Financial Policy
Thank you for choosing me as your mental health care provider. I am committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of the Financial Policy, which you are required to read and sign prior to any treatment.
All patients must complete our Information and Insurance form before seeing the doctor.
- FULL PAYMENT IS DUE AT THE TIME OF SERVICE -
- WE ACCEPT CASH, CHECKS, OR CREDIT CARDS -
Appointments are scheduled for the same day and time each week unless altered by the doctor or yourself in advance.
Timely Payment
I understand that payment is expected upon receipt of service. I agree to pay 1.5% per month if I am delinquent in my account and have to be re-billed. I also understand that should any action need to be taken to collect for professional services rendered, the professional provider shall be entitled to recover any attorney fees.
Regarding Insurance
We cannot bill your insurance company unless you give us your insurance information. We are not a party to that contract. We require that you be pre-approved and we will do so as a courtesy. Whatever portion your insurance does not pay will automatically be transferred to your bill. Please be aware that some, and perhaps all, of the services provided may not be considered reasonable and necessary under your insurance plan.
Usual and Customary Rates
Our practice is committed to providing the best treatment for our patients and we charge what is usual and customary for our area. You are responsible for payment regardless of any insurance company's arbitrary
determination of usual and customary rates.
Adult Patients
Adult patients are responsible for full payment at time of service.
Minor Patients
The adult accompanying a minor and the parents (or guardians of the minor) are responsible for full payment. For unaccompanied minors, non-emergency treatment will be denied unless charges have been pre-paid by credit card or cash.
Missed Appointments
We require, at least 24 hours in advance, to cancel an appointment. Any calls made after 5:00pm or on Saturdays and Sundays to cancel appointments will not be accepted .Thus, if your appointed is after five o’clock, you must call before five o’clock on the previous day. If your appointment is on a Monday, you must call before 5:00pm on the previous Friday. Please help us serve you better by keeping scheduled appointments.
Telephone Time
Unless it is an emergency, all therapeutic contacts take place in the office. Should you request therapeutic interventions on the telephone you will be charged $225 per hour prorated in .10 hours. Most insurance companies will not reimburse telephone time.
Thank you for understanding our Financial Policy. Please let us know if you have questions or concerns. I have read the Financial Policy. I understand and agree to this Financial Policy: