HAWAI'I PSYCHOLOGICAL 
ASSOCIATION  FOR A HEALTHY HAWAI'I

On May 9, 2017, Colin Denney asked:

Is this actually a norm? I was under the impression that we are expected to charge copays under the terms of contracts with insurance carriers, and that with a few exceptions, we are allowed to pass the GET on to patients.

Tanya Davanzo:
Charge the copay.Jim Spira:

If, after checking with the insurance company, there is indeed a copayment due on their plan, and if it's not a federal plan such as Quest, Medicare, FEP Blue, TriCare, or equivalent, then it is completely appropriate and expected that you collect the patient portion of their bill as well as pass along the GET. If they're from the mainland, they're probably unfamiliar with paying a GET on services.

Issues around charging for services are difficult for many people, and I think particularly hard for people inclined to be psychologists -- most of us have a self-sacrificing bent and a need to be liked.  I am aware of many psychologists who do exactly what your patient reported.  I had a psychiatrist tell me once that when she hired a receptionist the person "paid for herself" by collecting the copays and GET, something she couldn't bring herself to do.   So it might not be the norm, but it is very common I believe.

In our DBT practice we have a set of agreements that clients make, including abiding by "research and payment agreements."  That helps me from the beginning to put it on the table.  But I then ask if they can actually afford the GET and copayments and usually wind up pointing out that it might be a real burden because they will need to pay both twice a week for a year -- it adds up.   I've found this discussion helpful because I can say "I want  you to have the therapy you need and I don't want money to be an obstacle.  No law says I have to collect the GET.  I can't wave the copayment, but we can set up a payment plan."  In my experience the clients really appreciate the discussion, try to pay as much as they can, and they generally adhere to the agreement.  It works for me too because I really mean it when I say I don't want money to be an obstacle -- insurance plays plenty.  When clients really have a financial challenge I emotionally write it off as pro bono work.

Elaine Archambeau:
I seem to have this vague but distant memory about having to collect Medicare copays.... or maybe Tricare?

As part of agreement...

I remember the argument that if we set precedent to accept lower fees without copays we are demonstrating willingness to accept lower fees.  

These were years ago discussions in a different state association.

Just random thoughts...

Jay Van Fleet, Ph.D.:
Good afternoon,

This topic is the best topic I have ever seen on the list server!  And it applies to anyone in private practice. Members not in private practice and thinking about starting one need to know about this important issue.  I suggest that everyone check their corporate structure (what it says about the provision of services/fees) and also check everything that is written in their agreements with insurance companies.  I have been on about 40 insurance panels and provided services to many insurance companies and the multiple variations of each company since the 1980s.  

When I worked in Kansas City for a psychiatrist we provided psychotherapy, medication management, and forensic services.  The psychiatrists enjoyed working with lawyers and had most of the cases in town that related to mental health and were often on the front page of the newspaper and lead story on the nightly news.  Because we had such visibility he had tax attorneys, accounting firms, and hired a billing service that created a software program just for us.  These experts told me that when we signed up to be on an insurance panel we agreed to charge them our "lowest price" for each service.  In short, we agreed in writing that no one else (patient or insurance company) would get a better fee.  To waive copays or give a patient lower fees was defrauding the insurance companies.  And there were some cases in town where an insurance company had found mental health professionals giving breaks in the form of lower fees and they sued.  They demanded to be reimbursed for all patients from their company ever seen in the practice.  And you probably realize that fraud is easily a felony when the amounts are even fairly low.  

The experts in billing told me that the only way to have a sliding scale would be to open a second corporation.  It could be housed in the same location but would not be covered by the insurance companies unless they would be given the lowest fee charged to any patient.  With the costs of a private practice this was not feasible for me.  One trend at the time was for therapists to open a practice and charge "cash only, one set fee at the time of service" with no billing service for the patients.  My friends and the psychiatrists I new that did this found it profitable enough.  Their charges ranges from 20 dollars to 40 dollars an hour.  They provided their notes to patients that wanted to try and get some insurance coverage but they did not fill out standard forms for any insurance company.  

I think it would be great if HPSlistserv compiled the latest advice for therapists on this issue.  I would like to know the latest expert advice even though I have retired and no longer provide mental health services.  Elaine Archambeau:
Thank you Jay.  In short we need to collect copays...Claire Roundtree:
This is a great thread. I have to just say that Dirk, I am humbled by your approach.I think it is fantastic truly and it sets the tone for a wonderful therapeutic relationship. I discuss copays and tax in my first session with each person I work with.I collect copays plus GE when applicable via Square at the end of every session. My clients are so fine with it and are glad I just can slide their card send the receipt via email or text and be done with it. When I discuss it in the first session it seems relieving to most of them as they can budget and I find it is also an investment in the process.Just my two cents :) Love our listserve.
Aloha, ClalreThomas A. Cummings, PhD:

I dont think for Medicare.  But Tricare now, under United Health Care, does have a variety of copays and deductibles.  I have lost a lot because it is very confusing.  Some have large deductibles.  The agents at Tricare are telling members that if they have Tricare Prime there is no copay nor deductible.  I am awaiting the RTPs to verify that.

It has become quite confusing and members say they have to wait for long times before they speak with a human, and I am getting conflicting reports on what they are told.  So...