Copayments and other patient costs:
Copayments are due at the time you receive care or services. The copayment amount is determined by your specific insurance plan. Phoenix Mental Health and Wellness has no control over what your insurance covers or charges for your services. If you will not be able to pay the copayment at the time you receive care or service, you will need to call ahead of time to cancel or reschedule your appointment. You, as the client, are responsible for all of the charges not covered by your insurance, based on your coverage and insurance plan.
Care or services not covered by your insurance plan:
Not every service is covered by every insurance plan. Some or all of the care of the services you receive might not be covered by your insurance or may be denied by your insurance plan. Even if we have an established contract with your insurance carrier you may still have some financial obligation based on your individual plan. If this is the case, and your insurance denies payment, or holds you responsible for part of the payment, you will be responsible for the cost determined by your insurance policy. We advise that you ask your insurance company to approve services in advance if there is any question about coverage. If you receive a service that is not covered, you are responsible for payment in full. Cash prices are $200 for initial visits and $125 for follow-up visits.
Upon scheduling your first appointment you will be required to have a debit or credit card placed on file for future charges. This card will be charged the day of your appointment for any copayments or known co-insurance due. If the card is declined, we will attempt to notify you so you can make payment and place a valid card on file. We will make attempts to reach you and send notices through multiple means of communication. If we cannot reach you, your next appointment will be canceled until you are able to make any outstanding payment and place a valid debit, credit, or HSA card on file.
If your insurance determines you are responsible for additional charges a statement will be emailed to you and your card will be charged 3 days after the statement is emailed to you. It is the responsibility of the client to make sure Phoenix Mental Health and Wellness has the correct email address and the client checks the given email address for emailed bills. If you do not agree to the balance on the statement, you must call our office at 928-985-1495 to contest the balance within 2 days. All self-pay appointments must be paid for at time of the appointment. Members paying through their insurance must email a copy of the front and back of their insurance card to email@example.com 48 hours prior to the time of the appointment to avoid appointment cancellation.
Clients are also responsible to make sure they keep updated insurance information on file with Phoenix Mental Health and Wellness. As soon as a client is aware that their current insurance is no longer valid, they must contact Phoenix Mental Health and Wellness to update our office with the new insurance information or make arrangements to become a cash pay client if they no longer have valid insurance.
If Phoenix Mental Health and Wellness becomes aware that a client’s insurance is no longer valid, we will attempt to notify you so you can update your insurance information or make arrangements to become a self-pay client. We will make more than one attempt to reach you and send notices through multiple means of communication. If we cannot reach you, we will leave messages informing you that you must call the office to update your insurance information. If we do not receive updated insurance information within seven days of your notice of the need to update insurance information, your account will be automatically switched to a self-pay account, and you will be charged cash pay prices for services received. ($200 for initial visits and $125 for follow up visits. Prices subject to change).
We send out text reminders about your appointment as a courtesy however it is your responsibility to confirm your initial appointment at least 24 hours before your appointment. If you do not call or text to confirm your appointment, then the appointment will be canceled.
CANCELLATION POLICY: Appointments canceled at least 24 hours in advance of the appointment time will not be charged a cancellation fee. Due to our commitment to respecting the time of both our other patients and our providers, any appointment canceled or not attended with less than a 24-hour notice is subject to a charge of 50% of the cash fee for the scheduled visit (totaling $100 for initial consultations and $62.50 for follow ups). This fee must be paid before scheduling a new booking.
In the case of virtual visits, patients are responsible to have the app downloaded correctly and be in an area that has sufficient internet coverage to allow for the visit. If the patient does not have the app downloaded correctly or does not have sufficient internet to complete the visit, this will be considered a missed appointment and the patient will be required to pay a no-show fee to rebook subsequent appointments.
We strongly encourage all patients to test the app prior to their appointment time to avoid any technical difficulties that may result in a no show and subsequent fees. As a courtesy, we will endeavor to send a reminder via text, email, or phone. If a reminder is not sent, it is still the responsibility of the patient to attend the scheduled appointment.
Visits cannot be completed while a patient is in a moving vehicle.
Missed appointments: If you do not call to cancel your appointment more than 24 hours in advance, we reserve the right to discharge you as a patient.
I understand my financial responsibility and agree to the above statements.