Here’s a hypothetical question – I’m curious to hear your thoughts.
Imagine a 1x/week patient who can pay $3200/year. Figure $3200/40 weeks (I’m figuring cancellations/vacations/etc.) = $80/session.
Imagine this patient is entitled to out-of-network insurance reimbursement based on a 35% co-pay (65% reimbursement) after the patient meets a $1,750 deductible.
I’ve done some math. If the fee were set at $150/session, and the patient turned over 100% of the reimbursement to me, s/he would end up paying the $3,200 we originally established s/he could pay.
Imagine that:
1) I bill $150/session
2) The patient pays $80/session until insurance kicks in (around week 8)…
3) At which point, in addition to continuing to pay $80/session, s/he either turns over insurance checks to me or makes payments equal to the reimbursement received from insurance company
To say it differently, this means I would structure their obligations to me such that I would implicitly lend them $70/session until their insurance kicked in (8 weeks in), at which point, insurance would begin paying down the balance of the “debt” – the balance would reach zero near the end of the year. At no point would I issue a statement that’s untrue – my statements would reflect actual fees charged, and payments received. So there would be no misrepresentation.
There are clinical questions (how does all this affect the relationship?), ethical questions (notwithstanding that in no instance would anyone be misrepresenting the “truth,” is this “ethical”?), and regulatory/code of ethics questions (would this violate the NASW prohibition on “dual relationships,” as I would, at least economically, be extending credit to my patient in this scenario?).
One final side note: I distinguish between “ethical” considerations and “code of ethics” considerations. I didn’t actually outsource my personal code of ethics to the NASW, and so I understand their code of ethics not as a resolution of ethical questions, but, rather, a requirement that I face in my practice.
So, the question for you: what do you think of all this?
