Payment Method
Payment for sessions is due at each visit unless other arrangements have been determined on an individual basis. Payment may be made by check, cash or credit card. If there are particular obstacles in making payments, we are willing to make a suitable payment agreement with you which would be written and signed by both of us. Should your account remain unpaid for over 30 days, we may suspend sessions until the balance is paid in full and/or assess a monthly interest fee.
Missed Appointments/Cancellations Policy
If you are unable to keep an appointment, please give 48 hours advance notice (weekends and holidays excluded); otherwise you will be charged for the time that was reserved for you. Example: If your appointment is scheduled Tuesday at 11:00 am, you will need to cancel by Friday at 11:00 am.
Insurance plans do not reimburse for missed appointment charges. You must cancel your appointment by sending an email or by phone/voicemail.
Insurance & Third Party Payments
Most insurance companies will cover outpatient psychotherapy services. Make sure to read your insurance handbook or talk with your insurance company representative to make that determination. We will provide regular statements to you for purposes of reimbursement. We will not bill your insurance company directly. You are responsible for getting reimbursement for our services through your insurance company. We are happy to assist you in this whenever possible so that you comply with your insurance policies to be fully reimbursed.
Billing
We will provide you with a billing statement for your insurance company on a monthly basis or more often at your request. Any excessive emailing/copying of statements or receipts will incur à $35 charge. The statement includes all the information that most insurance companies require. It is your responsibility to submit the statement along with the necessary forms for reimbursement. You should be aware that insurance companies require a clinical diagnosis by the therapist as a condition for payment. If you have any concerns about this, please don't hesitate to discuss them with your therapist.
Phone/Email Consultation
Any phone and/or email contact with family, friends or professionals would have to be approved and a release signed prior to us talking with such people. Phone and/or email consultation with you or others at your request beyond 10 minutes will be charged the standard fee on a pro-rated basis. There is no charge for routine contact regarding scheduling or for a brief contact under 10 minutes.
Confidentiality
All information you share is confidential. The only legal exception to this is when a mental health professional believes you may be of danger to yourself or others. Otherwise, no information may be shared about you without a signed release. Clients under the age of 18, confidentiality will be maintained, however there will be times that information will be shared with the parent or guardian of the said client at the therapists discretion.
Legal Proceedings
At anytime if a client or parent of the identified client becomes involved in litigation due to divorce proceeding, etc. The parent(s) or guardian of the client, or the client themselves, agrees to pay all legal fees associated with the said litigation for Moving Forward, PLC.
If you have any questions at all, please don't hesitate to bring them up. We look forward to working with you.
Please sign below acknowledging that you have read this financial agreement and agree to comply with the policies of Moving Forward, PLC.