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Billing Information - Mental Health Counseling and parent coaching

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					                                 BILLING POLICY
                                   Please Read Carefully

For those people wishing to take advantage of the 20% cash discount:
Because cash payment lowers office overhead (employing a insurance billing company,
postage), people using cash are offered a discount. Full payment, using cash or check,
is expected at the beginning of each appointment. If you wish to use a credit card or
PayPal, make an online payment prior to attending the session. To make an online
payment, just log on to www.dianedempseymarr.com and click on “Make a Payment.”

Should you arrive unprepared to make payment, you will be charged the full fee ($125)
for the service. The bill you receive must be paid before your next appointment.

If you need to cancel an appointment, please call Dr. Marr at 360-770-0647 to do so.
This allows her to schedule somebody else in your place. Appointments must be
cancelled within 24 hours of the scheduled time to avoid a late charge equaling half the
full fee for the session. The bill you receive by mail must be paid before your next
appointment.

For those people wishing to use insurance:
Please be aware that most insurance companies request information. This information
cannot be released without your written consent. If you do not wish to have your
behavioral health information shared, it is your choice not to use your insurance benefits
to cover the cost of your therapy. Instead, you can take advantage of the 20% cash
discount.

Many insurance companies pay all or a portion of the cost of counseling. I have
employed CMSI to provide the necessary information to your insurance company at your
request. However, it is your responsibility to see that your account is paid in full.

The rules that determine specific benefits vary greatly from policy to policy. Ultimately,
you are responsible for contacting your insurance carrier and understanding your
benefits. It is expected that you bring a statement of your benefits to your first
appointment. Please use the form titled, “Insurance Verification’” to gather the necessary
information. You can find the form posted at www.dianedempseymarr.com under the
“Helpful Forms” tab.

Should you choose, instead, to have my billing service, CMSI, research benefits for you
following your initial visit, a retainer equaling the cost of the initial intake session and one
additional session is expected at the beginning of this appointment. The retainer will be
used to cover any deductible you may owe the insurance company, as well as co-pays
for service. Once benefits are verified, any remaining balance will be promptly returned
to you. Full payment of your co-pay is expected at the beginning of each session.

You may use cash, check, or credit card to pay your co-pay. Should you choose to use a
credit card or PayPal, make your payment before attending the session. To do so, log
on to www.dianedempseymarr.com and click on “Make a Payment.”




July 10, 2011
If you need to cancel an appointment, please call Dr. Marr at 360-770-0647 to do so.
Appointments must be cancelled within 24 hours of the scheduled time to avoid a late
fee equaling half the full cost of the session. Late fees are the responsibility of the client
and will not be paid by the insurance company.

CMSI will also send you your bill. If you wish to speak to the CMSI representative in
charge of my account, you may contact Natalie Pardue by phone at 509-217-2881, or by
fax at 509-466-0359, between the hours of 9 AM and 3 PM, Monday through Friday.

Payment is expected within 15 days of receiving your bill unless other arrangements are
made in advance. Accounts are expected to remain current and balances beyond 90
days may be turned over to a collection agency. The specific content of services
(diagnosis, treatment plan, progress notes) is not disclosed to the collection agency.
Prior to your account being turned over to collection, you will receive a notification letter
from Dr. Marr. Please note that credit cannot be extended beyond $200.00. Anything
beyond this balance will result in services being suspended until the bill is paid in full.
Should you be financially unable to continue services, Dr. Marr will provide you with
referral information for low cost therapeutic services.

Returned Check Policy
Returned checks will incur a $35.00 fee. This fee will be added directly to your account.
Those people with more than one returned check will be required to pay using a
cashier’s check.

Send payment to:
Dr. Diane Dempsey Marr, 4603 Kingsway, Anacortes, WA 98221

I, the undersigned, acknowledge that I have read and understand the billing policy
above, and agree to the policy therein.

I authorize payment of medical benefits directly to Dr. Marr for any services provided to
me.

I understand that I am financially responsible for any amount not covered by my
insurance contract.

I also authorize release of my private health care information to CMSI and my insurance
company. This information will be used solely for the purpose of evaluating and
administering claims of benefits, and for billing purposes.



___________________________________________________
Client name (print)


_____________________________________________                  _______________________
Signature of client (or parent)                                Date



July 10, 2011
                      Fees for Direct Counseling Services

For those who choose to use insurance benefits to pay for services:

   o   90 minute counseling intake session ($190)
   o   50 minute individual counseling session ($125)
   o   60 minute family counseling session ($160)
   o   90 minute group counseling session ($50)

Dr. Marr is a provider for the following insurance companies and county
programs:
    · Aetna
    · First Choice PPO Health Network
    · LifeWise of Washington
    · Magellan Behavioral Health
    · MultiPlan
    · Premera Blue Cross Blue Shield Assoc.
    · Private Healthcare Systems (PHCS)
    · Skagit County Community Wellness Program
    · Skagit County ARIS Program

For those who prefer to pay cash for services, there is a 20% discount.
   o 90 minute counseling intake session (cash - $152
   o 50 minute individual counseling session (cash - $100
   o 60 minute family counseling session (cash - $128
   o 90 minute group counseling session (cash - $40

Fees for Other Services Not Covered By Insurance

   o   Report writing – not court related ($150 per hour)
   o   Record review – not court related ($100 per hour)
   o   Phone consultation – not court related ($125 per clinical hour)
   o   Travel outside of Anacortes – not court related ($25 per hour + $.65 per mile)
   o   Collaboration with child’s school (free of charge)
   o   All legal and court-related services ($250 per hour, with a minimum $1000
       retainer)


Please note: By email or otherwise, no Internet consultation or Internet
counseling will be offered.




July 10, 2011

				
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