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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Looney Tunes on July 20, 2008, at 13:01:43
Any thoughts on therapists who do not negotiate fees at all?
I met one recently who is not involved with insurance at all, but also does not reduce his fees. And the fees are quite high.
I guess that means that they only want to treat a certain population, because at $150 an hour...alot of people can not afford that weekly.
At first it was kind of depressing, because in my job, I would never let money get in the way of helping the people if they really needed it. (And trust me, I am broke!..so I could use the money)
Not sure what to think.
Posted by no_rose_garden on July 20, 2008, at 13:09:43
In reply to Therapists who do not negotiate fees?, posted by Looney Tunes on July 20, 2008, at 13:01:43
hmmm...just my first impression, but sounds like somebody who only wants rich people (not negotiating fees) who want complete anonymity (no insurance)
Posted by DAisym on July 20, 2008, at 15:39:29
In reply to Re: Therapists who do not negotiate fees?, posted by no_rose_garden on July 20, 2008, at 13:09:43
Perhaps...
but I think you might reach a point in your career where you are so in demand that you don't have to reduce your fee to keep a full caseload. And we shouldn't assume that folks who pay the fee are less in need of a good mental health professional than someone who can't pay the fee.
More and more I think it is about the paperwork. Insurance companies create a mountain of it and then they want to decide what your treatment strategy should be, how often you should see the client, whether they need to continue, etc. It is a royal pain. So if you don't have to, why would you?
Remember, I work for a nonprofit, so my world is really different. I just don't want to assume money-hungry motives for therapists who don't.
Posted by seldomseen on July 20, 2008, at 15:56:47
In reply to Therapists who do not negotiate fees?, posted by Looney Tunes on July 20, 2008, at 13:01:43
Mine does not negotiate fees and he doesn't deal with insurance either. I'm acutally glad, it gives him time to focus on what he was trained to do. I would rather have him buried in the latest literature rather than buried under a mound of paperwork.
At least where I live, 150 an hour is quite reasonable for a therapist. Of course, an attorney bills out their time at a considerably higher hourly fee, an auto-mechanic can charge up to 90 an hour labor and a plumber recently came to my house and charged 160 an hour for his time (and it wasn't even an emergency visit).
I think T's get a lot of flack because our relationship with them is a lot of things - and one of them is fiduciary and their fee and how they handle it is part and parcel to their practice.
If they won't negotiate, then that may be a signal to you that they aren't the right therapist for you. It doesn't bother me that much.
Posted by no_rose_garden on July 20, 2008, at 16:40:17
In reply to Re: Therapists who do not negotiate fees? » Looney Tunes, posted by seldomseen on July 20, 2008, at 15:56:47
"it gives him time to focus on what he was trained to do. I would rather have him buried in the latest literature rather than buried under a mound of paperwork."
That makes sense...what I said earlier I guess was just my first impression (I should work on not judging)...
Wow!! I didn't realize other services were also so expensive!!!!
Posted by Lemonaide on July 20, 2008, at 19:00:10
In reply to Re: Therapists who do not negotiate fees? » seldomseen, posted by no_rose_garden on July 20, 2008, at 16:40:17
My T has a secretary who he shares with a handful of other T's who does all the insurance and making appointments. After my insurance ran out again, he just had me pay what I paid with insurance, I didn't even ask him.
With my old T, who said doing insurance filling is a pain in the butt, you always get paid late for work done a month earlier, would actually give you a small discount for not using insurance. It saved him a lot of time, but he did everything.
Posted by pegasus on July 21, 2008, at 10:56:16
In reply to Re: Therapists who do not negotiate fees?, posted by Lemonaide on July 20, 2008, at 19:00:10
I've been told that - at least in my state - it is not legal for a T to charge one rate for insurance, and another for those without it. That said, I did have a T at one point who gave a discount after my insurance ran out for the year. I don't know if he didn't know the laws, or if there really isn't a law against that. If I had to bet, my money would be on his ignorance of the law, or perhaps a knowledgeable flaunting of it.
And, of course, there are many, many Ts around here who have a sliding scale. I think adjusting fees to fit incomes is in a different legal category than adjusting fees to encourage not using insurance. It seems to be mostly those who are earlier in their careers, though. I always figured that was because everyone, including Ts, likes to be more financially stable as they get older. Plus, they probably aren't as hungry for clients when they're more experienced/established as they are when newly licensed.
Keep in mind, too, that out of that fee, a T usually needs to pay rent for their office, malpractice insurance, any assistant's salary, answering service fees (or other phone fees for their business), higher taxes for being self-employed, fees for any consultation/supervision, and cover all the time they spend outside of sessions but still working (paperwork, research, consultations, supervisions, etc.) I've probably forgotten other things. But my point is that perhaps some Ts have more expenses than others, and so find it harder to flex their fees?
I remember calculating once that my T probably brought home only about half of what I paid him. For what that's worth. It didn't add up to a very high income. And he was well established. So I guess I was getting an excellent deal.
- peg
Posted by antigua3 on July 21, 2008, at 11:05:54
In reply to Therapists who do not negotiate fees?, posted by Looney Tunes on July 20, 2008, at 13:01:43
My pdoc fees are quite higher than what you've quoted, and my insurance pays a pittance. He refuses to negotiate--I tried when I started to see him twice a month. He told me he had raised his fee since I started, but he did agree to roll back the 3% yearly increase. One of his boundaries again.
My T costs a little less than what you quoted. I tell her she should raise her fees, compared to what I pay my pdoc, but she wisely said her patients can't afford it.
Neither one deals with insurance, unless it's a med issue with my pdoc (which there are plenty).
W/my pdoc, it's another thing that's difficult to deal with. I think he's money hungry!
antigua
Posted by Hermitian on July 21, 2008, at 11:33:28
In reply to Re: Therapists who do not negotiate fees?, posted by antigua3 on July 21, 2008, at 11:05:54
Net revenue based on an hourly fee can be really misleading. Say a therapist charges 200 bucks a session and sees 4 patients per day. And say he works 46 weeks per year (10 national holidays + 4 weeks vacation.) Then his gross revenue is $184K per year.
Somebody already mentioned his business expenses. And then you also have to throw in his self-funded retirement, health insurance and his doubled up FICA (15% instead of 7.5%). So a lot of that gross gets chewed up leaving a pretty modest net income for someone with that level of training (especially the MDs.) So it may seem callous, but they really have to protect their price point or it could become a downward spiral of insufficient revenue.
Posted by Phillipa on July 21, 2008, at 12:51:17
In reply to Re: Therapists who do not negotiate fees?, posted by Hermitian on July 21, 2008, at 11:33:28
One of the reasons had to quit couldn't afford to go. Wow how do you guys afford those high fees? Phillipa
Posted by AbbieNormal on July 21, 2008, at 18:03:17
In reply to Re: Therapists who do not negotiate fees?, posted by Hermitian on July 21, 2008, at 11:33:28
4 patients a day? Mine sees that many before lunch....at least double that salary since he works late too.
This is the end of the thread.
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