ANXIETY - PANIC - PHOBIA
TREATMENT CENTER
LTD.
Outpatient Psychotherapy services rendered at
290 main Street
Cotuit, MA
are charged as follows (effective 4/1/09):
FEE SCALE:
Initial Diagnostic Evaluation $250.00
Subsequent Treatment Sessions $200.00
These Fees are based upon a forty-five to fifty minute therapy session.
CANCELLATIONS:
Irrespective of insurance coverage, the ultimate responsibility for any charges lie with the client.
APPTC REQUIRES A 24-HOUR NOTICE FOR CANCELLATION OF AN APPOINTMENT. PATIENTS WILL BE CHARGED THE FULL $125.00 FEE FOR ANY CANCELLATION MADE WITH LESS THAN 24 HOURS NOTICE. YOUR INSURANCE COMPANY WILL NOT PAY FOR THIS CHARGE.
Our telephone number has 24-hour coverage, so Monday appointments may be cancelled during the weekend. Late cancellations will be charged directly to the client and not to the insurance carrier. Charges for missed appointments must be paid prior to rescheduling another appointment.
FEES FOR OTHER SERVICES:
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Any out-of-office consultation to schools, homes or offices will be billed at $350.00 per hour, plus total transportation time from the 290 Main Street office to the consultation and back.
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Any type of psychological or behavioral report, evaluation, progress report, summary, case status or utilization review will be billed at $350.00 per hour.
Minimum charge for any report, $50.00 per hour
No reports will be sent out of the office until they are paid-in-full.
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Any face-to-face consultation that is related to therapeutic issues between the therapist and the patient's spouse, parent, child or significant other will be billed at $200.00 per hour
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Telephone conversations related to therapeutic issues between the therapist and the patient's spouse, parents, significant other or lawyer will be billed at $3.00 per minute plus any long-distance phone charges.
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Copying Fees are $1.50 per page.
FEES FOR THESE SERVICES ARE DUE AND PAYABLE
AT THE TIME THAT THE SERVICES ARE RENDERED
Clients should be aware that some of these services may not be covered by their insurance carrier.
LEGAL CONSULTATION POLICY:
If Dr. Tokarz is involved in your case and he is subpoenaed by the "other side" (i.e., spouse, DSS, the Commonwealth, or any other source) to engage in a deposition or court testimony -- even if you did not request or desire his presence -- then he will be forced to bill you for his time at a rate of $350.00 per hour from the time he leaves his office until he returns. These same rates apply if he voluntarily testifies at a deposition or court hearing on your behalf. Also, all preparation time, tele-cons or face-to-face discussions with attorney, reviewing of medical records and reports used for courts or depositions will be billed at $350.00 per hour. Minimum court appearance or deposition retainer will be no less than $2,500.00. Minimum fee for forensic evaluation and report will be no less than $1,900.00.
INSURANCE:
APPTC is a provider for various insurance carriers (i.e., Harvard Pilgrim, Blue Cross Blue Shield, Magellan, United Behavioral Health, Health Care Value Management and Tufts. Most Policies contain either a client deductible and/or co-payment for which you are responsible. Co-plays do vary based on specific plans. Some insurance companies may include APPTC under out-of-network Out-patient Mental Health benefits. Payment is due at the time of service.
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APPTC does not accept Medicaid, Mass Health or Cigna.
Ultimately, it is the patient's responsibility to check with their insurance carrier and confirm their benefits. APPTC cannot be held responsible for errors made by your insurance carrier. It is the patient's responsibility to notify APPTC of any insurance changes (i.e., a switch to another insurance company or dual coverage).
AFTER HOURS COVERAGE:
APPTC will have a secretary or answering machine taking all calls Monday through Friday, 8 A.M. to 8 P.M., Dr. Tokarz will be available during these hours to respond to any emergencies. However, if you have an emergency during uncovered hours, please go to the nearest hospital emergency room.
COLLECTIONS:
If any client should incur a balance in excess of 60 days, APPTC will take them to Small Claims Court and report the delinquency to the credit bureaus, Equifax, Trans Union and Experian. All expenses incurred during that process (i.e., consultation with lawyers, secretarial time going to court, certified letters, etc.) will be the responsibility of the patient.
Clients should feel free to discuss any questions
concerning
this Office Policy with their therapist.
