Fees & Forms

New Client?

Welcome to our practice!  Please feel free to call our business office with any finance questions you may have.

Fees

Insurance Clients:   All fees are subject to the rules and stipulations of your medical  insurance.  You may be quoted an estimate at the time of your first  visit of your out of pocket costs.  Deductibles, copays and out of  pocket maximums vary greatly among individual policies.  Sometimes it is  necessary to communicate further with the insurance company before a  final determination of your out of pocket expenses will be.  All copays  are due at time of service.  We are "in-network" with ACI, Anthem Blue  Cross/Blue Shield, Aetna, Cigna, Compsych, Humana, Medicare, Medicaid,  MHNet, Optima, Tricare (Standard and Prime), United Healthcare, United  Behavioral Health and Value Options. Please ask the Billing Manager if  you have any questions regarding insurance claims and filing.   

Self-Pay Clients:   Our agency rate is $125 for the first session and $110 for any  subsequent sessions.  If you are unable to pay these rates, you may be  eligible for a discount.  This discount is decided on a case by case  basis and is negotiated on the first visit between the counselor and the  client.   

Late Cancellations and Missed Appointments:   Every individual will be subjected to a late cancellation and/or  missed appointment fee if an appointment is missed with less then 24  hours notice given.  Exceptions may be made for emergency situations (at  the counselor's discretion).  Please keep in mind that each hour is  reserved specifically for one client only.  If we are aware of your  cancellation in ample time, we are able to give that time to someone  else.   

NEW! Payment Options: Effective  October 1, 2015 our new practice software has the ability to encypt and  store credit or debit cards in your electronic chart.  Once you provide  a debit or credit card, you have the option to keep that method of  payment on file.  This creates added convenience for you and your  counselor.  Plus, its paperless! 

Forms

Release of Information Request (pdf)

Download

HIPAA Privacy Acknowledgement (pdf)

Download