Updated September 2023
Welcome to our practice. This document contains important information about our professional services and business policies. Please read it carefully and jot down any questions you might have so that we can discuss them at our next meeting. When you sign this document, it will represent an agreement between us. Any language using I/me/my refers to your Phases Therapy Clinician as the provider/clinician, whereas you/your/yours will refer to you as the client seeking services at our practice, Phases Therapy, Inc.
APPOINTMENTS & FEES
We will usually schedule one 45- 53 minute session per week or every other week at a time we agree on, although duration and frequency of sessions can vary based on need. Once an appointment hour is scheduled, you will be expected to pay for the allotted time unless you provide 24 hours advance notice of cancellation or [unless we both agree that you were unable to attend due to circumstances beyond your control – See cancellation policy below]. If it is possible, we will try to find another time to reschedule the appointment. On occasion, your clinician will be out due to vacation, professional development, or have to cancel an appointment due to an emergency, or illness. We will make every effort to notify you as early as possible and to reschedule with you to a date and time that is convenient for you.
The fee for sessions is $125 (45 min) or $150 (53-55 min) unless otherwise agreed upon with your clinician. In addition to therapy session related appointments, we charge for other professional services you may need. For phone calls lasting over 15 minutes, this is $37.50 per 15 min increments (which we can charge to your insurance when necessary-like in a crisis call situation). These fees are subject to increases of no more than 10% annually.
If you request any letters, paperwork, etc, we charge an upfront $50 fee for the 1st 20 minutes of work.After that, it is $2.78 per minute for any work over 20 minutes. This must be paid in full, as well as any other balance on your account, before we hand over the paperwork/letter. You are welcome to discuss a payment plan with your clinician and make the appropriate arrangements. If you fail to meet the terms of this arrangement or the described above, you are still ultimately responsible for paying your bill.
If for some reason your insurance does not cover sessions or is refusing to pay, the client is responsible for the balance. Phases Therapy, Inc. is open to discussing payment plans when applicable. Anychanges need to be discussed with Phases Therapy, Inc./your clinician and updated in writing. We are happy to print invoices for you so you may submit them to your insurance company for reimbursement (if that is an option). You are also allowed to elect to self-pay and will fill out a form waiving coverage. A $10.00 service charge will be charged for any checks returned for any reason for special handling.
If you become involved in legal proceedings that require your clinician’s participation, you will be expected to pay for the professional time even if called to testify by another party. This additionally includes travel to and from, as well as any prep needed for the court time present. Because of the difficulty of legal involvement, we charge $300 per hour for preparation and attendance at any legalproceeding.
Any unpaid bills after 90 days that have not had arrangements made with your clinician may result in legal action.
You will be expected to pay for each session/service at the time it is held/completed, unless we agree otherwise. Payment schedules for other professional services will be agreed to when they are requested and will follow the protocol above. We can offer the options of accepting the payment at the end of session, or by setting up autopay through our electronic health record (EHR) Simple Practice. This will charge the card on file the same night as the session between 2-4am. A card must be kept on file in Simple Practice if you are an active client. We cannot see all of the information and it is HIPPA compliant. If for some reason you need to work out a payment schedule, please discuss it with your clinician and it will be put into writing.
Your appointment time is reserved specifically for you. It is important that you cancel at least 24-48 hours ahead of time. If sessions are canceled within 24 hours of your appointment time or you miss your appointment without notifying your clinician in advance, you will be charged the full session amount. Late cancellation and no show fees will not be covered by insurance. We encourage you to discuss with your clinician about why you are canceling or why you miss an appointment in advance. We reserve the right to waive the fee if we deem it is due to circumstances beyond your control. If you have 3 late cancellation and/or no show appointments, we reserve the right to terminate therapy.
If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon (e.g., payment plan), we have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court. If such legal action is necessary, its costs will be included in the claim. In most collection situations, the only information we release regarding a client’s treatment is his/her/their name, the nature of services provided, and the amount due. Should there be $200 or greater account balance, your clinician may not schedule subsequent sessions until a mutually agreed upon payment plan has been made or balance is paid in full. In this event, referrals to other providers are available upon request.
The laws and standards of my profession require that we keep treatment records for a certain amount of time. You are entitled to receive a copy of your records, or we can prepare a summary for you instead. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. If you wish to see your records, I recommend that you review them in your clinician’s presence so that we can discuss the contents. [We are sometimes willing to conduct a review meeting without charge.] Clients will be charged an appropriate fee for any professional time spent in responding to information requests.
Recording sessions, phone conversations, or consultation is not permissible without the permission and knowledge of the provider.