Fees and Payment for Services: You will be required to pay for services and other fees that your insurance does not cost. These fees are listed below and by signing below you agree to these costs prior to beginning therapy, and should confirm with your insurance if part or all of these fees may be covered.
Fees: Payment for each individual or family psychotherapy session is due at the time of the session.
- Individual Counseling: $150 per session
- Couples/Family Counseling: $150 to $200 per session
- Initial Intake and Assessment $200
- Treatment summary up to $100 per (cost determined on length of report)
- Request for dates and diagnoses: up to $20 per Records request (notes, etc.)
- $30 to $100 per letter on behalf of client providing but not limited to progress, treatment, attendance, recommendations.
- Attendance in court: $2,000 per appearance/per day.
You should also know about the following: If you are unable to attend therapy, you must contact your Provider before your session. Otherwise, you may subject to fees outlined in this fee agreement. Insurance does not cover these fees.
- No-Show and Late Cancellation Fees are $25 per occurrence.
- A 48-hour cancellation is required to avoid being charged for the missed session. We know that emergencies do happen and will consider each cancellation and/or no-show on a case-by-case basis.
- If you miss a total of three scheduled sessions in a row without calling to cancel within the 48 hours your case may be closed, and you may be discharged from this office.
- If you have an established reoccurring appointment and you miss 2 of these in a row without contacting the office, you will have your subsequent reoccurring appointments cancelled and you will have to reschedule your future appointments.
Payment Methods: Payments can be made by cash, check, Discover, Visa, or Mastercard. An insufficient fund fee of $35.00 will be billed to you for any denied check/debit/credit card payment. Checks should be made out to Blackstone Counseling & Behavioral Health, LLC. For your convenience you can select to put your HSA or credit card on file to have your fees charged to and this card will be charged for the amount due at the time of service and for any fees you may accrue unless other arrangements have been made with the practice ahead of time. It is your responsibility to keep this information up to date, including providing new information if the card information changes or the account has insufficient funds to cover these charges.
Phone Calls: There is no charge for brief phone calls lasting under 10 minutes. Charges for calls lasting more than ten minutes will be prorated at the cost of $1.75 per minute after the initial 10 minutes.
Balance Accrual :Full payment is due at the time of your session. If you are unable to pay, tell your Provider. Your Provider may offer payment plans or a sliding scale. If not, your Provider may refer you to other low- or no-cost services. Any balance due will continue to be due until paid in full. If necessary, your balance may be sent to a collections service.
Administrative Fees: Your Provider may charge administrative fees for writing a letter or report at your request; consulting with another healthcare provider or other professional outside of normal case management practices; or for preparation, travel, and attendance at a court appearance. These fees are listed in the fee agreement above. Payment is due in advance.