Setting Different Fees For Different Clients
One of the choices every practitioner in private practice has to make is how to set your fees.
Karlaye from Arizona writes . . .
. . . I set my base fee at $ 125 per hour . . . but the insurance companies that I work for set it at $85-95. If I have a private patient, its fine, but when I have a client that wants to use their insurance, I can only set it at that price. Is that correct?”
And, Jason from Colorado asks . . .
Is it OK to charge my cash-paying clients $85 / hour and charge my insurance- paying clients $100 / hour? It’s the only way I can see surviving in this economy.”
When setting your fees, you need to be careful. Health care providers are the most common perpetrators of insurance fraud. Sometimes such fraud occurs out of greed; however, it is much more likely that you may be engaging in fee-related practices that are illegal and not even know it.
If you have chosen to work with insurance companies, make sure that you are not charging you cash-paying clients a different rate than those who are filing on their insurance. Regardless of your intent, charging different clients different fees for the same service (based only on whether or not your client pays cash / uses insurance) is not OK.
Look for a future post when I discuss reduced fees and sliding scale fees.
8 comments so far
This is an interesting topic that I have talked to a colleague of mine about on occasion. What about the issue of health care providers charging insurance patients more than the contracted rate?
Plz address the need for and differences between NPI and Caqh.
thx.
Kristene
Hi Tamara, as a new practitioner, I too struggle with the issue of setting fees. I’m looking forward to hearing about reduces fees and sliding scale fees.
Love the website and all the information!
Many thanks.
Dianne
Hi, Jill! Thanks for asking! If you have contracted with a client to charge a certain fee, you are not allowed to charge your client more that that contracted rate. Neither can you collect a higher co-payment than the amount you initially agreed upon. Such practices are illegal, unethical, and would probably cost you both clients and referrals in the long run.
A better practice would be to read the fine print with each managed care contract that you are considering and make sure that you agree to each requirement in it. If you cannot understand all the legalese that is sometimes in the contracts, then take the time and spend the money to have an attorney review them for you. Under no circumstances should you sign a contract that you do not understand or fully agree with. It could be a costly mistake.
Hi, Kristene! I’m not familiar with the acronym, CAQH. Can you please tell me what this stands for or refers to? Then, perhaps I can help.
Thanks, Dianne, for checking back in. If you can tell me what you are struggling with concerning the issue of setting fees, perhaps I can help!
I charge on a sliding scale based on income. I rely on an honesty system where no proof of income is required. I’ve found that people are honest and that the fees from my higher income clients compensate for the reduced fees paid by my lower income clients.
Hi, Paul! Thanks for dropping in and sharing your comments here! So you don’t ask for any “proof” of income and that seems to work well for you. How do you decide where people fall on your sliding scale? Do you have some type of formal matrix or how does that work for you?