Initial Assessment and Intake, Individual Therapy, Brief Individual Therapy, Couples Therapy, Family Therapy
AVAILABILITY:
Limited evening and weekend hours are available. At this time we also offer virtual appointments, phone appointments, and appointments via chat for your convenience.
ATTENDANCE AGREEMENT/CANCELLATION POLICY:
For you to get the most out of your treatment, we ask that you follow the attendance agreement contract and expectations:
1. Attend all scheduled appointments on time.
2. If you show up late to an appointment you will still be charged for the full price of the session unless under special circumstances. Special circumstances will be determined by your therapist.
3. If you cannot make your scheduled appointment, we ask that you give at least a 24-hour cancellation notice. If you do not give 24 hours notice or have a "No Show" (no call, no show) you will be charged the amount that you agreed to pay for your session (e.g.: if you agreed to pay $100 for each session, you will be charged $100 for cancellations past the 24-hour notice). However, we understand that there are some situations and circumstances that cannot be predicted, so it will be up to the discretion of the therapist if there is a valid reason as to why a 24-hour notice cancellation was not implemented.
4. If you have 3 cancellations in a row or demonstrate 50% absences it may be grounds for discharge depending on the circumstances of each cancellation and absence.
5. If you have 3 "No Shows" that is grounds for discharge.
6. If you are discharged from therapy due to low attendance you will be given written notice of the discharge in the mail. A written notice will be sent to you after your therapist has either discussed your low attendance with you and no positive change has been made, or your therapist has made 34 attempts to contact you to reschedule an appointment or talk with you.
Please email administration@marriageandfamilyfocus.com or your therapist directly to reschedule or cancel your appointments.
Please note: Insurance carriers will not pay for late cancellations or missed appointments. Once an appointment is scheduled, that time is reserved specifically for you. Cancellations must be made at least 24 hours in advance. Although 24 hours is the minimum if you need to cancel or reschedule please give as much notice as possible. You may notify our office of cancellation by phone or email to your provider. Late cancellations (fewer than 24 hours before the appointment) will incur a fee of $60.00.
INSURANCE POLICY:
Please note that it is your responsibility as a client to check with your insurance provider to ensure you will be covered with Marriage and Family Focus LLC practice. You are responsible for reaching out to your insurance provider for co-pays and whether or not your insurance will cover virtual appointments. Marriage and Family Focus, LLC utilizes Crisp Point Billing Services to file insurance as a courtesy to you, and that you (not your insurance company) are ultimately responsible for your bill. If your insurance company denies a claim filed on your behalf, then you are responsible to pay Marriage and Family Focus, LLC for the difference between the standard rate and the amount previously paid as copay unless approved otherwise by owners of the Marriage and Family Focus, LLC. I agree to (1) allow Marriage and Family Focus, LLC to bill my insurance directly for services provided; (2) give Marriage and Family Focus, LLC permission to release any information the insurance company and Crisp Point Billing Services required in order to process payment; appoint Marriage and Family Focus, LLC as my authorized representative to act for me in obtaining payment; (3) assign all of my rights to claims and payment by my insurance to Marriage and Family Focus, LLC; and (4) agree to assist with the claims and payment by my insurance to Marriage and Family Focus, LLC or my insurance provider.
Charges not covered by insurance:
1. Medical Records Requests: $15.00 per request
2. Case Management: $50.00 (pro-rated per 15 min.)
Please Note: Case Management includes indirect services provided outside session times such as writing letters, consultations made at your request (for which a written authorization for disclosure of confidential information is required), coordinating adjunct and Court Advocacy services, and compelling forms or reports. On occasion, you may request that we testify or be present in court proceedings on your behalf of a subpoena from the court the time billed will begin from our arrival at the courthouse to completion of testimony.
3. Phone Consultations: (11-60 min.) $50.00 (pro-rated per 15 min.)
Insurance reimbursement: Marriage and Family Focus, LLC accepts and processes insurance payments through a variety of insurance providers. If you are using insurance to pay for our services, then we will:
• Expect and accept payment of your co-payment amount at the time of service;
• File your claim with the insurance provider
• Receive payment from your insurance provider
Expect that you will pay your portion due of copay, co-insurance, deductible, or fee difference at the time of your appointment.
ADDITIONAL FEES:
• Late cancellations/Missed Appointments – fewer than 24 hrs. prior to appointment $35.00
Non-sufficient funds (bounced) check $40.00
• Past-due accounts – over 30 days $25.00 per month
Amounts past due by more than 30 days will incur a late fee each month of $25.00. If your account has not been paid for more than 45 days and arrangements for payment have not been agreed upon, Marriage and Family Focus, LLC may resort to legal means to secure payment. This may involve hiring a collection agency, an attorney, or going through a small claims court. If such legal action is necessary, you will be responsible for those costs.
• Checks returned due to insufficient funds will incur a fee of $45.00
HIPAA NOTICE OF PRIVACY PRACTICES
By law, I am required to ensure that your PHI is kept private. The PHI constitutes information created or noted by me that can be used to identify you. It contains data about your past, present, or future health or condition, the provision of health care services to you, or the payment for such health care. I am required to provide you with this Notice about my privacy procedures. This Notice must explain when, why, and how I would use and/or disclose your PHI. Use of PHI means when I share, apply, utilize, examine or analyze information within my practice, PHI is disclosed when I release, transfer, give, or otherwise reveal it to a third party outside my practice. With some exceptions, I may not use or disclose more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is made; however, I am always legally required to follow the privacy practices described in this Notice. Please note that I reserve the right to change the terms of this Notice and my privacy policies at any time. Any changes will apply to PHI already on file with me. Before I make any important changes to my policies, I will immediately change this Notice and post a new copy of it in my office. You may also request a copy of this Notice from me or you can view a copy of it in office.
