Have you ever noticed when the topic of therapist fees comes up in Facebook groups, especially when it’s related to raising fees or earning more, there is one person who jumps in, writes some random comment about “PRICE-FIXING” all in caps and then either ghosts hard core or pops in and makes enigmatic statements about illegalities that leave you confused and slightly unmoored?
While you’re fairly certain you haven’t done anything untoward, you can’t help but feel a little bit uneasy, worried that maybe you have acted unlawfully in someway without even realizing it.
Well – today we’re going to put those fears aside, once and for all. Unless, of course, you are engaged in unlawful price-fixing, then your fears are 100% warranted and you’d better watch your back. Chances are, however, you’re all good.
Therapists & Shit-Throwing FlyBy’s on Facebook
First, a quick word on the PRICE-FIXING-IN-ALL-CAPS-FB-COMMENTER.
Look, money brings up all kinds of feelings, especially when we’re talking about earning more money in your practice. I’m going to say with 110% certainty that the person who jumps in, yells about price-fixing and leaves you feeling uneasy is probably not earning much in her practice, struggles to find clients and feels a ton of envy, shame and fear about the state of her business.
This action of vehemently inserting feelings out in the world and demanding that others process these feelings – we are all very aware of this phenomenon. In fact, it’s our job to process these feelings – with our clients. For money.
Given this, I absolve you, now and forever more, from working as a therapist for free for rando therapists who flail around and attempt to project shit into you via FB comment flybys. Feel free to gently step out of those conversations and have real conversations with thoughtful clinicians IRL.
What is price-fixing?
Let’s really look at what price-fixing is and isn’t once and for all. There is an amazing, but slightly boring article on this very topic put out by the FTC that clears all this hootinanny up in one fell swoop.
According to the article, “Price fixing is an agreement (written, verbal, or inferred from conduct) among competitors that raises, lowers, or stabilizes prices or competitive terms.”
What would this look like in the therapy world? It would mean you are getting together with all the therapists in your town and agreeing to raise your fees to, let’s say, $182. This means that if someone in that town wanted therapy for $100, there are zero options because you have all gotten together and agreed to set your fee at $182 so that anyone wanting therapy would have to pay that fee. If you haven’t done this, you’re not price-fixing.
In fact, according to the article, “The antitrust laws require that each company establish prices and other terms on its own, without agreeing with a competitor.” If you follow heytiffany.com, you know that I encourage therapists to set their fees based solely on your personal and professional needs – not by looking at Psychology Today and seeing what the ‘going rate’ is, not by asking your friends what they charge, not by basing it on what your therapist charges and then charging less than that. NOPE!
As long as you are setting your fees based on what you need to do your best work, then you’re not price fixing, even if you’re talking about it on Facebook. Definitely download the Fun with Fees Online Calculator if you haven’t done so. It will calculate exactly what your fees should be based on YOUR unique needs!
What price-fixing would look like in the therapy world
Here’s an example of what you cannot do as a therapist in private practice.
You can’t get together with a bunch of therapists who are all insured with the same panel and decide that a $65 co-pay is bullshit. Well, you can actually get together and express irritation about a $65 co-pay. What you can’t do, however, is then go further and agree that you are all going to refuse to see clients at that rate until the insurance company agrees to raise the rate to $100. That, my love, is price-fixing.
So, to be clear once and for all – you are 100% allowed to talk about fees in private practice. You can talk about why you charge what you charge and how you came to it. You can talk about the feelings associated with higher and lower fees, sliding scale, premium fees and your discomfort or confidence around charging the fees you charge.
Lightning Round: Price Fixing – Yes or No
Asking a question about how someone raised their fees – No.
Talking about your fears around raising fees – No.
Asking if you should get on insurance panels – No.
Asking what reimbursement rates are typical for insurance panels – Nope.
Challenging colleagues to earn more in their practices – No.
Lamenting that your fees are so low you can’t afford corn – No.
Gathering a bunch of therapists together and colluding to enact fee-raising practices as a group in order to force insurance panels or individuals seeking therapy to have to pay a particular rate in order to receive care – YES.
As long as you are not getting together with colleagues and agreeing to fix fees at a certain price in order to force individuals seeking therapy to all have to pay a certain rate in order to receive services, you are golden. If you ARE price-fixing, you’d better be doing it on the down low with the awareness that the fed is going to eventually have your number, kid and life in the clink is no good, NO GOOD.
Now, we’d love to hear from you! What are the pro’s and con’s of using Facebook communities to talk through your fee-setting anxieties and policies?! Leave your responses in the comment section and join the conversation!
If I am understanding the idea of price fixing correctly,it seems to me that insurance companies are engaged in it by setting reimbursement rates. So perhaps that is what all the paranoia is about disclosing what the rates are on FB? I’m not sure. What I am sure of is that there is a culture of fear that I see new clinicians buying into every day. When I see posts that begin “ Are we allowed to….. I feel as if I have gone in a time capsule back to second grade and a Sister Loretta! I mean come on,let’s use our brain,our sense of agency and common sense to get answers until such time as we are feeling more empowered. Clinicians need to follow rules yes but they need to grow a pair also. It is vital for our profession and our clinical work.
I LOVE your attitude, Donna! You bust me up. I really appreciate what you are saying about encouraging therapists to embrace their authority and trust their education and their thinking capacity in order to make decisions about their businesses, rather than operating from fear. Your my kinda therapist!
This is so helpful that I might share this in a few therapists groups… it will not likely be received well, but if we continue to follow a few’s over the top reactions, too many of us will remain grad school broke. I will likely definitely share this with my colleagues of the group practice.
Do share and I hope Hope HOPE it IS received well. I think therapists WANT to do well financially, but they’re afraid of being attacked or shut down by internal and external professional demons. I believe it IS possible to change our culture around this. We can do it, Courtney!
Oh my…there are just so many ways to be supportive of each other, what a bummer when it goes the other way. Tiffany – thank you for calling this kind of thing out. Recently there was a FB discussion around “feeling bad” about raising rates – I said there and will say again, we need to charge enough that we can sustain reasonable, stress-free lives out of the office in order to do good work in it. Attorneys in my area charge 3-4 times my hourly; doctors, way more, golf pros – I thought about the same then a friend of mine told me what she pays…people, golf pros charge MORE than therapists. Let’s all know and be proud of our value and not suffer in the name of “serving”. And knowing what your colleagues are up to, including fees, is smart, not illegal. Thanks again Tiffany!!
AMEN Pamela!!! I’m SO glad you are out there advocating for therapists who struggle to advocate for their own needs.
This is awesome and totally happened to me on a local listserv. I asked if people would be willing to tell me what some of the best and worst insurance panels were, in terms of reimbursement. I got totally shamed about the ethics of my question and price fixing! Fortunately, I also had a couple people call me on the phone to say they’d love to share their information with me as well as ease my mind about crossing an ethical line.
UUUUGH. It’s funny how quick therapists can be to publicly shame and then privately offer support. What would it be like if we led with support, kindness and curiosity as a professional rule?! I’d dig that shit.
Let me be the first to YAHOO this article! Really helpful! To all who read: Tiffany has really helped me get the fee I deserve! Our resistance to having a life is tied up to so much history and negative self-talk, T will help you overcome that and have a decent life. You can’t properly take care of your clients until you take care of yourself.
TERESA! Thank you! It has been amazing to watch you take hold of marketing strategies and fucking up your therapy game! We need more therapists like you out there in the world!!
About getting together as a group thing – it’s funny that’s considered price fixing since isn’t that what happens in group practices or when hospitals and providers form a collective bargaining organization (I forget the actual name & acronym)? So we get penalized if we are solo I guess … I can’t see therapists colluding to increase a cash price, but insurance companies never pay your cash price – their maximum allowable is invariably lower than the going rate. And they certainly use these rules to their advantage to keep from having to pay us more than BS rates. Thanks for an enlightening and anxiety relieving article! I think it’s so much harder to be confident you’re playing by the rules when the rules don’t make sense to you – I needed somebody to explain it!
My pleasure Kim and thanks for weighing in! Yes – when it comes to the money stuff, it is easy to get paranoid as our professional culture (the therapist culture) often leads money conversations from a place of fear. It’s really helpful to get clear about what the rules actually say and to avoid getting caught up in hyperbolic rhetoric.