This month’s blog for the LCSW and LMSW ASWB exams focuses on a topic that is sure to show up on your exam: fees. There are a number of different payment related scenarios that can show up on the exam:
What to do when a new client can’t afford your fee for service?
What to do when an existing client has a change in income and can no longer pay for therapy?
How to address a client who is refusing to pay?
How we will approach each of these scenarios varies situation by situation.
When a new client can’t afford your fee
If a new client presents for treatment and cannot afford your fee, the best thing to do is to connect them to a lower cost service. We do not want to set our clients up for failure. We also don’t want to create a situation where they can only get services for a limited period of time due to funds. If you haven’t begun a relationship with a client and payment will be an issue, the test is looking for you to connect them to affordable services.
When an existing client has a change of income
If a client you have an established relationship with has a change in their ability to pay your fee, what should you do? This depends on the specifics of the scenario. If the change in pay is temporary and it is an option, we may choose to temporarily reduce their fee or offer a sliding scale. This is ideal since we have an existing relationship and want to have continuity of services when possible. Our code of ethics states “ Social workers should take reasonable steps to avoid abandoning clients who are still in need of services.” So whenever possible, we want to continue offering services when clients need them. If, however, there is a situation in which a client is unable to pay for the foreseeable future it may be necessary to refer them to a lower cost service provider.
What about insurance?
If we are billing insurance for a client and they have a change in income, can we go ahead and reduce their copay? No; not right away, at least. If we want to temporarily reduce a client’s copay, we must inform and get permission from insurance to do so.
When a client refuses to pay
What do we do if a client simply is not paying their fee for service? This is a scenario that certainly could show up on the exam. Our code of ethics states that social workers are allowed to terminate services when clients are 1. Not paying an overdue balance, 2. Have discussed financial arrangements/expectations and subsequent consequences of non-payment with the client, and 3. Are not an imminent danger to self or others. For purposes of the exam, you want to keep two things in mind. First, you want to check and double check that clients understand the fee for service arrangement. Then, if they still aren’t paying (and are not in a crisis situation), we can move forward with termination.
ASWB Practice Question
A social worker in private practice meets with a client for an initial session. The client shares they want to begin working on childhood trauma issues and the subsequent emotional and relational consequences of this trauma. The client informs the social worker they are only able to pay for 5 sessions at the lowest sliding scale rate offered by the social worker. What should the social worker do?
A. Meet with the client for 5 sessions and refer out
B. See the client on a pro bono basis
C. Meet with the client for 5 sessions and reevaluate
D. Refer the client to a lower cost treatment
(Scroll for answer and rationale)
The correct answer is D: Refer the client to a lower cost treatment. We do not want to begin trauma work with the client and refer out (A). It also would be irresponsible to begin trauma treatment with the client (which will likely take longer than five sessions) and to then reevaluate the situation (B) when there is no indication the client will be able to pay after those five sessions. Nothing in the question stem indicates the social worker is offering free services (C).
ASWB Masters and Clinical Exam Preparation
How did you do on this month’s social work practice question on fees? Know that TDC is here for you whether you feel 100% confident on questions regarding fee for service or whether you need a little extra support in this area. TDC’s LMSW and LCSW ASWB exam prep courses give you everything you need to pass the exam, and none of the extra stuff that can make studying so overwhelming. We give you all of the factual content you need as well as the reasoning skills to successfully pass your exam with confidence. One of the best parts of TDC is that you can email your coach anytime you have questions as you go through the program. So you’re never left alone in the study process with confusion and unanswered questions. TDC has helped THOUSANDS of social workers across the nation PASS their exams. Are you next?