The Terms and Conditions for Insurance Claims
and Client Billing…
Day of Service – Commercial Insurance Clients
All co-pay, co-insurance, sliding fee scales, payment plans, deductible amounts, and other payments are due on the service date. If client payments are not made on the date of service, or if arrangements for an alternate payment plan have not been made, charges will be submitted to the client’s credit or debit card on file with our office.
Insurance Coverage
Anyone who uses insurance coverage for any psychotherapy service must be given a diagnosis; insurance-covered treatment must be deemed “medically necessary.” If you are concerned about a diagnosis on your medical record or prefer not to frame your concerns in a medical model, we offer the option of paying for services directly (Private Pay). If requested, we will discuss the benefits and drawbacks of each choice with you on your first visit.
Most health insurance plans include behavioral health coverage, but the exact coverage varies widely with each insurance plan. Clients are responsible for services received not covered by insurance; therefore, we strongly recommend that clients call their insurance company to verify coverage.
As a service to our clients, we can help verify eligibility and discuss all options on the first visit.
Cancellation Invoices and Missed Sessions
Clients are responsible for notifying their clinicians if they cannot attend their session. The required notice for cancellation is at least 24 hours unless in an emergency.
Clients will be charged the full contracted insurance rate for the session if there is a less-than-24-hour cancellation notice (late cancellation) without rescheduling or if clients do not attend appointments without notice. **Please note: insurance companies will NOT reimburse for missed sessions or late cancelations. Clients are solely responsible for these fees. Medicaid clients are exempt from this policy; however, after two continuous missed sessions may be dropped from service.
We understand emergencies happen, and winter weather often does not play nice. Where possible, clients may be offered an alternative appointment (reschedule). You will be given as much advance notice as possible regarding holidays or the need to cancel your appointment for any other reason.
Medicaid & Medicare
At this time, Licensed Professional Counselors are not eligible to participate in the Medicare system; only Licensed Clinical Social Workers can see Medicare clients. All clinicians may see Medicaid clients.
We are proud supporters of and providers for Wisconsin’s Badgercare (Medicaid) system.
Client Liability
All charges are ultimately the client’s responsibility, regardless of insurance coverage. We require all commercial insurance clients to keep a credit card on file.
As a service to our clients, we file claims with insurance carriers on their behalf and accept assigned benefits. However, clients are responsible for the payment of deductibles, and co-payments, which are due at the time of service. We accept cash, checks, and major credit cards.
In case of a claim denial, we resubmit all denials and request an explanation of benefits for all our clients. If a denial is upheld, clients are responsible for payment at the insurance contracted rate, which will be discussed.
If you cannot afford services, speak with us – we can help!
Clients are responsible for updating information, including insurance coverage, with their clinician.
Networks
Each clinician (psychotherapist) is solely responsible for insurance credentialing/contracting. We maintain a list of credentialled/contracted insurance companies at the following location: https://counseling.sacwan.net/insurance–low-income/
Rates
Each clinician has a contracted rate with the respective insurance carriers, which may vary based on time credentialed, type of license, level of education, and specializations.
Cash rates will be discussed with those clients requesting cash services and will be based on their ability to pay. We maintain a detailed fee chart for insurance purposes and allow yearly rate increases.
Current commercial insurance rates will be discussed with each client per their insurance contract.
Refunds
Due to the nature of our services, refunds on services or co-pays are NOT allowed. If credit card payments are stopped, we will use an appropriate and HIPAA-compliant collection service to retrieve our fees.
