100 Chase Pk S, Hoover, Alabama 35244, United States
Alabama Child & Adolescent Counseling
Alabama Child & Adolescent Counseling
A Good Faith Estimate enumerates the expenses you can reasonably expect to pay for your mental health care services provided by me and my counseling practice. The estimate is created based upon the information known at the time the estimate is first created. It does not include unknown or unexpected costs that may arise during treatment. It is possible you may incur more charges than the estimate enumerates if complications or special circumstances arise. If this happens, the federal law provides you a right to dispute your bill. If you are billed for $400 or more than your Good Faith Estimate, you have the right to dispute the bill. You may contact me directly if you are billed charges that exceed the Good Faith Estimate. You can request for me to update your bill to match the Good Faith Estimate, request to negotiate the bill, or you may request information about financial assistance availability. You also have the right to initiate a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days from the date on the original bill. There is a $25 fee to use the dispute process. If the dispute-reviewing agency agrees with you, you will be responsible for the amount provided on your Good Faith Estimate. If the agency disagrees with your dispute and agrees with the fees charged by me that exceed the Good Faith Estimate, you will have to pay the higher amount charged. To learn more visit www.cms.gov/nosurprises or call HHS at (800)368-1019. Your estimate is not a contract. You are not obligated to receive services from me. My office can provide you with alternative referrals at your request at any time.
Below is a schedule of standard fees for my clinical services for clients who are self-pay. Reduced fees are available based on financial criteria and circumstances per a reduced fee application and committee review process.
Parent Intake Call: $115-145 per session
Communication with Other Professionals: varies per hour
Family Session (Child & Parent): $158.50 per session
Family Session (Both Parents): $178.50 per session
Family Session (Both Parents & Child): $198.50 per session
Late Cancel/No Show: $103.50 per session
Excessive Communication: $78.50 per half hour
Record Requests Admin Fee - $28.50 GFE/Bill Dispute Fee - $28.50 Court involved work not billable for reimbursement to your insurance – $203.50 per hour
Court appearance is $250.00 which will cover the first hour.
A deposit of $500.00 is due at the time of scheduling and is not refundable.
These expenditures include but are not limited to: travel, preparation, parking, lunch and the like. These expenditures at the rate of $250 the first hour, and $150 billed in ½ hour increments. Other letters and paperwork requested by the client will be assessed a charge of $150 per hour
Educational Requests:
In the event that it is requested that the therapist attend Parent/Teacher conferences, IEP meetings, DHR meetings, manifestation meetings, and any other like meetings, the therapist’s rate will be $150 per hour, plus mileage, and estimated cost per hour(s) of the office at a rate of $150 per hour. Any travel time that exceeds an hour round trip will include additional travel expenses. Any documentation requested by the client, that the therapist must prepare and bring to the meeting will also accrue a separate charge (minimum of $75.00).
Letters:
In the event that a professional letter to an outside agency, school, team, doctor, or other outside entity is requested. A $150 charge is to be paid prior to the letter being drafted.
Phone & Email Communication:
Clients are not charged for reasonable phone or email communication. Example: brief contact once a week. Any conversations with therapist or office staff in excess of 10 minutes once a week, will be charged at the following rate and will be billed by the ¼ of the hour, and will be due prior to next visit.
Any outstanding charges past 30 days will be automatically billed to your credit card on file.
However, if excessive communication is necessary between the client, therapist, ACA staff, or outside persons, the rate will be $150 per hour, $75 per half hour. All charges are billed a ¼ of an hour increments
Copyright © 2016 Alabama Child & Adolescent Counseling Services - All Rights Reserved.
ACA Counseling EST 2016