Give Clients Plenty of Notice
Letting clients know at least a few months in advance can reduce their stress (and yours) significantly. You never want to rush referrals, discharges, or changes to client fees.
Give clients written and verbal notice. When I’m making a change that affects clients, I talk with the client during a session first. Then I let them know that a form needs their signature and it will be coming through the patient portal that week. Now they know to look for it and I won’t have to follow up later.
Here’s some verbiage for your client letter if you’re at a loss for words:
Dear Clients,
Starting [date], I will no longer be contracting with [insurance company name]. This means if you are a member of [insurance company], I will no longer bill for your appointments. You’ll pay [an agreed-upon fee or your standard fee] for your appointments using the credit card on file. Here are some options to consider.
Using Out-of-Network Insurance Benefits:Your [insurance company name] plan may still cover a large portion of your therapy costs if you have “out-of-network” benefits for mental/behavioral health. Look up your plan details (specifically under the out-of-network Mental Health Outpatient Services). If you don’t have out-of-network benefits, consider switching to a plan that does during the Open Enrollment period.
Getting reimbursem*nt using your out-of-network benefits is easy. Just log in to the patient portal and print your “superbills.” They will have all the information your insurance company will need to process a claim for you. They will send you a check in the mail for whatever portion is covered, usually within a couple of weeks.
Health Savings Accounts:Counseling is eligible for reimbursem*nt with a flexible spending account (FSA), health savings account (HSA), and health reimbursem*nt account (HRA). These are tax-advantaged savings accounts that allow you to use pre-tax money toward your therapy sessions. This way, you get the full value of your dollar (no taxes) and you reduce your income (lower taxes overall).
I’m happy to speak with you about any questions you have regarding these changes. Please bring your questions to your next appointment.
BY SIGNING BELOW I AM AGREEING THAT I HAVE READ, UNDERSTOOD, AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.
[Insert signature fields]
Plan for Client Discharges
While clients generally have a right to terminate treatment at any time and for any reason, not so with therapists! We are under the ethical and legal duty to refer the client to another therapist or treatment facility. Proper termination requires the therapist to consider whether a referral is necessary or appropriate, and if so, how will the referral be handled.
When I terminated a recent contract with an insurance company, I gave clients notice three months in advance and offered them a fee that was lower than my full fee but higher than what I was receiving from their insurance company. I did this because my full fee was significantly higher than what clients were accustomed to paying and it would have been cost-prohibitive for all of them. Some clients stayed and used their out-of-network benefits. A few were ready for discharge, and this gave them the nudge they needed to do it. Some clients transitioned to a new therapist.
I can’t stress enough how important it is that terminations, referrals, and other arrangements be made in a clinically appropriate manner.
