FEE POLICY AND FEE AGREEMENT
Health Solutions is a non-profit Corporation which relies heavily upon client fees for continued operation. Therefore, it is important that you:
Understand the basis on which you are being charged.
Agree to assume the responsibilities for regular payments.
When applicable, cooperate with Health Solutions in collecting reimbursement from your insurance company.
ESTABLISHING FEE RATES
At the time of intake you will be asked to complete a financial statement.
Our normal fee may be adjusted to your ability to pay which is determined by your gross household income from all sources and from all members of your household and by the number of dependents in your household.
In order to qualify for Health Solutions sliding fee you must provide us with all proof of income within thirty (30) days of signing this Financial Agreement.
You will be charged on a per-contact basis.
If you miss your scheduled appointment, you will be charged unless you notify your therapist of cancellation 24 hours in advance of your scheduled appointment time.
Your fee will be reviewed whenever your financial status changes or once every 12 months if you are in treatment for an extended period.
INSURANCE CLAIMS
In order to process your insurance claim, you have the following responsibilities to Health Solutions:
It is your responsibility to provide us with your current insurance carrier information (i.e. a copy of your insurance, Medicare and/or Medicaid cards) at each visit.
For each visit, a claim will be sent to the payer on file.
If the claim is denied for any reason or if the payer has changed and we have not received notification, you will be responsible for the charge at 100%.
Copays are due at time of visit.
After we receive the benefit payment, your account may be adjusted depending on the explanation of benefits provided by your insurance company.
You will be responsible for your adjusted fee.
If you are unable or unwilling to provide Health Solutions your insurance information at the time of intake, you will be billed at 100% of Health Solutions full rate.
It is your (parent, if a minor) responsibility to notify Health Solutions of any payer changes.
You may be charged for telephone calls that are therapeutically significant.
BILLING POLICY
Payment is expected at the time of service.
If, after 2 months, you have made no effort towards making payments or payment arrangements on your balance, you will be contacted by a representative of the agency to set up a payment plan. Failure to create a payment plan may result in your account being sent to collections.
If you are unable or unwilling to pay and have not contacted the billing department, we reserve the right to stop treatment and use normal collection procedures which may include referral to an outside collection agency. You will be responsible for all cost of collections, including attorney fees.