• Payment Agreement

  • Payment Agreement & Policies
    We are committed to providing high-quality occupational therapy services and appreciate your partnership in keeping sessions consistent and payments timely. Please review the following policies carefully.


    Medicaid Patients
    I am a Colorado Medicaid provider. Services will be billed directly to Medicaid as long as:

    -Your child’s Medicaid eligibility is current, and
    -A signed physician’s order (prescription) with a valid diagnosis is on file.
    -Please note: Orders must be signed by a physician, not a nurse practitioner or physician’s assistant.
    -If your child has other insurance coverage, you must notify me. Colorado Medicaid requires that I have accurate and updated information about:

    -Physician name and contact
    -Medicaid status
    -Address or phone number changes
    -Any additional insurance coverage

    Private Insurance Patients
    I am considered an out-of-network provider for all insurance companies.
    If your plan includes out-of-network therapy benefits, I am happy to provide you with a superbill that you may submit to your insurance for possible reimbursement.


    Cancellation & No-Show Policy
    Consistent attendance is essential for your child’s progress. Appointments are in high demand, and missed sessions limit our ability to offer care to other children.

    -24 hours’ notice is required for all cancellations.
    -Cancellations made with less than 24 hours’ notice will incur a $35 fee.
    -Cancellations made after 9:00 a.m. on the day of service or no-shows will be charged the full session fee.
    -In cases of illness, please notify us as soon as you know your child is unwell.
    -If more than 3 cancellations occur within a 2-month period, your recurring appointment time may be offered to another family on the waitlist.

    Fee Schedule & Payment Terms
    Private pay rate: $140 per session
    Invoices are sent monthly
    Payment is due via check, Zelle or Venmo within 15 days of the invoice date
    A $25 late fee will be applied to payments received after 15 days
    If a payment plan is needed, please contact Julie to make arrangements

    By signing below, you acknowledge that you have read, understand, and agree to these policies.

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