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 48-hour notice. Failure to notify your therapist will result in a $75 charge.

Insurance Coverage

I am credentialed with the following insurance companies:

• Blue Cross & Blue Shield
• United HealthCare/Optum
• Beacon
• Cigna
• Humana
• Tricare/Triwest
• Aetna
• UMR

It is your responsibility to understand your coverage and know your 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: _____________________________________________________

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 my member ID the same as what is listed on my card? ______________________

4. Is pre-authorization necessary? _____________________________________________

5. If yes, enter the number of sessions approved and the CPT codes ________________ _____  the authorization number and date span covered. _______________________________

6. Do I have a deductible for mental health services?______________________________

7. If yes, how much is it and how much has been met so far? _______________________

8. In what month does your policy year begin? __________________________________

9. What is my co payment for each visit, or what is the percentage of coverage? _______

10. 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? _____________                                  

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