Common use of Insurance Reimbursement Clause in Contracts

Insurance Reimbursement. In order for you and Xx. Xxxxxx to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. With your permission, Xx. Xxxxxx'x billing service and Xx. Xxxxxx will assist you to the extent possible in filing claims and ascertaining information about your coverage, but you are responsible for knowing your coverage and for letting Xx. Xxxxxx know if/when your coverage changes. Due to the rising costs of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. Managed Health Care plans such as HMOs and PPOs often require advance authorization, without which they may refuse to provide reimbursement for mental health services. These plans are often limited to short-­‐term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While a lot can be accomplished in short-­‐term therapy, some patients feel that they need more services after insurance benefits end. Some managed-­‐care plans will not allow Xx. Xxxxxx to provide services to you once your benefits end. If this is the case, Xx. Xxxxxx will do her best to find another provider who will help you continue your psychotherapy. You should also be aware that most insurance companies require you to authorize Xx. Xxxxxx to provide them with a clinical diagnosis. (Diagnoses are technical terms that describe the nature of your problems and whether they are short-­‐term or long-­‐term problems. All diagnoses come from a book entitled the DSM 5. There is a copy in Xx. Xxxxxx'x office and she will be glad to let you see it to learn more about your diagnosis, if applicable). Sometimes Xx. Xxxxxx has to provide additional clinical information such as treatment plans or summaries, or copies of the entire record (in rare cases). This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, Xx. Xxxxxx has no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. Xx. Xxxxxx will provide you with a copy of any report she submits, if you request it. By signing this Agreement, you agree that Xx. Xxxxxx can provide requested information to your carrier if you plan to pay with insurance.

Insurance Reimbursement. In order for you and Xx. Xxxxxx us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually may provide some coverage for mental health treatment. With I will fill out forms and provide you with whatever assistance I can in helping you receive the benefits to which you are entitled, however, you (not your permission, Xx. Xxxxxx'x billing service and Xx. Xxxxxx will assist you to the extent possible in filing claims and ascertaining information about your coverage, but you insurance company) are responsible for knowing full payment of my fees. It is very important that you find out exactly what mental health services your insurance policy covers. I require $90 at the time of the session, and if you have insurance I will bill them. I usually bill within two weeks and/or monthly so you will receive the insurance money back in a reasonable time. You should carefully read the section in your insurance coverage and for letting Xxbooklet that describes mental health services. Xxxxxx know if/when If you have questions about the coverage, call your coverage changesplan administrator. Of course, I will be happy to help you in understanding the information you receive from your insurance company. If it is necessary to clear confusion, I will be willing to call the company on your behalf. Due to the rising costs cost of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. “Managed Health Care Care” plans such as HMOs and PPOs often require advance authorization, without which authorization before they may refuse to provide reimbursement for mental health services. These plans are often limited to short-­‐term short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While a lot much can be accomplished in short-­‐term short-term therapy, some patients clients feel that they need more services after insurance benefits end. Some managed-­‐care plans will not allow Xx. Xxxxxx to provide services to you once your benefits end. If this is the case, Xx. Xxxxxx will do her best to find another provider who will help you continue your psychotherapy. You should also be aware that most your contract with your health insurance companies require you to authorize Xx. Xxxxxx to company requires that I provide them with a clinical diagnosisinformation relevant to the service that I provide to you. (Diagnoses If you have an Oregon insurance policy with the state law requirement that by accepting policy benefits, you are technical terms that describe the nature deemed to have consented to examination of your problems Clinical Record for purposes of utilization review, quality assurance and whether they are short-­‐term or long-­‐term problems. All diagnoses come from a book entitled peer review by the DSM 5. There is a copy in Xx. Xxxxxx'x office and she will be glad insurance company, then I may provide clinical information to let you see it to learn more about your diagnosis, if applicable)insurer for such purposes. Sometimes Xx. Xxxxxx has I am required to provide additional clinical information such as treatment plans or summaries, or copies of your entire Clinical Record. In such situations, I will make every effort to release only the entire record (in rare cases)minimum information about you that is necessary for the purpose requested. This information will become part of the insurance company files and will probably probable be stored in a computer. Though all insurance companies claim to keep such information confidential, Xx. Xxxxxx has I have no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. Xx. Xxxxxx I will provide you with a copy of any report she submitsI submit, if you request it. By signing this Agreement, you agree that Xx. Xxxxxx I can provide requested information to your carrier carrier. Once we have all of the information about your insurance coverage, we will discuss what we can expect to accomplish with the benefits that are available and what will happen if they run out before your feel ready to end your sessions. It is important to remember that you always have the right to pay for my services yourself to avoid the problems described about [unless prohibited by contract]. You are protected under HIPAA. This law insures the confidentiality of all electronic transmission of information about you. Whenever I transmit information about you electronically (for example, sending emails or faxing information), I will be careful to insure confidentiality. If you elect to communicate with me by email at some point in our work together, please be aware that emails are not completely confidential. All emails are retained in the logs of our or my internet service provider (ISP). While under normal circumstances no one looks at these logs, they are, in theory, available to be read by the system administrator(s) of the internet service provider. Any email I receive from you, and any responses that I send to you, will be printed out and kept in your treatment record. In addition to weekly appointments, I charge $75 for 50 minutes for other professional services you may need, though I will break down the cost if I work for periods of less than 50 minutes or prorate mutually agreed upon time and cost for services such as: report writing, telephone or electronic conversations lasting longer than 10 minutes in a week, attendance at meetings with other professionals you have authorized, preparation of records or treatment summaries, and the time spend performing any other service you may request of me. If you become involved in legal proceedings that require my participation, you will be expected to pay for my professional time even if I am called testify by another party. Because of the difficulty of legal involvement, I charge $175 per hour for preparation and attendance at any legal proceeding. My policy if you plan are in couples therapy If you and your partner decide to pay with insurancehave some individual sessions as part of the couples therapy, what you say in those individual sessions will be considered to be a part of the couples therapy, and can and probably will be discussed in our joint sessions. Do not tell me anything you wish kept secret from your partner. I will remind you of this policy before beginning such individual sessions. Your signature below indicates that you have read this agreement and agree to its terms and also serves as an acknowledgment that you have received the HIPAA Notice from described above.

Insurance Reimbursement. In order for you and Xx. Xxxxxx us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. With your permission, Xx. Xxxxxx'x billing service and Xx. Xxxxxx Xxxxxxx will assist provide you with whatever assistance he can in helping you receive benefits to the extent possible in filing claims and ascertaining information about which you are entitled; however, you, not your coverageinsurance company, but you are responsible for knowing full payment of fees. It is very important that you find out about mental health services your coverage insurance policy covers. If you have questions about the coverage, call your plan administrator. We will provide you with whatever information we can and for letting Xx. Xxxxxx know if/when will call the company on your coverage changesbehalf to clear up any confusion. Due to the rising costs cost of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. Managed Health Care Some plans such as HMOs and PPOs often require advance authorization, without which authorization before they may refuse to provide reimbursement for mental health services. These plans are often limited to short-­‐term short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While a lot much can be accomplished in short-­‐term short-term therapy, some patients clients feel that they need more services after insurance benefits end. Some managed-­‐care plans will not allow Xx. Xxxxxx your therapist to provide services to you once your benefits endcease. If this is the case, Xx. Xxxxxx we will do her our best to find another provider who will help you continue your psychotherapy. You should also be aware that most insurance companies require you to authorize Xx. Xxxxxx to provide them with a clinical diagnosis. (Diagnoses are technical terms that describe Once we have all of the nature of your problems and whether they are short-­‐term or long-­‐term problems. All diagnoses come from a book entitled the DSM 5. There is a copy in Xx. Xxxxxx'x office and she will be glad to let you see it to learn more information about your diagnosisinsurance coverage, we will discuss what we can expect to accomplish with the benefits that are available and what will happen if applicable)they run out before you feel ready to end your sessions. Sometimes Xx. Xxxxxx has It is important to provide additional clinical information such as treatment plans or summaries, or copies of remember that you always have the entire record (in rare cases). This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, Xx. Xxxxxx has no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. Xx. Xxxxxx will provide you with a copy of any report she submits, if you request it. By signing this Agreement, you agree that Xx. Xxxxxx can provide requested information to your carrier if you plan right to pay with insurancefor our services yourself to avoid the problems described above [unless prohibited by contract].

Insurance Reimbursement. In order for you and Xx. Xxxxxx us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. With We will fill out forms and provide you with whatever assistance we can in helping you receive the benefits to which you are entitled; however, you (not your permission, Xx. Xxxxxx'x billing service and Xx. Xxxxxx will assist you to the extent possible in filing claims and ascertaining information about your coverage, but you insurance company) are responsible for knowing full payment of our fees. It is very important that you find out exactly what mental health services your insurance policy covers. You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, call your plan administrator. Of course, we will provide you with whatever information we can based on our experience and for letting Xxwill be happy to help you in understanding the information you receive from your insurance company. Xxxxxx know if/when If it is necessary to clear confusion, we will be willing to call the company on your coverage changesbehalf. Due to the rising costs of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. "Managed Health Care Care" plans such as HMOs and PPOs often require advance authorization, without which authorization before they may refuse to provide reimbursement for mental health services. These plans are often limited to short-­‐term short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While a lot much can be accomplished in short-­‐term short-term therapy, some patients feel that they need more services after insurance benefits end. Some managed-­‐care managed-care plans will not allow Xx. Xxxxxx us to provide services to you once your benefits end. If this is the case, Xx. Xxxxxx we will do her our best to find another provider who will help you continue your psychotherapy. You should also be aware that most your contract with your health insurance companies require you company requires that we provide it with information relevant to authorize Xxthe services that we provide to you. Xxxxxx We are required to provide them with a clinical diagnosis. (Diagnoses Sometimes we are technical terms that describe the nature of your problems and whether they are short-­‐term or long-­‐term problems. All diagnoses come from a book entitled the DSM 5. There is a copy in Xx. Xxxxxx'x office and she will be glad to let you see it to learn more about your diagnosis, if applicable). Sometimes Xx. Xxxxxx has required to provide additional clinical information such as treatment plans or summaries, or copies of the your entire record (in rare cases)Clinical Record. This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, Xx. Xxxxxx has we have no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. Xx. Xxxxxx We will provide you with a copy of any report she submitswe submit, if you request it. By signing this Agreement, you agree that Xx. Xxxxxx we can provide requested information to your carrier carrier. Once we have all of the information about your insurance coverage, we will discuss what we can expect to accomplish with the benefits that are available and what will happen if they run out before you plan feel ready to end your sessions. It is important to remember that you always have the right to pay with insurancefor our services yourself to avoid the problems described above (unless prohibited by contract).

Insurance Reimbursement. In order for you and Xx. Xxxxxx us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. With I will fill out forms and provide you with whatever assistance I can in helping you receive the benefits to which you are entitled; however, you (not your permission, Xx. Xxxxxx'x billing service and Xx. Xxxxxx will assist you to the extent possible in filing claims and ascertaining information about your coverage, but you insurance company) are responsible for knowing full payment of my fees. It is very important that you find out exactly what mental health services your insurance policy covers. You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, call your plan administrator. Of course, I will provide you with whatever information I can based on my experience and for letting Xxwill be happy to help you in understanding the information you receive from your insurance company. Xxxxxx know if/when If it is necessary to clear confusion, I will be willing to call the company on your coverage changesbehalf. Due to the rising costs of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. “Managed Health Care Care” plans such as HMOs and PPOs often require advance authorization, without which authorization before they may refuse to provide reimbursement for mental health services. These plans are often limited to short-­‐term short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While a lot much can be accomplished in short-­‐term short-term therapy, some patients clients feel that they need more services after insurance benefits end. (Some managed-­‐care managed-care plans will not allow Xx. Xxxxxx me to provide services to you once your benefits end. If this is the case, Xx. Xxxxxx I will do her my best to find another provider who will help you continue your psychotherapy. .) You should also be aware that most your contract with your health insurance companies require you company requires that I provide it with information relevant to authorize Xxthe services that I provide to you. Xxxxxx I am required to provide them with a clinical diagnosis. (Diagnoses are technical terms that describe the nature of your problems and whether they are short-­‐term or long-­‐term problems. All diagnoses come from a book entitled the DSM 5. There is a copy in Xx. Xxxxxx'x office and she will be glad to let you see it to learn more about your diagnosis, if applicable). Sometimes Xx. Xxxxxx has I am required to provide additional clinical information such as treatment plans or summaries, or copies of your entire Clinical Record. In such situations, I will make every effort to release only the entire record (in rare cases)minimum information about you that is necessary for the purpose requested. This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, Xx. Xxxxxx has I have no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. Xx. Xxxxxx I will provide you with a copy of any report she submitsI submit, if you request it. By signing this Agreement, you agree that Xx. Xxxxxx I can provide requested information to your carrier carrier. Once we have all of the information about your insurance coverage, we will discuss what we can expect to accomplish with the benefits that are available and what will happen if they run out before you plan feel ready to end your sessions. It is important to remember that you always have the right to pay with insurance.for my services yourself to avoid the problems described above (unless prohibited by contract). YOUR SIGNATURE BELOW INDICATES THAT YOU HAVE READ THIS AGREEMENT AND AGREE TO ITS TERMS AND ALSO SERVES AS AN ACKNOWLEDGEMENT THAT YOU HAVE RECEIVED THE HIPAA NOTICE FORM DESCRIBED ABOVE. Client Name: Signature: Date: Parent Name: Signature: Date:

Insurance Reimbursement. In order for you and Xx. Xxxxxx us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. With We will fill out forms and provide you with whatever assistance we can in helping you receive the benefits to which you are entitled; however, you (not your permission, Xx. Xxxxxx'x billing service and Xx. Xxxxxx will assist you to the extent possible in filing claims and ascertaining information about your coverage, but you insurance company) are responsible for knowing full payment of fees. It is very important that you find out exactly what mental health services your insurance policy covers. You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, call your plan administrator. Of course, we will provide you with whatever information we can based on my experience and for letting Xxwill be happy to help you in understanding the information you receive from your insurance company. Xxxxxx know if/when If it is necessary to clear confusion, we will be willing to call the company on your coverage changesbehalf. Due to the rising costs of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. “Managed Health Care Care” plans such as HMOs and PPOs often require advance authorization, without which authorization before they may refuse to provide reimbursement for mental health services. These plans are often limited to short-­‐term short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While a lot much can be accomplished in short-­‐term short-term therapy, some patients clients feel that they need more services after insurance benefits end. Some managed-­‐care managed-care plans will not allow Xx. Xxxxxx us to provide services to you once your benefits end. If this is the case, Xx. Xxxxxx we will do her our best to find another provider who will help you continue your psychotherapy. You should also be aware that most your contract with your health insurance companies require you company requires that we provide it with information relevant to authorize Xxthe services that we provide to you. Xxxxxx We are required to provide them with a clinical diagnosis. (Diagnoses Sometimes we are technical terms that describe the nature of your problems and whether they are short-­‐term or long-­‐term problems. All diagnoses come from a book entitled the DSM 5. There is a copy in Xx. Xxxxxx'x office and she will be glad to let you see it to learn more about your diagnosis, if applicable). Sometimes Xx. Xxxxxx has required to provide additional clinical information such as treatment plans or summaries, or copies of your entire Clinical Record. In such situations, we will make every effort to release only the entire record (in rare cases)minimum information about you that is necessary for the purpose requested. This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, Xx. Xxxxxx has we have no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. Xx. Xxxxxx We will provide you with a copy of any report she submitswe submit, if you request it. By signing this Agreement, you agree that Xx. Xxxxxx RHEMA Counseling & Support Services, PC can provide requested information to your carrier carrier. Once we have all of the information about your insurance coverage, we will discuss what we can expect to accomplish with the benefits that are available and what will happen if they run out before you plan feel ready to end your sessions. It is important to remember that you always have the right to pay with insurancefor your services yourself unless prohibited by your health insurance contract.

Insurance Reimbursement. In order for you and Xx. Xxxxxx us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. With I will fill out forms and provide you with whatever assistance I can in helping you receive the benefits to which you are entitled; however, you (not your permission, Xx. Xxxxxx'x billing service and Xx. Xxxxxx will assist you to the extent possible in filing claims and ascertaining information about your coverage, but you insurance company) are responsible for knowing full payment of my fees. It is very important that you find out exactly what mental health services your insurance policy covers. You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, call your plan administrator. Of course, I will provide you with whatever information I can based on my experience and for letting Xxwill be happy to help you in understanding the information you receive from your insurance company. Xxxxxx know if/when If it is necessary to clear confusion, I will be willing to call the company on your coverage changesbehalf. Due to the rising costs of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. Managed Health Care plans such as HMOs and PPOs often require advance authorization, without which authorization before they may refuse to provide reimbursement for mental health services. These plans are often limited to short-­‐term short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While a lot much can be accomplished in short-­‐term short-term therapy, some patients feel that they need more services after insurance benefits end. Some managed-­‐care managed-care plans will not allow Xx. Xxxxxx me to provide services to you once your benefits end. If this is the case, Xx. Xxxxxx I will do her my best to find another provider who will help you continue your psychotherapy. You should also be aware that most insurance companies require you to authorize Xx. Xxxxxx to provide them with a clinical diagnosis. (Diagnoses are technical terms that describe the nature of your problems and whether they are short-­‐term or long-­‐term problems. All diagnoses come from a book entitled the DSM 5. There is a copy in Xx. Xxxxxx'x office and she will be glad to let you see it to learn more about your diagnosis, if applicable). Sometimes Xx. Xxxxxx has to provide additional clinical information such as treatment plans or summaries, or copies of the entire record (in rare cases). This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, Xx. Xxxxxx has no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. Xx. Xxxxxx will provide you with a copy of any report she submits, if you request it. By signing this Agreement, you agree that Xx. Xxxxxx can provide requested information to your carrier if you plan to pay with insurance.

Insurance Reimbursement. In order for you and Xx. Xxxxxx us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. With We will fill out forms and provide you with whatever assistance we can in helping you receive the benefits to which you are entitled. However, you (not your permission, Xx. Xxxxxx'x billing service and Xx. Xxxxxx will assist you to the extent possible in filing claims and ascertaining information about your coverage, but you insurance company) are responsible for knowing full payment of our fees. It is very important that you find out exactly what mental health services your insurance policy covers. You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, call your plan administrator. Of course, we will provide you with whatever information we can based on our experience and for letting Xxwill be happy to help you in understanding the information you receive from your insurance company. Xxxxxx know if/when If it is necessary to clear confusion, we will be willing to call the company on your coverage changesbehalf. Due to the rising costs of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. “Managed Health Care Care” plans such as HMOs and PPOs often require advance authorization, without which authorization before they may refuse to provide reimbursement for mental health services. These plans are often limited to short-­‐term short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While a lot much can be accomplished in short-­‐term short- term therapy, some patients feel that they need more services after insurance benefits end. (Some managed-­‐care managed-care plans will not allow Xx. Xxxxxx us to provide services to you once your benefits end. If this is the case, Xx. Xxxxxx we will do her our best to find another provider who will help you continue your psychotherapy. .) You should also be aware that most your contract with your health insurance companies require you company requires that we provide it with information relevant to authorize Xxthe services that we provide to you. Xxxxxx We are required to provide them with a clinical diagnosis. (Diagnoses Sometimes we are technical terms that describe the nature of your problems and whether they are short-­‐term or long-­‐term problems. All diagnoses come from a book entitled the DSM 5. There is a copy in Xx. Xxxxxx'x office and she will be glad to let you see it to learn more about your diagnosis, if applicable). Sometimes Xx. Xxxxxx has required to provide additional clinical information such as treatment plans or summaries, or copies of your entire Clinical Record. In such situations, we will make every effort to release only the entire record (in rare cases)minimum information about you that is necessary for the purpose requested. This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, Xx. Xxxxxx has we have no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. Xx. Xxxxxx We will provide you with a copy of any report she submitswe submit, if you request it. By signing this Agreement, you agree that Xx. Xxxxxx we can provide requested information to your carrier carrier. Once we have all of the information about your insurance coverage, we will discuss what we can expect to accomplish with the benefits that are available and what will happen if they run out before you plan feel ready to end your sessions. It is important to remember that you always have the right to pay with insurancefor our services yourself to avoid the problems described above (unless prohibited by contract), and we will provide a statement which you can submit to your insurance company for reimbursement.

Insurance Reimbursement. In order for Insurance is a contract between you and Xxyour insurance company. Xxxxxx We are not a party to set realistic treatment goals and prioritiesthis contract. We will bill your primary insurance company as a courtesy to you. Although we may estimate what your insurance company may pay, it is the insurance company that makes the final determination of your eligibility. You agree to pay any portion of the charges not covered by insurance. Once again, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. With your permission, Xx. Xxxxxx'x billing service and Xx. Xxxxxx will assist you to the extent possible in filing claims and ascertaining information about your coverage, but understand that you are responsible for knowing the full payment of your coverage and account (not your insurance company). It is very important that you find out exactly what mental health services your insurance policy covers. Also, i f your insurance requires a pre-authorization, you are responsible for letting Xx. Xxxxxx know if/when your coverage changesobtaining it. Due to the rising costs of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. “Managed Health Care Care” plans such as HMOs and PPOs often require advance authorization, without which authorization before they may refuse to provide reimbursement for mental health services. These plans are often limited to short-­‐term short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While a lot much can be accomplished in short-­‐term short-term therapy, some patients feel that they need more services after insurance benefits end. Some managed-­‐care managed-care plans will not allow Xx. Xxxxxx your psychologist to provide services to you once your benefits end. If this is the case, Xx. Xxxxxx your psychologist will do her their best to find another provider who will help you continue your psychotherapy. You should also be aware that most your contract with your health insurance companies require you company requires that we provide it with information relevant to authorize Xxthe services that are provided to you. Xxxxxx We are required to provide them with a clinical diagnosis. (Diagnoses Sometimes we are technical terms that describe the nature of your problems and whether they are short-­‐term or long-­‐term problems. All diagnoses come from a book entitled the DSM 5. There is a copy in Xx. Xxxxxx'x office and she will be glad to let you see it to learn more about your diagnosis, if applicable). Sometimes Xx. Xxxxxx has required to provide additional clinical information such as treatment plans or summaries, or copies of your entire Clinical Record. In such situations, we will make every effort to release only the entire record (in rare cases)minimum information about you that is necessary for the purpose requested. This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, Xx. Xxxxxx has we have no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. Xx. Xxxxxx We will provide you with a copy of any report she submitswe submit, if you request it. By signing Once we have all of the information about your insurance coverage, we will discuss what we can expect to accomplish with the benefits that are available and what will happen if they run out before you feel ready to end your sessions. It is important to remember that you always have the right to pay for our services yourself to avoid the problems described above unless prohibited by contract. Please complete and sign the Patient Information form indicating that you give this office permission to release any information obtained during examinations or treatment of this patient that is necessary to support any insurance claims on this account and secure timely payments due to the assignee or yourself; you understand that you are responsible for all charges, regardless of insurance coverage; you hereby assign medical benefits, including those from government- sponsored programs and other health plans, to be paid to Dr Xxxxx LLC; have read and understand the above Psychologist - Patient Services Agreement, you agree that Xx. Xxxxxx can provide requested information and have been provided the opportunity to discuss any area addressed in the Agreement or other concerns related to your carrier if treatment (or treatment of your xxxx); you plan have read the above and agree to pay with insuranceits terms and also acknowledge that you have received or reviewed the HIPAA Notice of Privacy Practices described in the Agreement.