I conduct substance abuse evaluations as part of child custody cases. As part of the evaluation process I request records from previous therapists the parties may have seen for individual or couples therapy.

By law clinicians are allowed to recoup costs for copying and providing records.  It makes good business sense to collect these monies to offset overhead costs.

I requested records from Dr. X. He calls and says he will be happy to send me the records but first wanted me to know the chart was 175 pages long. He computed the amount due to be $170.80 and he would mail the records once he received the check from me.

So I called Dr. X and said, “While I know you are legally entitled to $170.80 I find this to be an outrageous fee for a clerical task. Therefore, I would like for you to accept $35 instead, because I think that is a more reasonable amount.” He replies, “I know this is an outrageous fee but it is what the law allows so this is what I’m going to charge. Pass the fee on to the clients who are millionaires.”

I do not pass such fees on to my clients. While I probably may do so: (a) it was not included in my financial agreement (since no one had ever asked for reimbursement previously) with the client, and (b) it doesn’t fit with my personal values.

I ask Dr. X to reconsider and he declines. On an occasional basis I have referred clients to Dr. X because he is an excellent clinician. I inform him that I will no longer do so if he won’t budge. He stays steadfast with his request to collect the outrageous fee.

In our book Financial Success in Mental Health Practice Jeff Barnett and I discuss the importance of maintaining good customer service practices.  This is with the clients that we see in our offices and the gatekeepers that send us clients to see. There are lots of excellent clinicians in my urban area to refer clients in need. Because of this customer service practice Dr. X is no longer on my referral radar.

In this instance Dr. X earned an additional $135 above what I offered for copying and mailing the records.  Because no future referrals will be coming his way he lost out on revenues from potential future clients, as well as clients that those satisfied customers that he treated may have referred his way.

The morale of the story: Be reasonable in your financial decisions and people will remember your reasonableness. Be unreasonable in your financial decisions and people will remember your unreasonableness.