INSURED CLIENTS CONTRACT


INSURED CLIENTS

Behavioral Health Payment AND Cancellation Policy

Welcome to Anchorpoint Counseling Ministry. We are committed to providing you the finest care, and would like you to understand that payment of your bill is necessary for maintaining quality care. For this reason we have adopted the following financial policy which we require you to read, agree and to sign prior to receiving any behavioral health care services from us.

INSURANCE: Primary and Secondary Insurance is billed by our contracted billing service as a courtesy to our clients. Insurance policies are contracts between you (or your employer) and the insurance company, Therefore, it is your responsibility to understand your insurance policy’s requirements and limitations. You are responsible for and expected to pay annual deductibles, co-pays, out-of-pocket/co-insurance (percentages) portion of “in network” carriers or for the difference between the amount that the “out of network” carrier pays and the amount of the charge. A copy of your insurance card is required and you are to supply all information for the billing agent to file a correct insurance claim. This policy applies to unaccompanied minors; therefore, parents/guardians must plan ahead for prompt payment. **Be advised that Anchorpoint Counseling Ministry is not in network with Medicaid programs. A private pay agreement is available.

INSURANCE COPAYS ARE DUE AT THE TIME OF SERVICE. Your deductibles or out of pocket amounts may have been met for previous rendered services by other health providers. We will be invoicing the expected amount due with our billing company. Invoices will be due upon receipt.

NOTICE OF CHANGES: You are responsible for notifying Anchorpoint Counseling Ministry of any and all relevant personal information and changes in your health care insurance most of which occur at the time an insurance policy is annually renewed. Failure to notify us of your changes may result in full payment of services.

CANCELLATION POLICY: You are responsible to be on time for your scheduled appointments. If you find it necessary to cancel an appointment, you are responsible for contacting your Counselor a minimum of 24 hours advanced notice. You may call the office (412-366-1300) to speak or leave a message for your Counselor. Failure to notify your Counselor you will be assessed a $20 cancellation fee. Your insurance company will not cover this fee.

RETURN CHECKS POLICY: If your personal checks are returned for NSF, you will be billed $25 to cover bank fee expenses. Subsequent payments for appointments must be paid in cash or money order.

TREATMENT AUTHORIZATIONS: Some insurance companies require treatment authorizations; it is your responsibility to know this is in your insurance contract. Your counselor will apply for those authorizations from your company as needed.

I have read, understand and agreed to comply with this policy:

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Document name: INSURED CLIENTS CONTRACT
lock iconUnique Document ID: 676ee4a5abbdacbdd3607db245bac53e947cb567
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May 21, 2020 1:04 pm ESTINSURED CLIENTS CONTRACT Uploaded by Lisa Feraco - [email protected] IP 50.73.169.97
May 28, 2020 11:52 am EST Document owner [email protected] has handed over this document to [email protected] 2020-05-28 11:52:36 - 162.144.177.109