If the client has a health insurance policy, it may provide some coverage for mental health treatment. Our billing service will assist you in filing claims. You are responsible for obtaining information about the client’s covered benefits. This includes determining if we are in or out of network, copays, patient responsibility, prior authorizations, deductibles, and all other plan details or limits to coverage. You are responsible for notifying us if/when the client’s coverage changes. Please direct any inquiries about the client’s coverage to their insurance company.
Guarantor responsibility invoices are mailed to you and are due monthly. You can also pay your balance by using a credit card over the phone or by mailing a check or credit card authorization form to our PO Box. If you refuse to pay your debt, we reserve the right to use an attorney or collection agency to secure payment, as well as to refer you to services with another provider.
If we are not a participating provider for the client’s insurance plan, they will be considered a private pay client. You may request a receipt for your payments, which you can submit to the client’s insurance company for reimbursement. Please note that not all insurance companies reimburse for out-of-network providers. If you prefer to use a participating provider, we will refer you to another agency.
By signing this consent form, you agree that you have disclosed all of the client’s insurance coverages and that they do not have Medicare as their primary coverage. By signing this agreement, you agree that if you have not disclosed Medicare as the client’s primary insurance coverage and their claims are denied because they have this coverage, you are responsible for payment in full of all services.
Unless otherwise prohibited by law, in the event that you fail to pay the charges of Heart and Solutions, Heart and Solutions will pursue legal remedy for the full invoice of charges and you shall be liable for all costs incurred by Heart and Solutions as a result of these collection efforts, including, but not limited to, attorney fees and collection agency costs, whether or not litigation is initiated.
Alternative Funding Sources
Coverage from alternative funding sources such as grants, regional funding, crime victims, wrap-around services, etc. are not considered guaranteed payment and do not negate your financial responsibility.
Additional Professional Fees
- Letter writing/documentation fee to any outside entity on your behalf: $35.00 per letter
- Returned Check Fee: $25.00
- Appearance in court after being subpoenaed: $200 per hour
- Preparation time for subpoena (including phone calls with attorney): $200.00 per hour
- Travel time to court if subpoenaed: $200.00 per hour
If the client’s case requires their provider’s participation, you will be expected to pay for the professional time required even if another party compels your provider to testify. It is important to note that insurance companies will not pay for these kinds of services, and so the responsibility is yours.
Our Private Pay rates are the same as our insurance rates, however a cash-discount is offered for bills paid within 90 days of the invoice. Heart and Solutions can not offer private pay cash discounted rates to clients who are paying for services due to deductible or patient responsibility from insurance. If payment is not made within 90 days of service, you will be responsible for the full amount and we reserve the right to end services and refer you to another agency.