Ethical and legal obligations when parents refuse to pay counseling fees

Psychology -- Counseling

The substance abuse problems that the 16-year-old (Jim) is going through may require more than counseling, but a good beginning -- after assessment instruments have been by a professional -- is certainly professional counseling. Regarding what the psychologist could and should do if Jake's parents refuse to take responsibility for the fees accumulated in this matter, this paper will provide answers to that question and others.

How would you respond to Jim's father's accusations and refusal to pay your fees? First of all it should be determined through research as to what specifically the health insurance company says it covers in the documents provided to Jim's parents. Certainly Jim's father is a lawyer (and a doctor) so he should be competent to determine what the policy states vis-a-vis coverage it would allow in these substance abuse cases. Jim's father may actually have a case against the insurance company and so by attacking me he is not going after the correct culprit.

Hence, as the psychologist I need to be calm, professional, and take the appropriate steps to attempt to resolve the conflict. I also need to research the ethical aspects of this issue and see what my legal responsibilities are.

According to the American Psychological Association's "Ethical Principles of Psychologists and Code of Conduct 2010," an agreement should have been reached at the outset of my interaction with Jim as to the fees and how they would be paid. "As early as is feasible in a professional or scientific relationship" the services provided by a psychologist and the recipients of those services need to "…reach an agreement specifying compensation and billing arrangements," according to the American Psychological Association (APA, 10.01).

Apparently this arrangement was never achieved, and I take responsibility for not insisting that Jim's parents sit down with me and go over my fees and what the insurance company says it will pay and what it will not pay. Certainly I should have -- after coming to the initial finding that Jim has a problem with cocaine and amphetamine -- had an informational session with the parents before three additional sessions.

Secondly, I should consult with an attorney before saying anything at all in response to Jim's father's belligerent assertions and accusations.

TWO: What legal and ethical actions can you take to collect your fees? The APA states that when the recipient of psychological services "…does not pay for services as agreed [there apparently was not an agreement per se, albeit the doctor/lawyer father certainly understands the concept of fees and payment of fees] and if psychologists intend to use collection agencies" or other legal tactics [such as a lawsuit] in order to achieve payment, the psychologist must "…first inform the person that such measures will be taken and provide that person an opportunity to make prompt payment" (APA, 6.04).

Certainly if Jim's parents continue to refuse to pay the fees incurred in this matter, and even rebuff efforts to pay on an affordable payment schedule (which doesn't seem a likely outcome because the father would seem to be an affluent person and wouldn't need a time payment plan), a bartering process might be appropriate. That is, the doctor could agree to provide certain healthcare-related services in lieu of paying me for my work. It is also possible that some of the fees could be forgiven, but that is not at the top of the list of possible solutions because it could bring charges of fraud.

THREE: Is it appropriate to use a collection agency? The Zur Institute does not recommend turning the situation over to a collection agency. Why? Common sense suggests that this is like a declaration of war. Because once a therapist turns the unpaid fee problem to a collection agency the therapist then has "no control over the kind of practices these agencies employ" (Zur). For example, harassing phone calls "at all hours," embarrassing calls to family members and other threats are not acceptable, ethical approaches to retrieving the money owed. Also, a psychologist must realize going in that he may only get up to 30% of what he is owed if the collection agency is successful in getting the parents to pay. Moreover, does the unpaid psychologist really wish to harm the parents' credit rating?

Additionally, the therapist began his association with this family because the son has a serious substance abuse problem; hence, the family saw the therapist as an ally, a confidante and a "trusted counselor" (Zur). But once collection agency begins its harassing, sometimes aggressive strategies, the family feels betrayed, and the two parties are enemies, which can only lead to hard feelings and negative messages and unkind, damaging rumors being spread.