Is sliding scale a good business practice?
Most therapists will agree that running a private practice solely on private pay is ideal. Even though working with health insurance can provide greater access to clients, the private practitioner is often left dealing with changing benefits, increasing deductibles, and long calls with insurance companies to rectify claims.
When dealing with insurance companies becomes a significant part of your week, it is typical to wonder if you may be better off removing yourself from insurance panels to run an out-of-pocket only business. When making this shift in your private practice, it is also wise to consider if offering sliding scale is in the best interest of your business.
Of course, the desire to make mental health care accessible to clients may be a main motivating factor in offering a sliding scale> But it may also be valuable to do some self-reflection as to why you may be willing to decrease your rate.
Before you change your pay scale, it is advantageous to explore if your desire to offer a client a lower rate comes from your own history of financial instability. If you have ever struggled with not having enough money to support yourself, you may worry about causing financial harm to your clients by asking them to pay your full rate.
Old personal narratives about your self-worth or need for survival may rear their heads during your business development. Likewise, old patterns, for instance, ones where you accept less so others are not inconvenienced, may step in and cloud your business decisions.
Being clear on your history and patterning will help you understand when you may be compromising your business because of a projection of your own backstory.
In addition to your personal narrative, it is important to consider if your desire to offer a sliding scale comes from self-doubt in yourself as a business owner. Do you doubt your ability to attract a client base who will pay your full rate and invest in the work?
Do you hold concerns that clients may not be willing to invest financially in their own mental health? These doubts are signaling to you your need to shore up your business confidence and make a solid business plan in which you can feel grounded. Without this clear planning, choosing a sliding scale may medicate your doubts, but it will not help your business progress.
If your desire to offer a sliding scale comes from your true and authentic agenda to keep your services accessible to as many clients as possible, then the question is: When will you and your business be ready to offer charitable work? As the adage goes, “You cannot give from an empty cup,” therefore, it is best to consider what business markers will signal to you that your practice can hold a sliding scale option. You may consider waiting for your practice to be full or for you to be financially abundant and thriving as a business owner before compromising your full rate.
The normalization of using a sliding scale in the psychotherapy profession can lead you to not fully consider your “whens and whys” of this payment option.
Sliding scale can be a thoughtful business practice for you if you are well-established and are a confident business person who feels satisfied with your practice. If you are shying away from asking for a full rate of exchange for your work because of self-doubt, or a projection of your own financial fears, you will want to address these issues so that you can make a thoughtful business plan as to when your practice is truly ready to offer compromises.
Offering discounted sessions for any reason outside of your readiness and ability to give back to the community is well worth reconsidering so you can make a clear and intentional business decision.