Financial Policy

The staff at Best Practice Psychotherapy hereafter referred to as the Practice are committed to providing caring and professional mental health care to all our clients. As part of the delivery of mental health services, we have established a financial policy that provides payment policies and options to all consumers. The financial policy of the Practice is designed to clarify the payment policies as determined by the management of the Practice.
 

The Person Responsible for Payment of Account is required to sign the form Payment Contract for Services, which explains the fees and collection policies of this Practice.
 

As a service to you, the Practice will bill insurance companies and other third-party payers but cannot guarantee such benefits or the amounts covered and is not responsible for the collection of such payments. In some cases, insurance companies or other third-party payers may consider certain services as not reasonable or necessary or may determine that services are not covered. In such cases the Person Responsible for Payment of Account is responsible for payment of these services. We charge our clients the typical rates for the area. Clients are responsible for payments regardless of any insurance company’s arbitrary determination of typical rates.

The Person Responsible for Payment (as noted in the Payment Contract for Services) will be financially responsible for payment of such services. The Person Responsible for Payment of Account is financially responsible for paying funds not paid by insurance companies or third-party payers after 60 days. Payments not received after 120 days are subject to collections. A 5% per month interest rate is charged for accounts over 60 days.
 

Insurance deductibles and co-payments are due at the time of service. Although it is possible that mental health coverage deductible amounts may have been met elsewhere (e.g., if there were previous visits to another mental health provider since January of the current year that were prior to the first session at the clinic), this amount will be collected by the clinic until the deductible payment is verified to the Practice by the insurance company or third-party provider.
 

The adult accompanying a minor (or guardian of the minor) is responsible for payments for the child at the time of service. Unaccompanied minors will be denied nonemergency service unless charges have been preauthorized to an approved credit plan, charge card, or payment at the time of service.
 

Missed appointments or cancellations less than 24 hours prior to the appointment are charged at a rate noted in the Payment Contract for Services.
 

Payment methods include check, cash, or the following charge cards: Amex, Discover, Visa, Mastercard. Clients using charge cards may either use their card at each session or sign a document allowing the Practice to automatically submit charges to the charge card after each session.

Questions regarding the financial policies can be answered by the Office Manager.

 

I (we) have read, understand, and agree with the provisions of the Financial Policy.

Person responsible for account:

Co-responsible party: