Agency Policies
PAYMENT POLICY:
Major Credit Cards, and HSA are Accepted. Payments for our services are non-refundable as they secure your appointment time. Payment is due at the time of service or upon receipt of your invoice depending on the service type.
Please note that you will be assessed at $50.00 late fee unpaid invoices pass 14 Days and your account will be placed on hold to prevent further charges.
Payments are due when you schedule your appointment or upon receipt of the invoice for coaching and consulting services as these may be offered via a package. We will cancel any appointments scheduled without payment.
Third Party Payors (Non-Insurance): Request for payment information will be denied without a signed Authorization to Disclose form on file.
Please note that if you have been identified as a “Responsible Party” during the Intake Process” a Guest Account will be created for you to manage all billing and payment information only. You will not have access to patient records without prior authorization in accordance with state and federal HIPAA regulations. Please note that payment for services does not entitle you to treatment information.
ATTENDANCE & CANCELLATION POLICY:
Providers will extend a 15-Min Grace Period for all appointments. After the 15-Min Mark, you are welcome to schedule a new appointment. We do not refund appointment fees for tardiness, or technological errors. Please be on time.
If you wish to cancel or reschedule your appointment, please contact us 48 Hours in advance so that this appointment may become available to other clients in need. Rescheduling appointments is based on the availability of the provider, is not guaranteed, and is left up to the discretion of the provider.
If you are paying via Insurance, you will be assessed a No Show/Late Cancel Fee, depending on your billing source (Headway) the fee will be $75.00 up to the self-pay cost. For Village Mindset, LLC/Mindset Adjusted Community Center clients please note that the No Show/Late Fee is set at $75.00 effective June 1, 2022.
If you cancel, reschedule, or no show three (3) consecutive times, or become inactive we will re-evaluate your needs, desires, or motivations for services. We reserve the right to discontinue any recurring appointments after three (3) consecutive no-shows or if the provider determines that services are no longer needed.
GOOD FAITH ESTIMATE NOTICE
Notice to clients and prospective clients:
Under Section 2799B-6 of the Public Health Service Act, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service, or at any time during treatment.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, or how to dispute a bill, see your Estimate, or visit www.cms.gov/nosurprises.