Billing problems

[psychma]

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I have been in private practice for five years and have not encountered any issues with billing until the last 2 months or so. Usually, when a client presents to my office for an assessment or therapy, they provide their credit card information upfront. We have the session and then I create a bill, enter the credit card information, and make the payment. Now, so many people’s credit cards are denied when I try to charge them. When I reach out, the clients tell me they have no money and can’t pay. I do not allow therapy clients to get more than 2 sessions behind as a rule, but for assessments there is more time and cost involved. The billed amount is higher and a non-payment is significant. What is really discouraging is that my therapist/social worker clients are the worst offenders lately!

Has anyone else seen this as a trend? How can I handle this going forward to prevent losing my shirt?

 

[R. Matey]

The ppl I know in PP tend to collect their fees upfront

 

[PsyDr]

Collect upfront.

Send the others to collections. The shared profession seems to indicate social transmission (I.e., “I just didn’t pay her, and she did nothing.”). People seem to suddenly find money when there are consequences.

 

[Sanman]

The answer is to collect upfront. That said, I know people have mentioned business being slower generally the past few months. However, Scott Bessent assures us that we are not in a recession and will not be in 2026.

 

[WisNeuro]

I'm going to fourth collecting any cash pay assessment fees upfront.

 

[PsyDr]

I REALLY want to emphasize sending people to collections.

There is a difference between “I can’t afford an evaluation, can you help me?”, and “Now that I have your evaluation in my hand, I'm revealing that I never had any intention on paying you for your services, AND I hid that from you from the start.".

 

[Peacemaker36]

Interesting about collections. I was taught that sending people to collections is likely to trigger a lawsuit, but I don't have any personal experience. I can imagine a patient feeling angry about collections and lashing out through litigation.

 

[Sanman]

Interesting about collections. I was taught that sending people to collections is likely to trigger a lawsuit, but I don't have any personal experience. I can imagine a patient feeling angry about collections and lashing out through litigation.

Never heard of that. Hospitals do it all the time. No one is spending thousands to sue you for a few hundred dollars.

 

[AcronymAllergy]

Interesting about collections. I was taught that sending people to collections is likely to trigger a lawsuit, but I don't have any personal experience. I can imagine a patient feeling angry about collections and lashing out through litigation.

I've heard of this in the sense of board complaints, but I think it's more of a fear than a common occurrence. I'm no attorney, but I'm not sure what grounds there would be for a lawsuit if the informed consent is reasonably clear. Same goes for a board complaint.

Although I've also heard many colleagues say that they don't bother pursuing via collections because it's not worth it to them. I've also heard folks say that they don't complete their work product, such as an evaluation report, before payment is received. You can't withhold a record for non-payment, but nothing says you have to work for free.

 

[WisNeuro]

Interesting about collections. I was taught that sending people to collections is likely to trigger a lawsuit, but I don't have any personal experience. I can imagine a patient feeling angry about collections and lashing out through litigation.

Never heard or seen this happen. And, I have never seen a board action in my state related to this.

 

[PsyDr]

Interesting about collections. I was taught that sending people to collections is likely to trigger a lawsuit, but I don't have any personal experience. I can imagine a patient feeling angry about collections and lashing out through litigation.

LOL. Let's think about this.

1) You're saying that someone, who can't pay for clinical services, is going to come up with money to hire a lawyer?
a. Or a lawyer is going to accept an IOU from someone who can't pay a much cheaper bill? That's like fearing that a homeless guy has the money to afford a gun.

2) For a lawsuit, you have to have damages.
a. Your premise is that someone is permanently upset because they being held accountable to their contractual debts. Can you imagine the legal effects if some court said, "You can't try to enforce contracts for sensitive people, because it might permanently hurt their feelings?". Every credit card company, mortgage company, etc would collapse immediately.

3) I'd pay money to watch a board complain.
a. Patient "Yeah, I signed an informed consent that said I would pay for services. And I had no intention to do so. But that's definitely not fraud...for .... reasons...".
b. Psychologist, "I am the victim of fraud. This is the perpetrator of the crime. Are you colluding with the perpetrator in this crime, potentially becoming accomplices?" (this is not far off from my response to my only board "inquiry", and I'm still here).

Protip: If someone says they're going to call their lawyer, they don't have a lawyer. (This also applies to people who claim to be rich, have ginormous gentials, or about to punch you).

 

[psychma]

Thank you. I agree about finding a way to collect upfront. I have let these people know they will not receive a report from me, but the financial damage is done. I also want to thank you for mentioning collections. In the past, I never thought it was something I would pursue, but I feel right now like even if I don’t get a penny, people should be responsible for honoring their agreements. I can’t imagine being seen for 5 hours of testing with the intent of not paying.