Just out of curiosity, as someone who is still starting his career: why not charge at the time of service? I feel there isn't much to gain, but a lot to lose, by asking for a deposit up front (unless you have an extremely high rate of no-shows for first appointments).
Even then, I just feel that asking for payment ahead of time, or allowing you to keep their cc on file if they agree, would work just as well without alienating patients who don't like giving cc over the phone.
I think if you didn't get the credit card ahead of time, you'd have a lot of logistical issues if someone no-shows to the initial appointment. What if they call a few hours later wanting to reschedule, or you just never hear from them again? I'm honestly amazed at how shameless some people are. If they don't have to pay a little bit ahead of time, some people will value your time so little they just blow it off and never call you or show up. This method kind of avoids those people.
Initially I was charging the whole amount, up front, over the phone, but I'd be a little hesitant at dropping hundreds of dollars on someone I hadn't met before, so I can understand that. Also I was having an issue where people would pay the $400 or whatever (I've changed the fee around a lot for the first appointment), and then no-show. Then they call up angry wanting a refund, or say they forgot. So I was eating credit card fees on $400 for nothing. It's way more palatable to only eat fees on $100 or $150, if you do a refund (or whatever your deposit is).
Basis, would you be willing to offer some wording you use to tell a client after an initial evaluation that it is not a good fit? And language you use on the phone to turn a client away, or to temper their expectations that an initial evaluation will lead to ongoing treatment? I struggle with setting these boundaries. Any advice on educational resources around language to use for boundaries would be helpful.
I'm naturally a pretty reserved guy, so I kind of turn up the charm when I'm on the phone with these people. After I get off the phone, I usually write them down in my 'no go' list that I keep, so that in case they call back I'm forewarned (perhaps they have spun a better story this time, not raising as many red flags). From what I can recall, and from looking at my no go list, these are the typical red flags:
- Got fired by their last psychiatrist
- Cursing (ok I'm not a prude but honestly what kind of person would call up a physician they've never met and use swear words?)
- Calling for a family member ("I told my husband if he doesn't see a shrink I'm leaving him!")
- Wanting disability or a support peacock
- Some kind of imminent crisis ("I got fired from my job and my doctor won't give me my oxy anymore, I don't know how I can cope!")
- On tons of controlled substances (they usually sound drugged and can't hold a conversation)
Anyway, in terms of what I say on the phone, I usually hem and haw about my schedule being pretty full for the next few months (yeah, it's not), and how I might not be the best fit for them since I'm just one person and it sounds like they might need a higher level of care. I try to devalue myself in their eyes, before they have the chance to do it. None of these people are really that invested or really demand to be seen. I usually say "I'd be happy to tell you about some community resources and some ways you can find a psychiatrist". I spent a few minutes on this, keep them happy, then get off the phone and put them on that list to warn myself. Only a few of them have ever called back, and they were too zonked out on xanax to remember having talked to me 2 weeks ago.
Also I tell everyone as part of my little phone speech, even people I think will be good patients, that I am extremely selective about who I take as an ongoing patient.
I've only had like less than 5 people actually come to a scheduled evaluation and then I did not take them as a patient. Most of those cases were people trying to hustle for drugs and thinking my 'no controlled substances' policy I told them about over the phone was somehow not going to apply to them.
I've usually told them, or the non-drug seeking ones, that they've pretty much tried everything I would have to offer, and I don't really think I can help them. A good angle for this is if they're ambivalent about medications, you can work this to your advantage and then they can walk away happy thinking "yeah I didn't want to be on meds anyway."
As I said in another thread, I refund 100% of the visit cost for these people I don't take. I don't want any bad reviews on google or anywhere else, and so far so good. I also want a nice clean break and I never want to hear from these people again. Do I wanna get paid for my time and effort? Of course, but this rarely happens now, and it keeps the antisocial guy from holding a grudge.
I think I have a good innate sense for boundaries, but I've found that some of the phrases and training I got from learning psychodynamic psychotherapy in residency is useful for this kind of stuff.