. A sliding scale usually takes into consideration the client’s household income. Now, let’s discuss the benefits of using a sliding scale.
The Benefits of Offering a Sliding Scale
It Fits With Your PhilosophyAs a mental health professional, you provide a useful and honorable service to your clients—one that brings both peace and clarity. You don’t want to exclude anyone who’s willing to do the work because they can’t pay. You got into mental health to help people, and the more people you can help, the better! You’re uncomfortable with the idea that someone cannot get the help they so desperately want and need. You believe that everyone should have access to proper mental health care, and you want to live what you believe. Offering reduced fees means that you can help more people, and that’s exactly what you want to do.
It’s More Affordable for Your ClientsYour clients will pay what they can afford to pay. Your clients won’t have to make the unholy choice between paying for mental health or paying their monthly utilities. Obviously, there’s some danger in offering reduced fees because not everyone will be honest about they can afford. But, in an effort to keep everyone honest, you should consider asking the client to provide proof of their household income.
You’ll See More ClientsNo insurance? No problem. Insurance, with its low copay requirement, often makes mental health more affordable for your clients. But what about the clients who don’t have insurance? Or what if you don’t accept insurance to begin with? Offering reduced fees based on what a client can afford automatically opens the door for more potential clients.
You Can ByPass Insurance Companies and Offer AnonymityDealing with insurance companies can sometimes feel like running through an obstacle course. Insurance companies can refuse to cover several diagnoses and associated treatments. They can also require constant updates and authorization. The paperwork alone is enough to make your life miserable. And of course, you don’t want to get into the dangerous game of misdiagnosis to fit insurance requirements. And then there’s the release of private information about the client. Some clients simply don’t want their insurance company (or anyone but their therapist) to know their personal details. They don’t just want to be labeled or they don’t want some third party payer to have access to their mental health records. By offering self-pay, you can provide anonymity for these clients. And by reducing that self-pay to a more manageable rate, you can service more clients.
The Negatives of Offering a Sliding Scale
You’ll Potentially Devalue Your ServicesIt’s one of the biggest dangers of offering a sliding scale: devaluing your own service. Sure, it doesn’t seem like you are. It seems like you’re helping people who couldn’t normally afford your services. But, on the flip side, what message do you send when you discount your services? My services are priced too high to begin with? You’re not going to get the same quality care as my regular pay clients? Some therapists also believe that clients are more invested when they’re more invested. In other words, when clients are required to pay more for a service, they’re more likely to assign a higher value to it. This isn’t always the case, of course. There are many people who absolutely cannot afford to pay higher rates but will still value and benefit from mental health services.
You’re Slighting Your Other ClientsIs it fair to offer some of your clients a reduced fee while forcing other clients to pay the full fee for the same exact service? With a sliding scale, you’re subsidizing your client base. Your full-fee clients are, in essence, paying the difference for your reduced-fee clients. Plus, it can be confusing to your clients why you offer some reduced fees while they must pay full rate. This is why you need to have a clear and transparent policy for offering a sliding scale if you choose to implement this system in your private practice. Every client should know it exists and who it exists for (and the requirements of getting a reduced rate). Also, your full-fee clients should know that their higher fee will subsidize your reduced-fee clients.
You’ll Work Longer HoursTrying to squeeze in enough reduced-fee clients to pay the bills will inevitably make for longer hours. If you charge a client 50% less than a full-fee client, you’ll have to see twice the number of reduced-fee clients. When you implement a sliding scale system in your private practice, you will work more for less—there’s no way around it. Working longer hours will also put you at increased risk of burnout.
You Actually Don’t Want to Reduce Your FeesYou feel like you’re being forced to reduce your fees because other practices around you offer reduced rates. But when you’re trying to compete with the “affordable” therapists around town, it’s a race to the bottom of the barrel. Because you’re concerned that potential clients will choose them over you based solely on price, you desperately implement a sliding scale to compete. While some people will always choose the lowest price, many people place a premium on quality mental health care, and won’t choose you because you offer the cheapest rates. In fact, it may be a filter to not choose you. Stay true to what you feel is right to do, and not just go with what everyone else is doing.
You’re Making It About YouAre you charging reduced fees to feel better about yourself? Perhaps you’re struggling with insecurities such as:
- I’m new and I don’t have a lot of experience.
- I have a small practice.
- When I charge my full fee for self-pay clients, I feel like a fraud.