Policies & Billing Information
Patient Agreement with Policies and Procedures
Welcome to ABC! The following information is provided to
assist you in understanding our policies and procedures. We strive to provide
you care which is both comfortable and of the highest quality. Please do
not hesitate to ask questions of your therapist or the administrative staff
about these matters.
Since patients are seen by appointment only (unless an
emergency situation dictates otherwise), the appointment time given is
50 minutes that has been reserved for you. Please give at least twenty-four
(24) hours notice if you must cancel your reserved time. Sometimes illness
and emergencies happen which prevent you from keeping your appointment
and we do not charge for these infrequent occurrences.
In the absence of such circumstances, you will be charged your usual
fee for missed appointments not cancelled twenty-four hours in advance
of the time. Please understand that insurance companies cannot be billed
for missed appointments and you are fully responsible for any charges due
to missed appointments.
Emergencies and Telephone Calls:
While you will be seen at a reserved time which fits your
schedule demands, there may arise occasions when you need to talk to your
therapist between appointments. Should this occur, you should call the
office during normal office hours and leave a message for your therapist
to return your call.
If your call is an emergency, you should declare your call to be
an emergency. Your call will be handled promptly. If you call outside of
normal hours, you will reach a voice mail message giving you the pager
number for the therapist on call.
Fees and Payments:
Fees are contingent on the type of service provided. The
initial diagnostic session is $150.00. All payments, including co-payments,
deductibles, and co-insurance amounts are due at the time services are
rendered unless prior arrangements have been made with the therapist or
with the office manager.
Insurance Usage and Issues of Confidentiality and Privileged
Many patients elect to file third party insurance coverage,
including Medicare, for services rendered. We will file insurance claims
for you, provided you authorize us to do so and provide us with the necessary
information for filing such claims.
It is our responsibility is to inform you about the compromising
of your confidentiality and privacy when complying with the requirements
of insurance companies. The compromising of your confidentiality is standard
in today’s marketplace whenever one chooses to use third party insurance
coverage for services rendered.
Fortunately the newly enacted HIPAA regulations
do provide you an increased degree of privacy and confidentiality regarding
your protected health information. Payors of care can no longer make full
release of your mental health record a condition for payment of your claims.
Instead, release of your mental health records is limited only to your
designated mental health record set and not psychotherapy notes made during
What you talk about in your established relationship with your therapist
is protected by privileged communication laws of the State of Tennessee
and confidentiality principles, with the exception of certain specific
actions (i.e., clear and imminent danger to self or others, suspected child
abuse, worker’s compensation related cases, if your mental health
becomes an issue in a lawsuit, whatever information is shared in utilization
review reports for authorization of care, compliance with chart audits
by your insurance carrier).
With these exceptions, unless you specifically sign a release of
information authorizing release of protected health information, all communications
are kept private, confidential, and privileged. We strive to maintain the
sacredness and privacy of your confidential communications with us.