|
Service |
Fee |
|
Diagnostic & Evaluation Session (1st Visit) |
$199.00 |
|
Regular Office Visits (Individuals, Couples & Play Therapy) |
$128.00 |
|
Family Sessions (90 Minutes) |
$191.00 |
|
Family Sessions (60 Minutes) |
$155.00 |
|
Court Appearance Fee |
$160.00/Hr |
|
Phone Consultation |
$50 for 30 Min |
|
Group Therapy |
$35-$40.00 |
|
Urine Drug Screens for Substance Abuse Clients |
$30.00 |
|
Sex Offenders Risk Assessment Evaluation |
$525.00 |
|
*Mental Health Evaluation for Court/Lawyer |
$250.00 |
|
*Substance Abuse Evaluation |
$150.00 |
|
*Outside office work (Inpatient visits, collaborative law services |
$100/Hr |
|
Written reports (courts, supervisors, pro-rated) |
$100/Hr |
|
Returned check fee - per check |
$50 |
|
No Show Fee - Including appointments cancelled within a 48 hour window prior to the appt. |
$60 |
|
PATIENT Record requests (subpoena'ed records included) UP TO 10 PAGES. |
$25 (+ $10/ADDITIONAL 10 PAGES |
*Indicates those services/fees which are note covered by insurance and will be paid by client at time of service.
**Please note your account is subject to a 1.5% interest per month or 18% interest per year as well as collection fees incurred in the recouping process (to include court costs and/or attorney fees of %33 or $30 - whichever is greater).
***A reasonable fee will be charged for copies of any records requested by clients or representatives of the client (pending release of information from client).
Patient Initials _________________
Insurance/Payors
Aetna
Aetna EAP
Anthem Blue Cross/Blue Shield
Anthem Healthkeepers
Anthem Healthkeepers Plus
Beacon/Humana
Beacon/Value Options
Behavioral Health Systems
Business Health Solutions
Business Health Solutions EAP
Cigna
Compsych
Magellan
Medicaid
Medicare
MHN/Tricare
MHNet/Coventry
Multiplan
Optima/Sentara
Optum/United Healthcare (UBH)
Tricare
Virginia Health Network
Virginia Premier
Services may be covered in full or in part by your health insurance or employee benefit plan. It is the responsibility of the PATIENT to check coverage limits, co-pays, and benefits. Please check your coverage carefully by asking the following questions:
- Do I have mental health insurance benefits?
- What is my deductible and has it been met?
- Do I have a co-insurance payment?
- What is my co-pay?
- How many sessions per year does my health insurance cover?
- What is the coverage amount per therapy session?
- Is approval required from my primary care physician?
Reduced Fee
Reduced fee services are available on a limited basis.
Payment
Cash, Check, or Credit/Debit are accepted means of payment.
Cancellation Policy
If you do not show up for your scheduled therapy appointment, and you have not notified us at least 48 hours in advance, you will be required to pay a $60.00 of $80.00 (depending on the day) " No Show " fee as stated above. Kindly remember that we have reserved our professional time for you. If you miss or cancel two appointments, then it is the policy of this practice to terminate treatment.
Schedule Online
Request a therapy appointment online here .
Contact
Questions? Please contact us for further information. You can reach our office @ 804-789-1224.
