Should you Accept Credit Cards in your Private Practice?

Are you thinking about accepting credit cards in your private practice? Don’t know which company to use? Feel worried about the clinical implications of doing so? I’ve worked in several different private practice settings over the years and have had numerous experiences with using credit cards to collect psychotherapy fees. Here I’ll share some of my thoughts about accepting credit cards in my private practice and some of the challenges I’ve encountered.

Living on Credit Cards
Living on Credit Cards (Photo credit: Images_of_Money)

Business vs Clinical

As a small business owner (i.e., my psychotherapy practice) I think about billing a little differently than if it were purely a clinical matter. Clinically, using a credit card may have significance. It may allow patients to avoid thinking about the financial aspect of the clinical relationship, or if patients are prone to carrying balances on their credit cards it may present a sort of enactment in which your fee furthers their debt. Of course for each patient there are a multitude of clinical implications which should be considered.

The Good

That said, from a business perspective accepting credit cards, in my experience, has several benefits. First, if they have the funds and the credit card is not declined, you are paid instantly. Second, right now, accepting credit cards may be a “benefit” to your service that distinguishes you from the other clinicians out there. This is likely to change in the near future, and may be a relatively small point, but anything that makes you stand-out is good business. Third, it benefits patients if they are responsible with their credit. That is, almost all credit cards now offer cash back, miles, or other rewards. Forth, if you provide any type of telepsychotherapy (phone, Skype, etc.) it greatly facilitates payment.

 The Bad

I’ve already mentioned the clinical potential for enactments, collusion, and avoidance, which may be related to accepting credit cards and should be treated therapeutically. From the business perspective there are also several draw backs. First, cost. Your credit card processor will charge you a fee. This can be a flat rate, a percentage or some combination. It may also be dependent on the type of card your patient is using. Most processors distinguish between debit cards and credit cards and charge more for the latter. Visa and MasterCard are also often preferentially treated with Discover and AMEX having higher processing fees. If you do a lot of business with credit cards this can represent a significant portion of your overhead. Second, it’s another system to learn, manage, and keep track of. You’re a busy clinician with a personal life too. Streamlining your practice so that the business aspect helps the clinical aspect should be the goal. When just starting out, any new system, be it payroll, bookkeeping, or accepting credit cards comes with a learning curve and can take away time from other important duties. Also, it’s another potential system that can fail, which requires time and energy to fix should something go wrong. Third, issues around confidentiality might apply. In accepting credit cards patients must be informed that identifying information will be shared with your bank and credit card processor. Patient Health Information (PHI) which is protected under HIPAA is not shared but it is still less than total confidentiality. True this also applies to checks, and if you accept insurance even more information is shared, but it does create a limitation to privacy. Forth, it creates a dependency on technology. Even though I live and practice in an urban area, the Internet does go down occasionally. Without this connection, I cannot accept credit card payments. My patients who pay by credit card then must remember to mail a check, visit an ATM, or I must remember to bill them later once the connection has been fixed. Also, a smartphone, tablet or laptop are required in nearly all situations. Fifth, some patients might be suspicious of the technology, not trusting the security of it. This can be particularly true of older patients.

My Choice

So, what about me? Do I accept credit cards? Yes, I accept credit cards. Part of my reasons for this are related to continuation of care. I previously worked at an agency which accepted credit cards. Clinically and professionally it made sense for me to continue to offer this service to my patients. Most business banking accounts offer some sort of credit card processing integration service, and historically have been the only option for psychotherapists in private practice. As such this has created a lack of competition and most chose to avoid taking credit cards because the banks charged so much. Now, with the advent of PayPal, Square, Flint and others, fees have gone down and  clinicians have more choices. Each system is a little different. Most clinicians I speak to either use their bank or Square. Square has been around for several years and has developed a good reputation. Ease of use and familiarity seems to be their main selling points. To greatly simplify it, they allow anyone with a smartphone or tablet to accept credit cards via a card reader that they provide to you.

I chose a different company for two reasons: (1) I didn’t want to deal with the card reader. It’s small and seemed easy to misplace. (2) Cost. When I was looking into it Square had two fee models, a flat monthly rate or a percentage. Though both seemed reasonable, there were other companies charging less. (See update below)


Ultimately I chose Flint, as it was cheaper than Square and didn’t require any additionally hardware. It also gave me a web portal where I could email patients invoices which they could then pay online. Their service works by utilizing your smartphone or tablet’s camera to read the credit card’s number. They are relatively new to the credit card processing field and this is evident in the developing nature of their services. I don’t intend this post to be a review or endorsement of Flint, but I’ll briefly list some my experiences thus far. Most of my patients find it cool. They like getting email receipts and signing with their finger. The camera-cum-card-reader has never failed, though it does prove to be far less streamlined than advertised. Even though it “scans” the credit card number it requires the expiration date, zip code, CCV, and email address for receipts to be entered manually each time. The Flint online backend also is less full featured than expected. I’ve had numerous times when working with a couple or family where multiple people want the invoice, I’ve been limited due to Flint’s inability to send invoices to multiple recipients. Also, beyond marking invoices paid, void, or resending them no other changes can be made once an invoice has been sent. Lastly, their backend can be buggy. Several times I’ve encountered error messages about how my data entry can only contain letters, numbers, punctuation, etc. when I haven’t included any non-permissable characters. The only way I can fix it is to change browsers. If you’re a Mac user and use Safari, you may also encounter consistent login-logout loops, like I have. All in all, it works for me and I am confident that these small issues will be worked out the longer Flint is in business.

Update (13 Jun 2014)

So much for Flint. I’ve switched over to Square. This was due to the consistent problems both my patients and I experienced. I had numerous occasions when a patient would email me to tell me that they couldn’t pay because Flint was giving them an error message. I also had the experience of calling their support line only to get a busy signal–the last thing you want to do is keep calling back when you have a business to run.

So, with all of that I had another look at Square. Since my last post, they updated their card processing fees to be more competitive. I signed up, was sent a card reader, and so far have been impressed by how much more streamlined their service is.

Clinically, my patients also seem to be more comfortable with it, citing name recognition and familiarity with the company.

Which company should you go with?

In deciding whether to accept credit cards or not, your decision will be a mixture of clinical and business needs. Hopefully the above offers some points to consider and will help you make a decision that works for you. In terms of choosing a particular company to process your credit cards, I recommend sitting down and looking at each company’s fee and services. Pick the one that offers the best value for you particular practice.

Should you Accept Credit Cards in your Private Practice?
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