Tuesday, February 10, 2009

Just A Little More Time


Okay, so I'm going to post a scenario and I want your opinion. There's no 'right' answer, I don't think, or you'll tell me if there is. I'm particularly interested in opinions from other mental health professionals, so please note in your comments if you're one of those, but as always, I'm interested in feedback from all our readers.

A patient and doctor have a long-standing relationship, they always meet for a 50 minute session, and if often goes closer to 60 minutes. Perhaps a few times they've even gone longer. It's been years, and now the sessions are scheduled erratically, so it's not a given that things can be finished up 'same time next week.' On this particular session, the patient brings up something towards the end that unexpectedly takes a long time-- maybe she wants the doc to write a new script (maybe it's even Xanax ! and the doc is uncomfortable). Some disagreement follows, and the session goes until a quarter after the hour. The doctor never formally states there will be a charge for the session that has run over and there has never been a charge for an over-time session before, though this session may be longer than any other. Is the doc justified in sending out a bill for the extra time? And if so, by how much? An extra quarter of a session, or an extra 50% given that the session technically ran 75 minutes and not 50 minutes. Does it matter if it was the last patient of the day and there's not an all-day back up for everyone else because of the extra time? Let's say it was the patient's final session and so please don't answer with "examine it in the next session" or "send a bill and see what the patient says." And don't worry about the Xanax, new script, whatever issue, it doesn't really matter Why the session ran over, the scenario is about the time and the unexpected charge.

I often run my 50 minute sessions closer to an hour, and sometime I run a few minutes over that. There have been a handful of sessions that have run quite a bit over, and it's never occurred to me to charge for something that wasn't agreed upon in advance, but I'm not saying it isn't the right thing to do-- boundaries, income, time-is-money and the doc has bills to pay, too.

Just wanted your thoughts.