Medicaid Insurance: Clients who have Medicaid insurance or receive coverage from a Managed Care Organization (MCO) contracted with Medicaid may require prior authorization for additional sessions, after the initial session.
Any copays required by Medicaid or one of the MCO’s contracted with Medicaid will be collected at the time of service.
Private Insurance: Clients with private insurance asked to contact their insurance company prior to the first session to determine if I am an in-network provider, whether pre-authorization is required (and if so to acquire an authorization number), the number of authorized sessions, copayment amounts and if there is a deductible for mental health/behavioral health services.
If an insurance company applies session charges towards a client’s deductible, clients are responsible for the uncovered contracted amount until the deductible is met. If I am not a preferred provider with your insurance company, please be aware that your insurance company may only cover a portion of your session charges.
If this occurs, clients are responsible for the amount uncovered by their insurance company. Clients are responsible for any session fees or copayments due at the time of each session.
Private Pay: The fee for the initial session is $140 and $125 for additional sessions.
Payment Information: All fees are due at the time of the service and cash and checks are accepted. All checks are to be made payable to Restore Family Counseling, Inc. If a check is returned to me for any reason, clients will be required to pay the original amount of the check as well as a $50 Returned Check Processing Fee.
All major credit cards and HSA cards are accepted through our secure credit card processing system.
Sliding Scale Option: Mental health is an important need for everyone, and payment/insurance should not be a barrier for services. Restore Family Counseling, Inc. is happy to offer a sliding scale option for payment for those who may need services but also require financial assistance.
The option for reduced payment is an option for eligible clients and details can be discussed on an individual basis. Please ask for more information about eligibility and payment options.
Court attendance: Due to the amount of time attending court would take away from my profession, you are agreeing to the following terms upon my receipt of a subpoena in a timely manner. $175 per hour with a 4-hour minimum deposit to be received prior to attending court.
This fee covers court preparation, travel time, time spent testifying, any waiting time while in court. Should the amount of time spent in court exceed the amount of the deposit for 3 hours, you will be provided with an additional invoice indicating the additional time and amount owed. Individual sessions will not proceed until the balance is paid in full.
Cancelation Policy: At Restore Family Counseling we are committed to providing the best service to our community in a timely manner. We aim to be able to help more clients with our updated cancellation policy.
Unfortunately, when a client cancels without giving adequate notice, it prevents another client from being served. This cancellation policy is used as a way of respecting the time commitment of all involved. It explains the process for requesting a cancellation and the fees applicable.
Cancellation Process: We understand situations can arise in which you must cancel your appointment. Due to limited appointment availability, we request that you cancel with adequate notice. This allows us to fill that appointment slot.
You may cancel or reschedule by:
- Logging in to your patient portal, selecting “Appointments” from the top menu bar, clicking on the appointment you want to cancel or reschedule, and clicking “Cancel Appointment.” Your request will be emailed to our office assistant for review.
- Emailing melinda@restorefamilycounseling.org the appointment that you would like to cancel, along with several dates and times you are available to reschedule.
We require a minimum of 24 hours’ notice before your scheduled appointment. This notice must be during business hours. If you cancel an appointment outside of business hours, your 24 hour window will begin at 9am on the next business day.
If there is no prior notice or the notice given is not provided within the minimum notice period, you will be charged a cancellation fee (see below) for the missed appointment.
After 3 missed or cancelled appointments without adequate notice, you will be discharged.
Late Arrivals: Will not be permitted to extend the appointment beyond the scheduled end time. If you are more than 30 minutes late past your appointment we will have to reschedule/ cancel the appointment, which may incur a cancellation fee.
Cancellation Fee:
- The cancellation fee is $75.
- The cancellation fee will be applied to your account and drafted from the card on file.
- The cancellation fee is the sole responsibility of the client and must be paid in full within 4 days after invoicing.
Failure to pay: Unless satisfactory arrangements are made, accounts past due beyond 60 days will routinely be turned over to a collection agency or an attorney. If the account is not paid when due and is turned over to collections, you will be charged for collection fees of 33-1/3%, court fees and any other related costs.
Further, an interest at a rate of 1.5% per month or a $2.00 re-billing fee per month (whichever is higher) may be charged on any balance outstanding after 60 days.