Terms and Conditions

These Terms and Conditions Supplement and provide additional terms to the neuroBridge, LLC (“Company”) Client Agreement that you have executed with the Company (terms and conditions, together with the Client Agreement, “Agreement”) 

Confidential Information, HIPAA, and Privacy.  

1.1 Confidential Information.
Company agrees to retain and maintain in strict confidence, and to require his or her agents, employees, independent contractors, and advisors to retain in confidence, any and all Confidential Information of Client. Company agrees that, without the prior express written consent of Client, Company shall not, either directly or indirectly, individually or in concert with others: (1) Disclose any such Confidential Information to any other Person; (2) use any such Confidential Information for the benefit of any Person other than Client; or (3) permit any Confidential Information to be Disclosed to or used by any Person other than Client. 

An exception to this provision is previously mentioned in Section 2 of Client Contract Agreement where the Company does maintain the right to correspondence with the school, teachers, and any administration it deems necessary to properly engage, plan, and jointly assist your child’s therapy session success. Further exceptions is listed below in Section 1.2.

1.2 Limits to Confidentiality:
If there is a court order to release information about the Company’s work together with you because of legal proceedings in which you are involved, then the Company must comply with the order.  Also some insurance companies require treatment summaries in order to pay for the services you receive. You have the option to refuse to supply the requested information to your insurer; however, they will not cover the claims submitted to them.  In all cases, the Company will inform you of any such request and discuss with you what information it would be required to share beforehand. If you use insurance to cover psychotherapy expenses, the dates of all our sessions will be disclosed as well as a diagnosis code and procedure code.  When submitting requests for additional authorization units, treatment goals and progress toward those goals will also be disclosed. There are some situations in which the Company or its employees or service providers are legally obligated to take action that would alter the confidentiality agreement usually maintained and where clinical information would be revealed.  If the Company or its employees, agents, or service providers suspect that a child under 18 years old is abused or neglected or if they have reasonable cause to believe that a disabled adult is in need of protective services, the law requires that the Company report these to the Department of Children and Families. If the Company or its employees, agents, or service providers believe that a patient presents an imminent danger to the health and safety of another, the Company has a “duty to warn” the potential victim in order to take protective actions.  If such a situation arises, the Company will make every effort to fully discuss it with you before 

taking any action, and the Company will limit my disclosure to what is necessary.  If the Company believes that a patient presents as an imminent danger to themselves, it will take appropriate action to ensure the safety of the client, including notifying the family or legal authorities when necessary.We will discuss any concerns you have regarding these confidentiality laws to the fullest of my understanding. 

1.3 Application of HIPAA.
Except for psychotherapy services, The Company is not subject to the Health Information Portability and Accountability Act (“HIPAA”). Solely to the extent that the Company may provide psychotherapy services to your child, the Company keeps records in compliance with HIPAA (see neuroBridge, LLC HIPAA Privacy Policy).

1.4 Children Receiving Psychotherapy:
We offer Psychotherapy Services through licensed healthcare professionals. If your child receives Psychotherapy Services, additional terms and conditions, including healthcare privacy disclosures are contained in our Agreement for Psychotherapy Services, which you will need to sign before services begin. 

 

2.0 Fees and Payment.

2.1. Rate Schedule.  Client shall pay for the services provided by Company in accordance with the current fee schedule.

Payment for services are due immediately upon receipt of invoice or on an agreed upon payment schedule. Invoices will be provided to Client at the email address provided to Company. 
A receipt will be issued and provided to you upon payment of invoice. 
If payment for services is not received within thirty (30) days, treatment will be placed on hold until payment is received and outstanding balances are paid. 

2.2 Invoices. There will be a $50 fee for customized invoices. The client is responsible for contacting the insurance company and verifying the specifics of your coverage and the items required on the invoice. An invoice must be marked paid in order to get reimbursed.

2.3 Payment Methods. Forms of accepted payment: Cash, Check, Credit Cards and HSA cards. Payments by Credit Cards may be subject to additional finance charges.

2.4 Late Fee. All past due payments are subject to late fees.

2.5 Returned Checks. There will be a $40 fee for any returned check.

2.6 Phone Calls. Phone conversations 10 minutes or less are generally free. However, if we spend more than 10 minutes on the phone or by electronic communication we reserve the right to bill you on a prorated rate for that time. 

2.7 Additional Fees. Unpaid invoices beyond 30 days late are subjected to a 5% late fee.

3.  Cancellation Policy.

3.1 Appointment Scheduling. Appointments will be scheduled according to your child’s daily classroom schedule with approval from the teacher. 

3.2 Rescheduling. Please give at least 24 hours notice if your child cannot attend their therapy session to avoid being charged for their session. 

3.3 Inclement Weather. We adhere to Hamilton County School's closings for inclement weather.   

3.4 Sickness. If your child is sick, or was not able to attend school due to an illness, they cannot attend therapy sessions through neuroBridge, LLC. In the event of sickness, please call us as soon as possible so that we may cancel the appointment.  

  (a)Note: No shows will be charged the full fee amount for the session. 
  (b)The following guidelines should direct when your child attends or refrains from therapy sessions: 

• A normal temperature for a 24 hour period in the absence of fever-reducing medication.
• No vomiting or diarrhea for 24 hours.
• Isolation periods of common communicable diseases:   
  - Lice: Medicated treatment administered and all nits removed.   
  - Chicken Pox: May only return once all lesions are scabbed and dry.
  - Strep Infections: a child who is awaiting laboratory results for a strep infection should not attend any sessions until a negative culture is confirmed or 24 hours of antibiotic therapy has been instituted.
  - Bronchitis/Sinusitis: 24 hours of antibiotic therapy before returning.
  - Conjunctivitis (Pink Eye): 24 hours after antibiotic treatment has been instituted.
   

 

4. Notices.  

Any notices to be given under this Agreement shall be in writing, sent by registered or certified mail, postage prepaid, return receipt requested, or by facsimile followed by a confirmation letter sent as provided above, addressed to such party as specified below: 

• a) Notices to Company:
  NeuroBridge, LLC.
  P.O. Box 4362
  Chattanooga, TN 37405
  
  
• b) Notices to Client: Shall be mailed to the address provided to Company on New Client intake form. 

 

Notices sent in accordance with this Section shall be deemed effective on the date of dispatch. Any changes in the information set forth in this Section shall be upon notice to the other party delivered in the manner set forth above.

Photography Release and Terms of Use. See Release Form regarding signature release and waiver for use of photography and video in conjunction with therapy sessions. 

Medical Information. In certain circumstances Company will be provided with Protected Health Information (“PHI”) or, through the course of psychotherapy, will create medical records and other PHI. If you wish this information to be shared with your child’s school, you agree to execute the Authorization for Release of Medical Information. 

7. Term and Termination.  This Agreement will be for an initial term of one (1) year beginning on the effective date as executed above ("Term"), and shall automatically be extended for successive one (1) year periods. Either party may terminate this Agreement by giving written notice of at least thirty (30) days. The relationship under this Agreement may be terminated prior to the end of any yearly period by the death of representative of Company, the disability of Company representative resulting in the inability to perform the services, or by written notice from Company that, in Company’s sole determination any of the following has occurred:

• a. Client has refused to pay fees due from services rendered under this Agreement.
  
  
• b. Student leaves the school to attend another school location, which gives the Company the right to terminate treatment if new school is not a partner with Company.
      i. Company will refund Cleint 80% of paid remaining balance if child should attend another school location due to described situation above.
  
  
• c. Family determines they would like to discontinue services
      i. Company will refund Client 80% of paid remaining balance.

8. Authorization. Client hereby authorizes and gives permission to the Company and its employees and agents to meet with, speak with, consult, analyze, assess, and treat Child with or without Client or other parent present. 

9. Notices.  Any notices to be given under this Agreement shall be in writing and addressed to such party as specified in Terms and Conditions. 

10. Governing Law.  The parties agree that this Agreement shall be governed by, and construed in accordance with, the laws of the State of Tennessee.

11. Arbitration. Any dispute, controversy or claim arising out of or related to this Agreement or any services performed hereunder which cannot be amicably resolved by the parties shall be solely and finally settled by arbitration in accordance with commercial arbitration rules. Judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. The arbitration shall take place before a panel of arbitrators sitting in Tennessee, Hamilton County. The language of the arbitration shall be English. The arbitrators will be bound to adjudicate all disputes in accordance with the laws of the State of Tennessee. The decision of 

the arbitrators shall be in writing with written findings of fact and shall be final and binding on the parties. Each party shall bear its own costs relating to the arbitration proceedings irrespective of its outcome. This section provides the sole recourse for the settlement of any disputes arising out of, in connection with, or related to this Agreement.

14. Attorneys' Fees. If either party incurs any legal fees associated with the enforcement of this Agreement or any rights under this Agreement, the prevailing party shall be entitled to recover its reasonable attorney’s fees and any court, arbitration, mediation, or other litigation expenses from the other party.

15. Entire Agreement. This Agreement constitutes the entire understanding between the parties, and supersedes all prior agreements and negotiations, whether oral or written. There are no other agreements between the parties, except as set forth in this Agreement. No supplement, modification, waiver, or termination of this Agreement shall be binding unless in writing and executed by the parties to this Agreement.