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Money and Ethics In Private Practice: No More “Sliding Scale”
Edited by Bet MacArthur, LICSW
[REPRINTED FROM JULY 2009 FOCUS]
The ideas that follow present a distinct point-of-view on some matters of financial ethics in clinical practice. Clearly many clinicians’ and agencies’ policies differ from these – and you may not agree, and so we invite your comments and perspectives on this month’s topic.
In the 1960s and 1970s it was a common practice for health and social services to set fees based on client income and family size. The fee “scale” was a printed spreadsheet, indexing family size against family gross income. The boxes in the grid were filled in with graduated amounts specifying various fees for services. Thus the “sliding scale” was a fixed, if arbitrary, ‘map’ for fee-setting that varied from agency to agency and provider to provider.
In today’s practice environment however, varying fees raise many technical questions. The term “sliding scale” as it is used today often refers not to an established (but no longer permissible) range of fees, but more often to the practice of random fee adjustments by clinicians, which may be unethical.
In the 1980s, providers’ use of a “sliding scale” was litigated by insurance companies who objected that a fixed, printed scale was a “promise to the public, in advance of any clinical justification, that there is more than one fee for the same service.” The courts agreed, and the practice of offering varying fees for the same procedure was proscribed. Unfortunately, to this day, many agencies and private clinicians have not heard about this...
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