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Sliding Scale Reimbursement: How to Set the Right Rate

Sliding Scale Reimbursement: How to Set the Right Rate

If you’re familiar with the principles of OpenCounseling, then you know our mission is pretty simple: we want to ensure that clients have access to affordable counseling, no matter their ability to pay. That’s why we give therapists in our directory the option of setting slide-scale rates in their profile. But what exactly is a sliding-scale rate? Basically, this means that for some clients, therapists are willing to look more closely at the client’s financial circumstances to offer a lower hourly rate than their standard reimbursement.

The benefits of offering sliding-scale are tremendous – this allows therapists to fill vacancies in their schedule (less reimbursement is better than none in our opinion). It also allows therapists to fill their professional obligation to offer a percentage of their treatment services to clients who would otherwise be unable to afford it. Let’s take a look at some of the questions to think about before offering sliding-scale as a payment option.

How Will I Determine Fees?

Consider your standard rate for self-pay clients – how much lower are you willing to accept for your hourly rate for some clients? Don’t be overly generous here – if you cannot afford to offer $40 session, then don’t. But if you look carefully at the number of vacancies you have in your current schedule, and estimate that a percent of those could be filled with clients at sliding-scale, what would that rate be to make this trade-off worth it for your time?

How Will I Determine Eligibility?

Next you’ll need to ask yourself what client factors you’ll use to decide who to offer this rate to, and what factors might bump a client up from the lowest rate to somewhere in between this and your standard rate. The easiest may be to look at gross client income; however, this may not capture the nuances of your client’s financial circumstances. Some other factors to keep in mind include whether or not they are insured; their “ability to pay” (which involves assessing both income and expenses); and, how long they may need treatment at the lower sliding-scale rate. The most important thing here is to establish a policy and abide to it consistently, that way all clients you agree to see at the sliding-scale rate are given an equitable assessment of their circumstances.

How Many Clients Will I Offer Sliding-Scale To?

This last question is completely up to you – before proceeding, look carefully at the financial solvency of your practice and decide at the beginning what your limit to sliding-scale clients will be. It’s okay to not offer this if you don’t have the space in your schedule; it’s NOT okay to accept more sliding-scale clients than you can afford. As important as affordable counseling is, in the end you are still running a business and need to keep the interests of this in mind.

So what happens if a client contacts you and cannot afford your rate? That’s where OpenCounseling comes in. Our resource directory has both therapists and counseling agencies, some that offer service at no cost, that we want you to use as needed to refer clients to. Together, we can partner to ensure no client is left without needed treatment due to an inability to pay.

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Jennifer N.
Posted on 08/19/2017 by Jennifer N.

Jennifer is a writer for OpenCounseling. She has worked at a number of state and non-profit organizations, providing counseling, training, and policy development



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