Common use of Fees, Payments, and Billing Clause in Contracts

Fees, Payments, and Billing. My fees are $250 for an initial assessment and $200 for subsequent sessions unless otherwise contracted with your insurance provider. Payment is due at the time of service. Additional professional services, including telephone conversations lasting longer than 15 minutes, letter and report writing, consultation with other professionals, longer sessions, preparation of records or treatment summaries, and time spent performing any other service you may request of me will be charged at the same rate unless otherwise indicated and agreed. If you choose to use your health insurance coverage, as a courtesy service, I will submit claim forms on your behalf and provide whatever reasonable information your insurance company requests but I cannot guarantee that they will pay. Insurance companies and policies vary in the amount of coverage, deductibles, and co-payments and it is your responsibility to verify the specifics of your coverage. Insurance companies may not cover all issues and conditions which are the focus of psychotherapy and may consider some services outside of the benefit provided and as a result elect not to pay for them (e.g. telephone consultations, preparation of letters and reports, missed appointments, etc.). Be advised that you (not your insurance company) are responsible for full payment if your insurance company rejects a claim or pays it in part. Disclosure of confidential information may be required by your health insurance carrier in order to process claims and many insurance companies require you to authorize me to provide them with a clinical diagnosis. On occasion, I may need to provide additional clinical information such as a treatment plan or copies of the record. I assure you that I will share only the minimum necessary to secure payment. Failure to pay fees may result in discontinuation of treatment. If there is any problem with my charges, my billing, your insurance, or any other money-related point, please bring it to my attention and I will do the same with you. Such problems can interfere greatly with our work and they must be worked out openly.