Financial Agreement
Mental health benefits are similar to insurance benefits. Each insurance company makes its own decisions related to diagnosis covered, amount of reimbursement, for specific services and what it seems necessary in terms of diagnostic procedures and testing. In fact, you made your own decisions about the type of coverage when you made choices about deductibles and co-pay amounts. NeuroBehavioral Associates works diligently to work with you and your insurance company to maximize the use of your available funds. We will always provide detailed information about which recommended services are covered by your insurance and which services are not, to the best of our ability.
It is important for you to understand that we are required to provide diagnostic codes and clinical information to insurance companies in order for you to be eligible for coverage of services related to that diagnosis. This diagnosis then becomes part of your permanent medical record. Some patients choose not to use insurance to cover our services in order to avoid the necessity of filing documentation of any psychological diagnosis. These are your decisions and we will do everything we can to make our services affordable no matter what you decide.
Full payment is due at the time services are rendered. As a courtesy, we may file your insurance, but you will be responsible for the full fee. If the session is longer than 45-60 minutes, you may be billed for the additional time in 10-15-minute increments. If neuropsychological or psychological testing takes longer than the time allotted by insurance due to the complexity of your case, you will be responsible for any balance owed. If your case required an affidavit, report, or if we need to consult with an attorney and/or guardian ad litem, we will charge for the time required to complete the task. A charge will be made based on the amount if time required for this service. Insurance will not cover services other than office visits between the client and the therapist. We will bill for all the time involved for phone calls to the client, family, or other testing or consulting individuals or written information to all individual involved. Time in court is also billed at a higher rate than therapy sessions as it requires preparation and is a different service.
Payment is expect at each session. There will be a fee charged for missed appointment and a late cancelation. We reserve the right to turn over any uncollected debt (over 60 days) to a collection agency and/or magistrate court. Insurance does not cover these types of services. If you have an outstanding balance greater than $45.00, we reserve the right to refuse scheduling another appointment until payment is received. If a collection agency becomes involved, you will be responsible for all associated fees. Additionally, workman’s compensation and forensics no-shows will incur the full fee of $331/hour. If workman’s compensation or your attorney does not pay on the claim, you will be held personally responsible. We will charge a credit card on file for all missed appointment balances greater than $45.00. Our patients will be notified 24 hours prior to any charges via phone call. Payment plans will be available upon request.
Appointment Cancelation Policy
You will be charged a fee of ($45 for therapy, $100 for intake evaluation, $300 for psychological or neuropsychological testing) if you do not provide 24-hour notice of a cancelation. Insurance companies do not cover appointments that are not kept. By signing this agreement, you are agreeing to pay for any services which are not covered by your insurance at the time the services are rendered. You are authorizing NeuroBehavioral Associates to charge the card your provided for any account balances which include, but are not limited to, co-pays, co-insurance, and written telephone correspondence. NeuroBehavioral Associates reserves the right to discontinue services if any unpaid balance are not paid within 60 days. Please note that the card provided must be a credit card to avoid problems related to nonsufficient fund transactions.