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Ethical Practice of Sliding Scales

Sliding Scales and Fee Discounts: Staying Safe!

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Mental health practices have a tradition of offering sliding scales to at least a few clients with financial need. But accepting even one insurance plan changes the dynamic and imposes contractual limits.

Then there are clients with insurance but huge deductibles. What happens if they can’t afford even the contract rate?

In a time of increasing financial uncertainty, how can you protect yourself?

Buckle up for some complex issues!!

  • What insurance expects with regards to collection of patient responsibility amounts.
  • Can you occasionally waive what insurance says your client owes?
  • Measuring and documenting financial need.
  • How are sliding scales different in vs out of network?
  • The role of the Good Faith Estimate.
  • Can you submit insurance claims for clients on sliding scales?
  • Managing client balances with high-deductible plans.
  • Some pitfalls of “credit card on file” to watch out for!
  • How to write a thorough client financial agreement without sounding like a lawyer!
  • Tread carefully: avoiding the appearance of discrimination and arbitrary fee-setting while also ensuring that you don’t accidentally commit insurance fraud!
  • Discounted fees, pro bono, and superbills.
  • Can a client waive use of their insurance?
  • Can you offer discounts/sliding scales if you’re practicing in a group or with a tech platform?

Recorded May 1, 2026.

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