Professional Fees and Payments. Payment is due at the time that services are provided unless special circumstances re- quire an alternate payment schedule. My Intake fee is $220 (one to two sessions) and my fee for subsequent sessions (code 90837) is $190.00. I typically raise my rate by $5.00 each year on January 1st. Sessions typically last 53 minutes but 30 minute ses- sions (code 90832) are available for $100.00. I do not bill insurance companies for couples therapy. The CPT session code (98047) is covered but the diagnostic code is not i.e., Z63.0 Relationship Distress with Spouse or Intimate Partner. In addition to weekly appointments, I charge $190.00 per hour for other professional services you may need, though I will break down the hourly cost in 15 minute incre- ments of $47.50 each. Other services include report writing, attendance at meetings with other professionals you have authorized, preparation of records or treatment sum- maries, documentation for disability or FMLA claims, and the time spent performing any other service you may request of me. These additional services are out-of-pocket ex- penses and cannot be billed to insurance. I will coordinate care with other health care providers as a courtesy to you, although phone conversations lasting more than 15 minutes (for example, in a time of crisis), will also be billed. In unusual circumstances, you may become involved in court actions such as litigation which may require my participation. You will be expected to pay for the professional time required even if I am compelled to testify by another party. Due to the complexity involved and difficulty of legal involvement, I charge $300.00 an hour for preparation and attendance at legal proceedings. Once an appointment hour is scheduled, you will be expected to pay for it unless you provide 24 hours advance notice of cancellation (one business day, Monday to Friday - not including Saturday or Sunday), or unless we both agree that you were unable to attend due to circumstances beyond your control, such as illness or emergency. My late cancellation fee or fee for missing an appointment is $160.00 This cannot be billed to your insurance company. Please consult my website for more information: xxx.xxxxxxxxxxxxx.xxx All accounts must be paid in full within 30 days. If your payment is not received within 30 days of billing, you will be charged a 10% fee on the remaining balance. In circum- stances of financial hardship, please talk to me about this as it may be possible to work ...
Professional Fees and Payments. We will discuss and establish our fee at the outset of treatment, and any fee change will be negotiated in good faith. Payment is expected at the beginning of each session unless we have agreed otherwise. Balances more than 120 days overdue may be subject to collection through the use of a collection agency. However, I will first attempt to make other arrangements with you as needed. In general, it is important to discuss with me any issues that arise in connection with our financial arrangements, so that they do not hinder our working relationship Client’s Initial’s_______ Health Insurance Claims: You are responsible for your bill and for recovering the insurance reimbursement. Upon request, we can supply you with a receipt for each visit for proof of payment. We may bill County medical or insurance companies as an out of network provider but we do not accept insurance deductibles and co-payments. You are responsible for payment of all fees even if you plan to seek insurance reimbursement. As a service to you, we will provide you with a billing statement that you can provide to your insurance company and other third party payers.
Professional Fees and Payments. My fee is $150.00 for individuals and $200.00 for couples unless otherwise agreed upon. Fees and co- payments are expected to be paid at each session unless we agree otherwise, for example, monthly. All letters, evaluations, appeals, forms and summaries that are lengthy or time-consuming will require special payment for their preparation and transmission. There is also a charge for copying and sending copies of the chart contents.
Professional Fees and Payments. My fee is $200-$250 for individual therapy. Fees and co-payments are expected to be paid at each session unless we agree otherwise, for example, monthly. All letters, evaluations, appeals, forms and summaries that are lengthy or time-consuming will require special payment for their preparation and transmission. There is also a charge for copying and sending copies of the chart contents. If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I reserve the right to suspend or discontinue treatment with you and to seek remuneration by any means legally possible including, but not limited to, the retention of a collection agency. By signing this agreement, you agree to bear all financial responsibility for all attorney and court costs associated with collecting any unpaid debt.
Professional Fees and Payments. We will discuss and establish our fee at the outset of treatment, and any fee change will be negotiated in good faith. Payment is expected at the beginning of each session unless we have agreed otherwise or I have obtained permission to bill an LDS Xxxxxx on your behalf. Balances more than 120 day overdue may be subject to collection through the use of a collection agency. However, I will first attempt to make other arrangements with you as needed. In general, it is important to discuss with me any issues that arise in connection with our financial arrangements, so that they do not hinder our working relationship. Client’s Initial’s Health Insurance Claims: You are responsible for your bill and for recovering the insurance reimbursement. Upon request, we can supply you with a receipt for each visit for proof of payment. We do not bill insurance companies and do not accept insurance deductible and co-payments. You are responsible for payment of all fees even if you plan to seek insurance reimbursement. As a service to you, we will provide you with a billing statement that you can provide to your insurance company and other third party providers. Fee Structure Per Hour Individuals Initial Assessment (child/adult) $110.00 Couples/Family Initial Assessment $140.00 Individual (child/adult) regular session $90.00 Couples/Family regular session $120.00
Professional Fees and Payments. The fee per individual therapy hour is $100 and is expected at the time of service. Balances over 90 days overdue may be sent to a collection agency, however I may attempt to make other arrangements with you first. If financial issues arise please discuss them with me. Client’s Initial’s The following forms of payment are accepted through this practice: VISA, Mastercard, American Express, Interac, cheque, cash, Apple Pay, Google Pay You will be provided with a receipt. Funding agencies may be billed directly. Your signature on this page confirms that you have read and understood the above information, and that you agree to all limitations and costs. It will be kept on file in the office, and you may keep a copy of this agreement for your personal records. Thank you.
Professional Fees and Payments. Sometimes therapy is a short-term process; this is most often the case when we have very clear and structured goals. Sometimes, however, therapy is more of an open-ended process, as goals are more vague or difficult, or change as therapy progresses. As a result, sometimes therapy is easier to afford, and sometimes it can be more expensive. My standard fee for individual 50-minute therapy sessions is $175 for individuals and $200 for couples. This includes note writing and record keeping, short telephone conversations, and consulting with other professionals, as I deem necessary. You are responsible for the fees of your therapy and are expected to pay for each session at the time of the session, unless prior arrangements have been made. Any bills overdue 30 days or more will be charged 1.5% interest per month. Also, if a check is returned for insufficient funds in an account, you will be required to pay the bank’s returned check fee. If you refuse to pay your debt, I reserve the right to use an attorney or collection agency in order to secure payment. In addition to weekly appointments, it is my practice to charge this amount on a prorated basis for other professional serves that you may require, such as report writing, lengthier telephone conversations, attendance at meetings or consultations with other professionals, which you have requested, or the time required to perform any other service which you may request of me. Also, if you become involved in a legal matter that requires my participation (although it is recommended that we discuss this fully before you waive your right to confidentiality), you will be expected to pay for all of my professional time, including preparation and transportation costs to court, even if I am compelled to testify by another party. In the event that you encounter some unusual financial hardship, such as losing your job, I may be willing to negotiate a temporary reduced fee, or arrange some kind of payment plan, so that you can continue receiving therapy during the difficult time.
Professional Fees and Payments. We will discuss and establish our fee at the outset of treatment, and any fee change will be negotiated in good faith. Payment is expected at the beginning of each session unless we have agreed otherwise, or I have obtained permission to bill an insurance company on your behalf. Balances more than 120 days overdue may be subject to collection through the use of a collection agency. However, I will first attempt to make other arrangements with you as needed. In general, it is important to discuss with me any issues that arise in connection with our financial arrangements, so that they do not hinder our working relationship. Client’s Initial’s Complaint: If you have concerns about my professional service, I hope you will speak to me directly so the issue can be clarified and resolved immediately. However, you have a right to file a complaint with Michigan Department of Licensing and Regulatory Affairs Bureau of Professional Licensing, Investigations & Inspections Division, PO Box 30670 Lansing MI 48909, 000-000-0000. Health Insurance Claims: At this time I do not file insurance claims. I only accept cash payment. You are responsible for your bill and for recovering the insurance reimbursement. Upon request, we can supply you with a receipt for each visit for proof of payment. We do not bill insurance companies and do not accept insurance deductibles and co-payments. You are responsible for payment of all fees even if you plan to seek insurance reimbursement. As a service to you, we will provide you with a billing statement that you can provide to your insurance company and other third-party payers.
Professional Fees and Payments. We will discuss and establish our fee at the outset of treatment, and any fee change will be negotiated in good faith. Payment is expected at the beginning of each session unless we have agreed otherwise or I have obtained permission to bill an LDS Xxxxxx on your behalf. Balances more than 120 days overdue may be subject to collection through the use of a collection agency. However, I will first attempt to make other arrangements with you as needed. In general, it is important to discuss with me any issues that arise in connection with our financial arrangements, so that they do not hinder our working relationship Client’s Initial’s Health Insurance Claims: You are responsible for your bill and for recovering the insurance reimbursement. Upon request, we can supply you with a receipt for each visit for proof of payment. We do not bill insurance companies and do not accept insurance deductibles and co-payments. You are responsible for payment of all fees even if you plan to seek insurance reimbursement. As a service to you, we will provide you with a billing statement that you can provide to your insurance company and other third party payers.
Professional Fees and Payments. We will discuss and establish our fee at the outset of treatment, and any fee change will be negotiated in good faith. Payment is expected at the beginning of each session unless we have agreed otherwise. Balances more than 120 days overdue may be subject to collection through the use of a collection agency. However, I will first attempt to make other arrangements with you as needed. In general, it is important to discuss with me any issues that arise in connection with our financial arrangements, so that they do not hinder our working relationship Credit Card Authorization Willow Harbor Therapy Center requires a credit card authorization on file so that your balances can be settled as they occur. Balances from no-show or late notice of cancellation fees, uncollected copayment, and insurance claim denials will be resolved with your credit card on file. When credit card charges arise, a statement of the charges will be mailed to you. By signing this informed consent, you are authorizing Willow Harbor Therapy Center to securely maintain your credit card information and any additional payment devices you use for services with Willow Harbor Therapy Center and to use this information to collect outstanding balances for your accounts.
