The M-Word: Take This Quick Quiz about Money and Insurance

By Barbara Griswold, LMFT (June 14, 2025)

There is one part of our job as therapists that most of us hate.  Ok, besides writing session notes.

It’s the M-word.

That’s right: Money.  Wouldn’t it be nice if we could just meet with our clients and not worry about all the money stuff?

But we can’t avoid it.  We need to set up strategies to collect money, keep track of money received from clients and health plans, keep track of money paid for expenses, make decisions about money, and set policies around money. And we need to make sure we are making money and continue to do so.

So, let’s test how well you understand the financial side of working with insurance clients with a little quiz!

ANSWER TRUE OR FALSE as if you are a NETWORK PROVIDER with the client’s health plan:

1. During the deductible period, you can collect your normal full fee from the client instead of your contracted rate with the health plan.
2. During the deductible period, there is no need to submit claims to the health plan.
3. If a client cannot afford their copayment, it is permissible to negotiate a lower rate or waive it.
4. It is advisable for the client to check their own coverage.
5. Checking coverage after the first session is recommended.
6. If the insurance pays more than expected, it is suggested that you apply it as a credit toward future sessions.
7. If your contracted rate with the insurance plan is $100 and your regular full fee is $150, you can charge your client the $50 difference.
8. You usually cannot charge an insurance client for a missed or late-cancelled session.
9. It is advised to bill clients for their copayments and any deductibles at the end of each month.
10. It is recommended to allow clients who late cancel or miss an appointment to reschedule later in the week for free if you have an available slot.
11. If a client misses or late cancels a session, you can charge them your regular full fee.
12. Getting a raise with an insurance plan is very rare.

OK, ready to see how you did?  Drumroll,  please!

The answer to all questions is “False.”   I’ll explain each below:

1. During the deductible period, you must charge the client your contracted rate as if it were a regular session. As a network provider, you offer a discount both during and outside the deductible period.

2. Submit claims during the deductible period to help the client eat up their deductible, which can help them be paid for potential future healthcare expenses.

3. Your contract with the health plan requires you to collect copays from clients. Waiving copays in advance or negotiating reduced rates is not allowed.

4. I strongly recommend that network therapists verify coverage to avoid income loss and treatment interruptions.  Also, clients may not understand what they are told about their coverage details.

5.  It is recommended that you check coverage before the first session. A client may have a high deductible or lack coverage for the services they require, making them unable to pay for your services, so starting before checking finances is not clinically or financially wise. A coverage checking handout is available in my book (available here).

6.  I recommend that you always immediately refund any extra money received from clients or health plans. Keeping balances at zero ensures clients feel free to end treatment at any time and prevents accusations of withholding refunds.

7. This is called “balance billing” and is a violation of your network contract.  You must accept the contracted discounted rate as full payment for the session.

8. Most insurance plans permit charges for missed or late-canceled sessions, provided this is in your informed consent and signed by the client. Check your contract.

9. I don’t recommend routine billing.  Getting payment at or before each session prevents extra work for you and potential income loss if a client gets mad at you, drops out of treatment or has money troubles, leaving you with an unpaid balance.

10. I only recommend that a session be rescheduled without a charge if the client misses it due to an unforeseen emergency or illness. Otherwise, if you reschedule for free you are allowing your client to take two time slots while only paying for one, potentially preventing you from filling and being compensated for the second slot.  This policy may also cause the client to expect such future flexibility.  Charging for missed sessions can also help reduce future no-shows.  For more on charging for missed sessions, see my article here.

11. You can only charge an insurance client their contracted rate for missed sessions.

12. Getting raises from insurance companies is possible, and is often worth the effort. In my last survey, 40% of therapists who tried to get a raise succeeded.  Read more about raises here, and purchase my Sample Raise Request Letter here.

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Barbara Griswold, LMFT is a private practice coach and the author of Navigating the Insurance Maze:The Therapist’s Complete Guide to Working With Insurance — And Whether You Should, 10th edition.  Check out Barbara’s online catalog of helpful online courses, practice forms, and other therapist resources related to insurance, documentation, and running your therapy business here.