Collecting Fees from Clients

Payment for services is a necessary component of your healing practice. For many mental health providers it can feel like an internal struggle to collect fees. Nonetheless, in order to succeed in private practice, practitioners must learn how to master the skill of fee collection. 

Set the expectation and make your terms clear

Stating the expectation of payment upfront is key to setting up successful cash flow in your private practice.

At first contact, inform your potential client that you require fees to be paid at the time of service and that you require all paperwork including a credit card authorization form completed prior to the first billable session (your EHR system may take care of this for you). It’s common practice to cancel the first session with a client due to lack of paperwork. This may feel counterintuitive, however it is good business practice when establishing a profitable practice.

Have your Fee Policy clearly stated in your Paperwork

It goes without saying that you must add your fee policy in your informed consent – it’s a requirement of our ethical standards after all! With that being said, have it clear and easily found. Be sure that your informed consent states that you collect fees at the time of service and how you collect fees! Consider enlarging the text or require the client to initial this area to help eliminate it being glossed over. You will encounter considerably less pushback from clients over the course of treatment if you establish these expectations up front. 

Include a Credit Card Authorization form as part of your paperwork

Credit card authorization form grant permission for a client’s card to be charged. This allows you to enter a client’s information into your system. These forms must have the following information:

• Cardholder’s name
• Card number
• Card network (Visa, Mastercard, American Express, Discover, etc.)
• Card expiration date
• Cardholder’s billing zip code
• Statement authorizing charges
• Cardholder’s signature and the date they signed

Once you upload this form into your secure system delete the form from all other platforms, such as your computer or email.

Verify Insurance Prior to the First Session

It’s best to request all insurance information prior to the client’s first billable session. This provides a clear picture of what their benefits are and what to expect before a session is billed, especially if a client happens to have a high deductible. Many people are more reluctant to pay their fee due to not understanding how their insurance works or unaware that they have a large deductible. 

Make your terms even more clear!

Prior to the first billable visit, a quick phone call or email outlining the client’s costs could prevent any misunderstandings that can arise when it comes time to collect fees.  Use this example script:

Hi [CLIENT NAME],

I look forward to meeting with you for your first session. I’d like to make sure we’re all on the same page on a few “small print” details before starting your sessions. Please let me know if you have any questions or if anything doesn’t match your expectations, or needs.

• I collect all fees at the time of service: Your card will be immediately charged after each session
• All paperwork must be completed before the first session. Your session will be rescheduled until all paperwork is provided
• Your intake session amount is $[DOLLAR AMOUNT] and scheduled on [DATE]
• Your ongoing session fee is $[DOLLAR AMOUNT] until your deductible is met, then $[DOLLAR AMOUNT] thereafter. 
• $[DOLLAR AMOUNT] will be charged for late cancellations (less than 24 hour notice) or no shows

I look forward to seeing you on [DATE]. Please let me know if you have any questions.

[YOUR NAME]

At the beginning of the year, when the majority of insurance deductibles reset, this is a particularly excellent habit to develop. It reminds your clients that their deductible reset on January 1st and you can gently remind them of your fee policy. 

Collect fees at the time of Service

Once the session is complete, immediately charge your client’s full fee,  co-pays or deductible. The longer a client waits to pay the less likelihood you will not receive the entire amount owed to you. Your practice should have a goal to collect 100% of all fees immediately after each session.

How late payment can affect your Practice

Poor payment habits, when clients fail to make payments on time, are one of the main issues that practices face. Likewise, poor payment collecting habits is also a large issue practice owners face. As a result this places a significant impact on businesses that struggle with sustainable cash flow. Late payments have led to serious repercussions for businesses and on occasions has forced some practices to close. 

Having the Money Conversation with clients

Discuss unpaid fees with your clients as soon as you are aware of an outstanding balance. Unpaid fees might be part of the presenting problem that lead your client into therapy and this may be an opportunity to process their relationship with money. 

Inform your client of an outstanding balance

Let your clients know that they have a past due balance, what that balance is and how they can pay their fees. Be polite and professional. Avoid language that shows disappointment or frustration. Use this example to create your template script.

Example scripts:

• “It was brought to my attention that you have a balance due. Your current balance owed is $[AMOUNT]. Is it possible that you received a new credit/debit card? Payments can be made by [DESCRIBE HOW TO MAKE PAYMENTS].  As a friendly reminder, our fee policy requires that payment is due at the time of service. If the balance is not settled by [DATE] sessions will be paused until the balance owed is paid. Please let me know if you would like to discuss payment options.”

Additional Strategies when collecting payment from clients

At times you may find that a different type of intervention may be needed. Use the below list to find additional options to prompt your client to pay their fees.

• Verbally discuss the outstanding balance
• Discuss reducing the number of sessions
• Discuss payment plans
• Email an invoice to your client after your verbal discussion
• If your payment collecting system has the option to set up auto reminders, this will save you even more time by not having to manually remind your clients!

• Mail via USPS an invoice to the client with instructions on how to make the payment. 
• Pause sessions until the outstanding balance is paid in full

Should your Practice use a collection agency?

Many mental health providers question if debt collection is the best solution for a client who has fallen behind on payments. Exploring the various pertinent facets of this problem, such as the professional, relational, clinical, ethical, legal, and potential unintended effects, is necessary to to consider. Here are a few more considerations when thinking about using a collection agency:

• Filing with a collection agency is probably not effective if a client has lost their home, employment, or both.
• Your informed consent must include that you contract with a collection agency. 
• You may only receive 10-30% of the fee owed after the collection agency takes their portion. 
• Find an agency that has experience working with businesses in healthcare and collect a BAA!

Lastly…

Starting your private practice career takes guts, and you deserve to be paid and respected for the hard work that your do, so stand up for yourself and your fee policy!