Fees for Services
I am committed to providing effective services at a reasonable cost. I believe it is important for my clients to have a clear understanding of my fees and the process of payment, so I offer the following guidelines:
The standard fee is $210 for the initial session and $150 for subsequent sessions. I cooperate with most insurance companies.
I do work with individuals that do not have insurance and are experiencing financial hardship. Call to receive an estimate of fees.
Payment is due at the beginning of every session unless we agree otherwise or unless you have insurance coverage which requires another arrangement. In order to make the most efficient use of your time, you may want to write the check in advance.
Cancellation or rescheduling requires a 24-hour notice. Failure to notify your therapist will result in a $75 charge.
I am credentialed with the following insurance companies:
- Blue Cross & Blue Shield
- United HealthCare/Optum
- Value Options
I am in the process of being credentialed with several other companies. In addition, a number of insurance companies have out-of-network benefits.
Guidelines for Using Insurance
Use the following guideline when calling your insurance company to get pre-authorization for your first session. Please bring this information with you to your first appointment. Call the Mental Health or Customer Service number on your insurance card and tell them that you "need to verify outpatient mental health benefits".
Name of patient/client: __________________________________________________
Name and social security number of policy holder: ______________________________
Name of Insurance Company: _____________________________________________
Name of company handling your mental health benefits (sometimes different from the insurance company): ______________________________________________________
Phone number called: _____________________________________________________
Person you talked to at time of call: ___________________________________________
Date and time of call: ______________________________________________________
Ask for the following information:
1. Is Janet M. Kinney, Ph.D. currently a network provider for my plan? _______________
2. If not, what are my out-of-network benefits? ________________________________
3. Is pre-certification necessary? _____________________________________________
4. If yes, enter the number of sessions approved and the CPT codes ________________ _____ the authorization number and date span covered. _______________________________
5. Do I have a deductible for mental health services?______________________________
6. If yes, how much is it and how much has been met so far? _______________________
7. In what month does your policy year begin? __________________________________
8. What is my co payment for each visit, or what is the percentage of coverage? _______
9. What are the restrictions or limitations to my coverage?
a) pre-existing conditions: ____________
b) dollar amount per year? ________________, per lifetime? _________________
c) number of visits per year?___________number of visits per lifetime? __________
d) is couples or family therapy covered? _____________
e) is psychological or psychoeducational testing covered? ____________ ______ If so, what are the benefits? ____________________________
10. What is the billing address for claims? ______________________________________
By talking to your insurance company directly, you reduce the chance of having unexpected expenses.
I ____________________________ understand that is my insurance company refuses to pay these claims for professional services, I am responsible for payment.
___________________________________________________________________ Signature / Date