I am in Nevada. Maybe I mis-spoke in calling it a retainer fee. I guess I should have said I have the client pay a $50 fee upfront. In general this fee barely covers the service fee since all of my visits are in home and their copay. (each private paying, non insurance covered customer gets 3 visits in a package, total package cost $125-$175 My private pay clients do not, in general, have more than this available, welcome to Nevada. My rates for private paying customers are no where near the rates on the east coast or a liveable wage, and are a steal in comparison.  I have to set rates based on 'what the market will bear'. www.breastfeedinglv.com.) . It usually doesn't cover everything but it makes collecting the remaining portion of the patient owed fee if all claims are refused much easier. 

When the claims are returned to me with the amount owed by patient. I give a discount to the patient owed fee, just as any hospital does to settle their accounts when they go to collection. So, if my reimbursement is $50 from insurance and they say the patient owes $200, I discount the owed amount to a total of $75 or $125- Most of my families do not have $200 laying around so the collection frustration on what the insurance company says they need to pay is not worth it (same concept as what a hospital does).  

What I have also found is that in having this upfront fee, the client completely understands their financial commitment to the private pay fee if their insurance does not pay. In other words, they understand this is not a free ride and the possibility of their insurance rejecting at least one of the claims is quite expected. I have yet to have to return this fee and usually end up collecting the rest of the fee, which is quite sad btw. 

Lisa Weinshenker, RN, IBCLC
Las Vegas, NV

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