PAYMENTS ARE EXPECTED by THE FIfth OF EVERY MONTH FOR SERVICES THAT HAVE BEEN RENDERED THE MONTH PRIOR UNLESS PRIOR ARRANGEMENTS HAVE BEEN MADE. WE ACCEPT CASH,CHECKS, DEBIT CARD (with Visa or MasterCard logo), VISA, and MasterCard.
1. INSURANCE: Professional services are rendered and charged to you, not your insurance company. Please understand that the contract is between you and your insurance company and payment for services is your responsibility. Each company negotiates different benefits and clients are responsible for understanding their individual policies. For all insurance companies we will supply you with any paperwork needed for you to submit your claim. Special financial arrangements must be made with the Office Manager prior to starting treatment. Our office will not enter into a dispute with your insurance company over your claim. You are responsible to provide your insurance company with any additional information they may need from you.
2. USUAL AND CUSTOMARY FEES: Our fees are what are usual and customary in our area not what your insurance company feels are usual and customary. You are responsible for any fees that are above insurance company’s usual and customary fees. We do not have a contract fee with ANY insurance company.
3. SELF-PAY PATIENTS: Payment is due by the fifth of every month for services that have been rendered the month prior (e.g. Payment is necessary by January 5th for all services provided to your child in the month of December). An invoice will be sent to you before the fifth of the month and a check can be mailed to The Language Lounge. You also have the option of auto-charging your visits. We will obtain your credit card information from you and charge your credit card on the fifth of the month for all services rendered the month prior. Lastly, you have the option of paying in installments on a per visit fee schedule. See attached Credit Card Billing Authorization form. Please note every client that is private pay MUST fill out the Credit Card Billing Authorization Form. It will only be used in the event that payment is not collected in a timely manner (you have a maximum grace period of 10 days and/or 15th of the month) PLUS a $25.00 late fee if NOT received. In addition: your credit card will be charged if: Proper cancellation procedures are not followed as noted in the Welcome Packet ($25.00 per 30 minute session, $35.00 per 45 minute session, and $50.00 per 60 minute session canceled) If for any reason services are terminated you will be charged for any outstanding balance for services rendered if arrangements haven’t been made. A check is returned for insufficient funds ($25 fee)
4. AUTOCHARGE: It is requested that a credit card be kept on file for any clients treated. See the attached Credit Card Billing Authorization form for details.
5. NON-PAYMENT: If payment is not made by the grace period of the 15th of each month, and the credit card was denied we must discontinue services. The account must be paid in full before therapy can be resumed.
BROKEN APPOINTMENT POLICY: Please consider your scheduled appointments carefully. We require a 24-hour cancellation notice or a fee will be charged. $25.00 per 30 minute session, $35.00 per 45 minute session, and $50.00 per 60 minute session canceled (Please understand that canceling late or having a therapist show up at your door and your child is napping, and/or you are not home is inconsiderate. Your therapist has allotted time for your child and can give time to another student who has adhered to the policy). We understand if certain special circumstances occur, please inform the director and consideration will be given on a case by case basis.
If you repeatedly miss your scheduled appointments therapy may be terminated at our discretion. Please cancel your session as soon as possible if your child is ill. Children should not attend therapy if they have had a fever in the past 24 hours or have diarrhea.
6. CONFIDENTIALITY: In an effort to ensure confidentiality we are unable to speak with anyone other than the patient or responsible party regarding an account without written approval from the patient. Minor Children: Accounts for minor children of separated or divorced parents are the responsibility of the parent who consented to the therapy. The Language Lounge will not be involved with custody matters.
7. OFFICE FEES: If you present a check for insufficient funds, or place a stop payment on an issued check, you will be charged a $25.00 fee for processing. Insufficient funds checks will not be reprocessed. You must pay by cash or money order.
I HAVE READ, UNDERSTAND AND AGREE TO THE STATEMENT OUTLINED ABOVE.