I appreciate you considering me as your mental/behavioral health provider. This material has been prepared to give you important information about fees, insurance, client responsibilities and related policies. Please read this carefully and if you have any questions, please discuss them with me.

 

FEES

My usual and customary fees are:          

• $175.00 for an initial intake        

• $140.00 per 45-50 minute counseling session       

• $150.00 per hour for psychological testing

 

You may also be billed for phone calls/consultations lasting over fifteen (15) minutes and for letters you request to be written. In addition, a $45.00 fee will be charged for checks returned for non-sufficient funds. Payment for counseling and testing is expected at the time services are rendered, by credit card (Visa, Mastercard, Discover).

 

INSURANCE

I accept the following insurance

• Blue Cross/Blue Shield (PPOs, HMOs, MEDCO)

• UnitedHealthcare

• United Behavioral Health

• Aetna

​​

​

WARNING: Please be aware that many insurance companies require pre-authorization for mental and behavioral health services. If this is required by your insurance carrier and you did not call, you may be penalized with denial or reduction of benefits. 

 

As a courtesy, I file your insurance for you, but must have your full insurance information, including secondary insurance, in order to do so. Payment for non-allowable and deductible charges, as well as co-payments, is expected when services are rendered. If insurance payment is not received with ninety (90) days after a claim is filed, the client is then responsible for payment of the total amount due regardless of any outstanding secondary insurance payments. It is your responsibility to follow-up with your insurance company for delayed payments or other concerns.

 

While I try to avoid situations in which insurance coverage is expected but later denied, I cannot guarantee the services provided will be reimbursed. It is up to you to know your insurance coverage, including knowledge of co-payment amounts and yearly deductibles. I cannot be responsible for verifying this information for you.

 

FINANCIAL RESPONSIBILITY

The client is considered responsible for payment of professional fees. It is the client’s responsibility to know if services are covered and the amount of their deductible and/or co-payment. If I am asked to bill a third party, such as a divorced spouse, relative, or insurance company, and that third party fails to make timely payments, payment is expected from the client or referring parent that signed the consent for services. The client will be responsible for fees for claims that are denied (e.g., due to exceeding the number of available sessions, if new coverage has not begun or if insurance has changed, filing past the insurance carrier’s time limit, etc).

 

BILLING

While payment at the time of service is expected, I bill monthly for outstanding balances and to keep you up-to-date regarding the status of your account. Refunds will also be mailed on a monthly basis.

 

PAST DUE ACCOUNTS

I send out several letters to clients with past due accounts in an effort to provide an opportunity to pay in full or make a payment plan. If a client has not made good faith efforts to pay their bill, the overdue account may be assigned to my collections agency and all collection costs associated with the debt will be the client’s responsibility. I also reserve the right to assign the account to small claims court, depending upon the total balance due.

 

CANCELLATIONS and MISSED APPOINTMENTS

If you are unable to keep an appointment, please notify me immediately. Consistent with industry standards, if an appointment is canceled or missed without 24-hour advance notice, you will be charged for the session time. Insurance does not reimburse for missed appointments so you will be financially responsible for payment If you are being seen through an Employee Assistance Program a late cancellation/missed appointment may count as one of your allowed sessions. 

 

​

​