Financial Consent

 Envision Psychiatry, has no control over the cost. Copayments are DUE at the time you recieve care or services. If you will not be able to pay the co-payment at the time you receive care or services rendered, you will need to call ahead to see if you will be able to keep your appointment. You, as the client, are responsible for all or part of the charges not covered by your insurance plan. 

 

 

Not every service is covered by every insurance plan. Some or all of the care or services you recieved might not be covered, 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 responsibile for the cost determined by your insurance policy. We advise that you ask your insurance company about coverage. A service that is not covered, you are responsible for payment in full. 

 Private Pay Rates: 

Initial Visit: $250.00 - 60 minutes

Follow-up: $100.00 - 15 to 30 minutes 

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 due. If your insurance determines you are responsible for additional charges your card will also be charged 7 days after a statement is emailed to you. It is the responsibility of the patient to make sure Envision Psychiatry, has your correct email address and the patient checks the given email address for emailed bills/invocies. If you do not agree to the balance on the statement you must call our office at 516-988-0974 to contest the balance within 7 days.  All self-pay appointments must be paid for at time of booking. Patients paying through their insurance must email a copy of the front and back of their insurance card to tg@envisionpsychnp.com if we do not already have it on file, within 48 hours from the time the appointment has been scheduled to avoid appointment cancellation.

Appointments cancelled at least 24 hours in advance of the appointment time will receive a full refund. Unfortunately due to our commitment to respecting the time of both our other patients and our providers, any appointment cancelled or not attended with less than a 24 hour notice is subject to a $75.00 fee, which must be paid before scheduling a new booking.

We strongly encourage all patients to test the their service and wifi internet service prior to their appointment time to avoid any technical difficulties that may result in a no show and subsequent fees.

Envision Psychiatry Policy, After Two Consecutive Occurrences:

No Show Appointment Fee: $75.00

Same Day Cancelation Fee: $75.00

 

Envision Psychiatry Policy;

Medical Documents, Letters, & FMLA

 

Medical Letters: $25.00

FMLA: $50.00

 I understand my financial responsibility and agree to the above statements.