RESPONSIBILITY FOR PAYMENT
Individuals (or parents/guardians of minor children) are responsible for the cost of services provided to them. If I am a provider on your insurance panel, I will bill the company for you. You are responsible for any insurance deductible, co-payment or co-insurance that your carrier does not cover. I am unable to bill secondary insurances. If I am not on your insurance panel, I will give you the necessary paperwork to send to the company, but you will be responsible for payment in full (Often your insurance company may pay a percentage of the costs to a non-network provider. However, you will be responsible for the entire amount. Reimbursement, if there is any, will come directly to you from the insurance company). In some circumstances, I am able to bill your insurance company as a courtesy.
Appointments that are cancelled with less than 24 hours notice, or missed appointments, cannot be billed to an insurance company. These charges will be billed to you.
A noncustodial parent or other party can be billed with written permission.
I am committed to protecting your personal information, as required by law. This NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION explains these rights. You may print a copy of this notice for your records, or if you prefer, request that I provide you with a paper copy.