Client and Family Responsibilities
Cancellation of Appointments and Discharge:
- Twenty-four hour notice must be given when cancelling or rescheduling an appointment.
- Discharge of a client shall occur when the client’s symptoms have been ameliorated and the client has agreed that there is no further medical necessity for treatment to continue.
- If the client is not “at risk,” and he/she fails to attend three appointments without contact within a six month period, (or) the therapist has not had any contact with the client after 30 days, the client may be discharged. If the client is considered to be “at risk,” the therapist will contact the case manager or family member to assist in setting up additional services.
- If the client is misusing or abusing medications which is prescribed by an ACE physician, he may be subject to immediate discharge.
- If the client has consistent mismanagement of medications or theft of his prescriptions, he may be subject to immediate discharge.
- If the client displays inappropriate behaviors when in the office which impedes on the therapeutic experience of others, the provider has the right to discharge.
Copays, Deductibles, Payment Plans:
- Copays and deductibles will be collected prior to services being rendered.
- Clients can be refused services if they are unable to pay for copays or deductibles at the time services are rendered.
- Payment plans will be available to those clients who have a balance that exceeds $80. Clients with balances less than $80 will be required to make payment in full prior to services being provided. Clients will be required to pay 20% of the balance (in addition to the copay, if applicable) at the time services are rendered.
- A credit card is required to be kept on file for all self-pay balances. Services can be delayed or terminated at the agency’s discretion if a client is unwilling to provide a credit card on file.
Fees for services (Out-of-pocket):
Clients who would like to receive services but do not have active or in-network insurance may pay for services out of pocket using the following fee schedule:
Individual therapy with non-licensed clinician (1 hour): $90
Individual therapy with licensed clinician (1 hour): $115
Medication check with psychiatrist (In-person): $90
Medication check with psychiatrist (telepsychiatry): $125
Psychiatric Evaluation: $225
EMDR with licensed clinician (1 hour): $225
Request for Medical Records:
- Clients may have access to his/her records upon request. Access does not imply physical possession of the medical record but rather a review of the record.
- Access may be denied when it is determined that disclosure of the specific information will cause a substantial detriment to the client’s treatment or when the disclosure of specific information will reveal the identity of persons or breach the confidentiality of other person who has provided information upon an agreement to maintain their confidentiality. Access may be denied if it is necessary to protect an individual’s privacy or the security of the health information. Access may be denied if it is not possible due to infeasibility of the record request or if IT temporarily being unavailable or if the request would degrade health IT’s performance.