Logistical/financial
– Not all credit card processors process HSA/FSA credit cards. Be sure that you check with the processor before signing up.
– They all charge similar fees, and fees are on the order of 3%. On individual payments/patients/clients, this isn’t much. In a practice, it adds up to a nice dinner or four a year.
– They range from super-HIPAA compliant (SimplePractice, Doxy) to super-UN-compliant (Venmo, whose default settings announce to the world both counterparties of every payment).
– Some of them give you your money instantly; others make you wait two, three, or more days.
Clinical
– I like it when my patients pay me.
– I like it best when my patients pay me in person, in cash. [I know lots of folks who have negative views of cash – “it’s dirty,” etc. My view is that cash is, in fact, money; nothing else is.]
– I like it second-best when my patients pay me during session using a format other than cash that causes them to have less money and me more in real time. Zelle does this. Venmo can do that (but I don’t like Venmo for other reasons – see above).
– I like it third-best when my patients pay me during session, using a format that causes them to have less money and me more, but not in real time. Checks do this.
– I like it fourth-best when my patients pay me outside of session using a format that causes them to have less money and me more in real time.
– I don’t like it when my patients ask someone else to pay me (such as a parent, or an insurance company), or if they ask someone else to pay me and then promise to pay that other entity back some time in the future (like a credit card company). I don’t like any of these because they introduce other entities into the transference. And, I don’t like it because, although dollars are fungible, I want my patient actually to have fewer dollars after they pay me. This feels like an essential aspect of reality that each of these other possibilities differently obfuscates.
I don’t represent any of these views as authoritative or correct, and my thinking on all this evolves continuously. But these are my thoughts.*
* Today.
