Financial Model

Pure Sliding Scale Mutual Cooperative Model

I am stating here in the first line I want your money. This is my occupation and my livelihood. I absolutely focused on my practice. My occupation requires humans to show up at my door. I do not know how they will be funneled to me, but I am almost certain it will be through a relationship with another person. I have absolute faith I will be able to help them when they call. You are one of those people. 

While I am compelled by the notion my community will provide the substance with which I live on; care is provided primary to pay. The pay conversation can come whenever, but the pay has to come after care. I will stand by that. Pay is not something I demand. Generations of my family have lived in shit conditions and complete poverty. I will only ever ask you for money because I have witness the lived reality time and time again not just myself, but through family and so many other humans; whole regions of the world even. Your money will not have value to me if you do not give it freely, intentionally, and with the recognition I am immensely thankful and proud regardless of what I am paid. 

This work is based in values. I operate from the fundamental belief that therapy be accessible to every person, regardless of their financial circumstances or economic status. I choose to operate purely as out of network to utilize a true honor-system 'pay what you can' model. This is beyond not the norm, I know that, and I am happy to explain myself. 

When I say pay what you can, I mean that literally. For some that means paying a fee similar to a standard copay, paying a fraction of that, giving five dollars, or pocket lint. I offer pro bono slots and pay-what-you-can slots. I am not a luxury service, but an everyday service. I am no different than the hairstylists or nail techs I share a space with. Because I output a service, my input is money. I am discouraged from accepting non-cash payment for my services; however, I am trained to make that discretion as a member of my occupation. 

As you do the forms through our session, the last one you will land on is titled: WHAT IS OUR RATE ___? If you are reading this right now, when you get to that form do not look up and stare at me. That would be criminal. Or if you do and you make me use telepathy to know that, I will demonstrate my powers. Okay I got lost in the sauce. Please write a number. You really cannot pay me too little. I want people to feel good when they walk out of that door.

I can tell you what would make me feel good walking out of that door. It would be leaving myself with zero surplus. I would still budget for pleasure, but maybe cut into it. I would never allow myself to give up my essentials and my livelihood. I could not bring myself to stop putting aside money to save. I would still put aside for incidentals because I do not want to fear collapse. But I would leave myself without surplus. II do not know everyone will share my view on this. But I will not budge on a person making themself needy. Maybe this can offer some comfort or clarity. 

I do have a rate and I am listing it at the bottom and only one time for a reason. That number is 200. This is the number I have decided I am worth. This is the number I choose to advertise my self as being worth. You do not have to decide I am worth that amount. You are welcome to choose a number that is higher than the number I stated I am worth. If you have the financial capacity to choose a higher rate, doing so directly sustains my operation, my life, and fulfills me. It literally creates the material capacity for me to provide care for others in our community. 

Note: 

[The pay conversation must come prior if you are a Medicaid client. Why is that? I am intentionally making this statement long and drawn out and annoying and run on to be bothersome to read despite the apostrophes, or is it colons? I literally cannot remember what these are called. Is it parentheses? That sounds right. Do you get my point? This is entirely mandated by the state. If you have Medicaid you do not have to tell me, but should I find out I have to document it and have a conversation with you, which is whatever it's not awkward, it will probably happen to people. Please tell me, we will have the pay conversation prior to meeting then I will send you a form via email you must fill out. And then I must receive that form back before we can meet. You can show up to the appointment and fill the form in person, but it will be prior to me letting you inside of my room and me closing the door. That is the moment our therapeutic relationship begins in that context. Moving on... Thank you for sticking with this! XD

TLDR: Medicaid wants me to inform people of their rights. I see the worth in this advocacy for the group. However, I am irate the state mandates this hurdle for a group who is, by definition, experiencing a hardship. They already mandate me to inform you, they should move the requirement into my charting. That is already the record which makes me liable for my conduct.]

Explanation of Benefits to Clients: 

Avoiding an insurance-mandated mental health diagnosis protects your future financial choices from so much legal bias. Life, disability, and long-term care underwriters scrutinize insurance databases (like the Medical Information Bureau) for mental health diagnoses, which can trigger permanently inflated premiums or outright denials. 

I am a medical expense on your taxes. You may deduct out-of-pocket therapy fees on their federal tax returns as an itemized medical expense under IRS Schedule A (Form 1040). To claim this claimed/qualified medical expenses must exceed 7.5% of you Adjusted Gross Income (AGI). If audited, the IRS requires proof of payment and a receipt showing the service was medical in nature. I use IVY PAY which provides you a recepit that clearly states the amount and identifies my practice as the expense. unlike health insurance companies, the IRS does not automatically ingest or audit specific clinical ICD-10 diagnostic codes to verify standard cash transactions. 

While insurance is bypassed, clients can sometimes pay using Pre-Tax Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA) without the provider submitting a claim to an insurer, depending on the specific administrator's verification rules. 

My work is advocacy, it should be very clear by now this is basically a PSA. If you have a high-deductible plan I will not refuse to do a superbill, but you have to know that my diagnosis is going to them. For those in high-stakes industries, preventing a clinical diagnosis from entering a centralized insurance registry eliminates potential risks to corporate advancement, federal clearances, or specialized licensing.