Payment Collection for Therapists: Best Practices
TL;DR
- Golden Rule: Collect payment/card details before the session starts.
- Automation: Use "Card on File" to auto-charge. Stop chasing invoices.
- Clarity: Mention fees in the first 5 mins of the first session.
- Tools: Use Stripe-integrated schedulers (OnlyCaly, SimplePractice) to automate receipts.
Nobody goes into therapy because they love talking about money. But unless you enjoy working for free, we need to have this conversation.
I've consulted with over 200 private practice therapists, and payment collection is consistently the #1 source of stress. The awkwardness, the chasing, the unpaid invoices that sit there mocking you.
Here's everything I've learned about getting paid without losing your mind.
Why Therapists Struggle With Payments
Before we fix the problem, let's name it.
The Training Gap Grad school teaches therapy. It doesn't teach business. Most therapists learn billing through trial and error, primarily error.
The Discomfort Money conversations feel incompatible with the healer role. "I'm here to help you, but also give me $150" creates cognitive dissonance.
The Relationship Fear Will asking for payment damage the therapeutic relationship? (Spoiler: it won't. Being resentful about unpaid bills will.)
The Systems Gap Many practices have chaotic or non-existent payment systems. Chasing payments one by one is exhausting.
Best Practice #1: Collect Payment BEFORE Sessions
This is the single biggest change you can make. When clients pay at booking or before the session:
- No-show rates drop 40-50%
- Collections stress disappears
- Cash flow becomes predictable
- No awkward end-of-session payment requests
How to implement:
Option A: Pay at booking Your scheduling tool collects payment when the appointment is made. Stripe or Square integration handles the processing. Client is charged immediately.
Option B: Card on file Collect card details during intake. Charge after each session automatically. Client gets receipt via email.
Option C: Pre-pay packages Sell 4-session or 8-session packages upfront. Client books sessions from their prepaid balance.
I recommend Option A for new clients, transitioning to Option B for established ones. Tools like SimplePractice, OnlyCaly and Acuity all support this.
Yes, some clients will push back. More on that later.
Best Practice #2: Automate Everything
Manual billing is for people who hate themselves.
Automate:
- Payment collection (card on file, auto-charge)
- Receipt sending (immediate after charge)
- Superbills for insurance (if client needs them)
- Payment reminders (for any stragglers)
- Late fee application (if you charge them)
The goal: payments happen without you thinking about them.
Set it up once, then focus on therapy.
Best Practice #3: Crystal Clear Policies
Your fee policy should be:
- In writing (intake forms, informed consent)
- Discussed verbally in first session
- Easily accessible (website, client portal)
- Consistently enforced
What to include:
Session fee: "Individual sessions are $X for 50 minutes."
Payment timing: "Payment is due at time of booking" or "Payment is collected at the end of each session via card on file."
Accepted methods: "We accept credit/debit cards. Cash and checks are not accepted." (Seriously, eliminate checks. They bounce.)
Cancellation policy: "Cancellations with less than 24 hours notice will be charged the full session fee."
Late payment: "Accounts more than 30 days past due will be subject to a $X late fee."
Write it down. Enforce it consistently. Consistency is kindness.
Best Practice #4: Address Money In First Session
Don't let money be the elephant in the room. In your first session, briefly say:
"I want to make sure we're on the same page about payment. Our sessions are $X, and [explain your collection method]. Do you have any questions about that?"
Done. 30 seconds. Now it's not weird.
If a client seems hesitant, explore it: "I noticed some hesitation there. Is cost a concern? Let's talk about that."
Sliding scale is an option if you choose to offer it. But don't apologize for your rates.
Handling Common Objections
"Can I pay at the end of the month?" "I appreciate you asking. To keep things simple, I collect payment at each session. This actually helps most clients feel more comfortable—no balance building up."
"My insurance should cover this." "I'm happy to provide a superbill for you to submit to insurance. However, payment is due at time of service, and reimbursement is between you and your insurer."
"I forgot my wallet." If you have card on file: "No problem, I can charge your card on file and send you a receipt." If not: "Let's get a card on file today to prevent this in the future."
"Money is really tight right now." This deserves a real conversation. Options: sliding scale, reduced frequency, referral to lower-cost providers, payment plan. But the client needs to ask for help—don't offer discounts preemptively.
Best Practice #5: Use Proper Tools
Stop using Venmo for therapy payments. I'm begging you.
Problems with casual payment apps:
- No HIPAA compliance
- Transaction descriptions visible to others
- No integration with your records
- Unprofessional appearance
Use instead:
- Stripe (integrates with most booking tools)
- Square (good hardware for in-person)
- Payment processors built into SimplePractice, TherapyNotes, Jane, OnlyCaly
The slightly higher fees are worth the professionalism and automation.
The Cancellation Fee Question
Should you charge for no-shows and late cancellations?
Short answer: yes.
Long answer: also yes.
Your time has value. When a client no-shows, you lose income and could have helped someone else. A cancellation fee:
- Compensates you for lost income
- Motivates clients to show up
- Respects your time and theirs
Typical policies:
- Less than 24 hours notice: full session fee
- Less than 48 hours notice: 50% fee
- Some therapists do one "free" late cancel, then enforce
The key is consistency. If you waive fees for some clients and not others, you create problems.
Pro tip: with pay-at-booking systems, cancellation fees happen automatically. No awkward "by the way, you owe me" conversations.
Insurance: The Complicated Part
Insurance billing is its own beast. Broad strokes:
In-Network:
- You've contracted with insurance company
- They set your rates
- Billing and payment come through them
- Requires more admin but guarantees client flow
Out-of-Network:
- You set your own rates
- Client pays you directly
- You provide superbills for them to submit
- Less admin on your end
Private Pay Only:
- No insurance involvement
- Highest control, highest per-session income
- Some clients can't afford without insurance
Many therapists do a mix. Whatever you choose, be clear with clients upfront about how it works.
Red Flags and When to Fire Clients
Sometimes payment problems signal deeper issues. Watch for:
- Repeated "forgotten" payments
- Bounced checks (if you still accept them, don't)
- Endless negotiation about fees
- Expressing entitlement to free sessions
- Making you feel guilty for charging
One or two instances: address directly. Pattern: consider termination.
Script: "I've noticed several difficulties with payment. To continue working together, I need [specific requirement]. If that's not workable for you right now, let's discuss other options including referrals to providers that might be a better fit."
You are not obligated to work with clients who don't pay you.
Common Billing Mistakes
- The "End of Session" scramble: Asking for payment when the client is emotional after a session.
- Accepting Venmo: It's often T&C violation and bad for privacy.
- No Late Fee: Without consequences, invoices sit unpaid for months.
Frequently Asked Questions
Can I accept Venmo or CashApp?
Technically yes, but it's risky. They are not HIPAA compliant (your transaction history is not private enough), and their terms of service often prohibit business use without a specific business account. We strongly recommend professional processors like Stripe.
Who pays the credit card processing fees?
Legally and ethically, this is a business expense that you (the therapist) absorb. You generally cannot add a "surcharge" for card payments in many states/contracts. Factor the 2.9% fee into your session rate.
How do I store credit cards safely?
Never write them down on paper. Use a PCI-compliant system like OnlyCaly or SimplePractice that tokenizes the card data. You should never be able to see the full card number after it's entered.
My Recommended Stack
Here's what works for a streamlined payment setup:
- Booking tool with Stripe integration (SimplePractice, OnlyCaly, Acuity)
- Card-on-file required for all clients
- Auto-charge after session or pay-at-booking
- Automatic receipts via email
- Auto-generated superbills for insurance clients
- Cancellation policy that enforces automatically
Setup time: maybe 2 hours. Time saved: thousands of hours over your career.
Quick Implementation Checklist
Starting fresh or cleaning up? Do these:
- Write a clear fee policy (or update existing)
- Add payment policy to intake/consent forms
- Set up card-on-file system
- Configure automatic charging
- Set up automatic receipts
- Configure cancellation fee automation
- Practice your "let's talk about payment" script
- Stop accepting checks (trust me)
The Mindset Shift
Charging for your services isn't greedy. It's professional.
You spent years training. You provide genuine help. You have bills. Getting paid appropriately allows you to sustain a practice that helps people long-term.
Therapists who feel resentful about money rarely do their best work. Clear, boundaried payment systems aren't just good business—they're good therapy.
Set up the systems. Then never think about payments again.
That's the goal.