Common use of (Basic Fees Clause in Contracts

(Basic Fees.  The basic fee for your therapy session is $150; fees for psychological testing and psycho-education are based upon number of hours and will be discussed with you beforehand.  If I am considered “in network” under your insurance policy, the fee is reduced based on my contract with your insurance company. Provided you do not have a deductible that needs to be met first, your insurance company will pay a percentage of the cost of your therapy per session and the remainder (co-pay) will be collected at the time of service.  If I am “out of network” for your insurance company, you may still have benefits available to help with the cost of your therapy. All professional services rendered are charged to you and are your sole responsibility regardless of insurance coverage. It is customary to pay for services in full as they are rendered unless other arrangements have been made in advance. Most insurance companies have a timely filing deadline, thus if you do not provide me with updated insurance information in a timely manner it may become too late for insurance to cover some of your sessions. If your insurance does not cover the cost of your sessions for any reason whatsoever, it is YOUR responsibility to pay the balance. Once services are completed, accounts with any balance remaining after 90 days are subject to a monthly, 1.5% interest charge on the remaining balance. There will be a $25.00 charge for all returned checks. By signing below you are assigning insurance benefits and payments, for any and all sessions between us, to me. In the event your insurance company miss-routes a payment to you that should have been sent to me as reimbursement for your sessions, it is your responsibility to forward payment to me immediately upon receipt of the miss-routed payment. Your signature below indicates that you agree to these terms. It also indicates that you understand that in the case where your account becomes delinquent, I have the right to send your remaining balance to a collection agency or small claims court. You are responsible for any and all legal fees, court costs and collection charges involved as a result of any collection activity.