FIRST APPOINTMENT POLICIES
GOOD FAITH ESTIMATE
We accept cash, check and credit card for the following services:
60-90 minute intake consultation
45-55 minute follow up treatment sessions
ADHD assessment: 5 sessions and a school observation
45-90 minute Group therapy sessions
Additional fees apply for requesting reports
*Please call us to discuss rates, sliding scale fees available as needed
We do take some insurance. As a courtesy to you, if we are not listed as a provider with your insurance company, we will provide you with an "Out-of-Network provider" super bill that you can send to your insurance company for reimbursement. You are, however, required to pay the full amount of session at the time of services.
We handle your insurance company. When you make an appointment, we call your insurance company to provide you with answers to the following questions:
How many sessions will be covered per calendar year?
What is my deductible?
What is my co-payment?
To have us verify your insurance, please fill out the form below 2 days prior to your intake appointment. You will be required to pay the full amount of intake session if we do not receive your insurance information prior to your appointment.
**Please note that insurance REQUIRES a diagnosis and this diagnosis becomes a part of your permanent medical record. By completing the form below, you are consenting to using your health insurance and providing diagnostic information to your insurance carrier. If you would like to know about receiving services without using insurance, please contact our office.
Please make sure to bring the intake form with you filled out or arrive 20 minutes prior to your appointment to fill it out. Your therapist will need to review it briefly before the intake appointment begins in order to structure the interview accordingly.
If you have a custody arrangement for your child, bring us or email beforehand a copy of the divorce decree. It is required by law that we keep a copy of this on file before seeing your child.
If you do not show up for your scheduled therapy appointment, and you have not notified us at least 24 hours in advance, you will be required to pay the full cost if it is your intake appointment, and a $50 no show/late cancel fee for follow up appointments. For these reasons, our policy is to secure your appointment with a credit card. Thanks in advance for your understanding.
Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” of expected charges. You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises