financial agreement

At Sundew Therapy and Wellness, we understand the importance of providing quality and affordable care. Your payment will vary based on your health insurance coverage and whether we are in-network with your provider. Please see below for the health insurances we accept. If your health insurance is not accepted then Sundew Therapy and Wellness is considered an “out-of-network provider” and you pay out-of-pocket for our services. Even though you’re required to pay out of pocket for services, Sundew Therapy and Wellness may be able to submit a claim to your insurance company for you, for more details, read the “Out-of-Network” section below.

To ensure a smooth process, we need your assistance and agreement to our payment policies. As the client or the person with legal authority to sign on the patient’s behalf, you understand and agree to the following:

  • To submit intake forms and a photocopy of your insurance identification card and all information required by your insurance carrier before your first visit.
  • To pay any required co-payments, co-insurance, and deductible.
  • To pay charges for services not covered by insurance, outstanding balances, and delinquent accounts at or before the time of service. For your convenience, we accept debit and credit cards (except American Express).
  • To notify us if your insurance changes before your next visit so we can make the appropriate changes to help you receive your maximum benefits.
  • To provide payment for any and all denied claims
  • Referrals or pre-authorization must be given to our office before your first appointment if required by your insurance policy. Read The Entire Policy Here.
  • If Sundew Therapy and Wellness is considered an out-of-network provider with your insurance then payment in full is required at each visit. Read The Entire Policy Here.
  • To cancel appointments at least 24 hours in advance. Read The Entire Policy Here.

It is your responsibility to be familiar with the requirements and limitations of your policy. 

 

 

Cancellation policy & fees

You will be billed for missed therapy session appointments unless the sessions are canceled 24 hours in advance.

Legal services Policy

In the event you become involved in litigation and your therapist is compelled to testify by another party; you will be billed an hourly fee for the professional time required. Due to the complexity and difficulty of legal involvement, per hour charge for preparation and attendance for any legal proceeding may be higher than your therapist’s clinical fee. If circumstances require that your therapist travel away from the office to provide professional services, the hourly fee will include travel time and a mileage fee.

Pre-authorization/referral policy

Referrals or pre-authorization must be given to our office before your first appointment if required by your insurance policy. Failure to do so will result in your appointment being rescheduled unless you plan to pay out-of-pocket for the services. If you choose to pay out of pocket for the services. You may be unable to successfully file a reimbursement claim with your insurance since services rendered would be prior to authorization. Please direct additional questions about referrals or pre-authorizations to your insurance.

In-Network claims policy

If Sundew Therapy and Wellness qualifies as an in-network provider for you then our office staff will file a claim on your behalf to your insurance company, however, if your claim is denied for any reason, you will be responsible for payment for services rendered.

Out-of-Network claims policy

If Sundew Therapy and Wellness is considered an out-of-network provider with your insurance then payment in full is required at each visit. Our office staff will be happy to submit insurance claims on your behalf. Any such request must be accompanied by a photocopy of your insurance identification card and all information required by your insurance carrier before your first visit. This service is provided at no charge to you, although requests for duplicate claims and statements are subject to an accounting service charge.

 

service fees

 

intake session

CPT Code: 90791

$200

53+ Min extended Individual Session

CPT Code: 90837

$145

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