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The Legal Department articles are not intended to serve as legal advice and are offered for educational purposes only. The information provided should not be used as a substitute for independent legal advice and it is not intended to address every situation that could potentially arise. Please be aware that laws, regulations and technical standards change over time. As a result, it is important to verify and update any reference or information that is provided in the article.
On Ethics: Avoiding Problems with Fees, Payment Agreements and Health Insurance
Michael Griffin, JD, LCSW
Reviewed November, 2017 by Ann Tran-Lien, JD (Managing Director, Legal Affairs)
Over the past few years, the CAMFT Ethics Committee has received a number of complaints from consumers alleging that a therapist may have acted unethically because he or she either misrepresented, or failed to accurately represent, some fee-related issue. As you might expect, when a therapist discovers that a former client has made such a complaint, it tends to be a very unsettling experience. In some cases, the therapist is surprised that the client has made such a complaint. But in many instances, fee-related problems were evident during the course of treatment but never resolved. In fact, a dispute involving the client’s fee, health insurance benefits, or some other payment-related issue may have precipitated the termination of the client’s treatment.
It is hard to overstate the need for LMFTs and pre-licensees to maintain clear communication with clients regarding the issue of health insurance and fees. There are numerous reasons for saying this, not the least of which is the likelihood that a fee or payment-related dispute will disrupt a client’s treatment. Such a dispute can also lead to an ethics complaint or a disciplinary action against a therapist by the Board of Behavioral Sciences.
Problems concerning fees and insurance can often be avoided by the exercise of due care by the therapist. The following precautions may be obvious to most therapists, but they are necessary, if a therapist hopes to minimize the likelihood of a fee-related complaint.
Take care to thoroughly discuss the issue of fees and responsibility for payment before treatment begins
It is understandable that a therapist may struggle in meeting this requirement. The therapist may be uncomfortable discussing the issue of money with the client, or the client may resist talking about the subject of fees, preferring to engage the therapist in a discussion of his or her immediate concerns. The therapist may also feel a sense of urgency in responding to the client’s emotional distress before doing anything else. But, the issue of fees must be appropriately addressed before providing services to the client. This includes all aspects of the fee arrangement, including missed appointment or cancelation fees, health care insurance arrangements, etc.
Take the time to identify and discuss health care plan benefits and limitations
The importance of clear communication with clients regarding fees and payment agreements is especially true when the client is utilizing his or her health insurance to pay for therapy. Considering that there are multiple types of insurance plans, with varying benefits and eligibility rules, it is quite easy for misunderstandings to occur. That doesn’t mean that every problem which involves the client’s health insurance is necessarily the therapist’s fault. A client may be angry when “discovering” the insurance plan has a large deductible, even though it was the client who purchased the plan. Or, the client may state that he or she didn’t realize that the insurance plan would not reimburse the cost of services provided by an “out of network” therapist.
Ultimately, it is recommended that the client record contain a clear written fee agreement, which contains the relevant office policies regarding the topic of health insurance. When, and if, problems arise concerning the client’s fee, the therapist should attempt to address the issue at the earliest possible opportunity.
Clients who are covered by Medicare should be informed that services provided by marriage and family therapists, are not currently reimbursed by Medicare.
Services provided by Registrants and Trainees
A client may be unfamiliar with the distinction between an LMFT and a Registered Associate MFT and fail to recognize that his or her health insurance benefits probably don’t apply to treatment rendered by the Associate. While it is possible that the health care plan may cover services provided by registrants is unlikely. Consequently, when services are to be provided by an Associate or Trainee, it is extremely important that the client be informed of the fact that his or her health insurance may not provide reimbursement for the treatment provided.
The Bottom Line: It is important to maintain clear communication with clients on any issue concerning fees, insurance and payment agreements
Regardless of whether the therapist or client is ultimately determined to be “at fault” for the problem, the bottom-line is that almost any fee-related dispute is upsetting to the client and to the therapist. Although it is probably impossible for a therapist to eliminate the possibility of encountering a problem in this area, it is possible to reduce the likelihood of such problems by thoroughly discussing any and all fee-related issues from the start and by maintaining clear communication with clients as issues arise.