I understand that there are times that some clients do not want to bill their insurance, or do not have insurance.  It is for this reason that a self-pay fee schedule has been set.   Please note that if you choose at a later date to bill your insurance company, the standard fees will apply ($80 an hour).  At that time you will be asked to sign a new Fee and Office policy reflecting such.  Self Pay means that you agree to pay for services at time of service and Child’s Play does not submit any forms to insurance or third party payees.   

 

Fees are as follows:   Initial intake session (1 - 1 ½ hr)………………………….…. $115.00

                                    1 hour individual/family session (40-55 min.)………………..  $60.00  

                                    ½ hour individual/family session (20-25 min)……………..…. $30.00

                                   Group Treatment per session (1 - 1 ½ hour)……….. . . . . . . . .  $25.00

                                  Phone consultations per 15 minutes .. . . . . . . . . . . . . . . . . .  . . . $20.00

                                  Late charge on overdue accounts, over 30 days, per month  .  …$ 5.00           

                                  Missed appointment (not called or canceled within 24 hrs)……$25.00

                                    Parenting classes, individual a session. . . . . . . . . . . . . . . . . . . $55.00

                                    (4 sessions total is $220)

                                   After normal working hours, up to ½ hour …………………$60.00           

                                  All other services are billed at $80 an hour

                                    This includes attorney consults, court reports, and court testimony, Court costs will include travel, reports & preparation time.

 

Cases involving court testimony:  I am often asked to testify in court.  As this takes me away from my office, and other clients will have to be rescheduled, I now charge for my time involved in the proceeding. This time includes not only the actual testimony, but often preparing reports, consults with attorney’s, judges, reviewing records, traveling, waiting, and preparation.  In order for me to attend any court/trial, your signed release must be on file and a $500.00 retainer for services must be paid for at least two weeks before the scheduled day of court.  Any fees paid, but not billed, will be returned to you or credited towards your child’s account.  Please note that in any court case, I may be asked questions that you may not want revealed.  For this reason, it is very important that you understand any risks or benefits that my testimony may cause.  In a court of law, I will be required to answer any and all questions that are asked of me by all attorneys  involved in the case, as well as the judge.

  

Cancellation Policy

I reserve the right to bill for missed appointments or cancellations within 24 hours.  Missed or cancelled appointment without 24 hours notice, for any reason other than an emergency, will be billed $25.00.  Those not canceled and are missed will be billed at the normal hourly rate.  This means that if you or your child does not show for a scheduled appointment, and do not call to cancel or reschedule, you will be billed the normal rate for the time.    

 

Client Responsibilities

 

Clients are expected to follow all office procedures for scheduling and keeping appointments, payment of services, and notification or termination of primary mental health professional prior to the initial assessment.  Clients are also expected to be motivated for treatment and show improvement in overall functioning over time.  If for some reason the client does not show improvement over a determined amount of time and/or in your opinion treatment is ineffective, you will be referred to another qualified professional.  Parent(s) &/or guardian(s) are responsible for paying for services at time services are rendered.

 

  Emergency Situations

 

The phone number to the office is 334-222-7094.  If an emergency occurs and you need to reach the therapist after hours, the above number will offer an alternative phone number.  If I am unavailable and the situation is desperate, please go to the nearest hospital, ER, or family physician. 

Medical Records Policy

 

Your or your child’s medical record will only be released with the signature of  a natural parent(s) or legal guardian if under the age of 14..  Legal forms stating guardianship must be on file in child’s chart in this office before information or records will be released.  If your child is age 14 or older, Laws and ethics require that I obtain the child’s signature before information can be released. 

 

Legal Responsibility

I am required to adhere to the Code of Conduct as established by the Alabama Board of Examiners and copies of these codes are available upon request.

 

The confidentiality of ALL communication is governed by both Federal and State statues.  There are exceptions to confidentiality which include 1) Danger to Self 2) Danger to Others 3) Evidence of Child or Elder abuse, and 4) If court ordered.  I am required BY LAW to notify the authorities immediately if any of these situations arise.

 

Potential Counseling Risks

 

In working with children, family issues often arise which become the primary focus of treatment.  For this reason, many families become avoidant or quit therapy all together.  These issues can be resolved but it takes commitment from all family members.  The primary rule in my office is “nobody gets hurt” but that does not mean that you will not experience hurt or painful feelings as a result of the things that you attempt to resolve. However, you will be in a safe and secure environment as I can possibly provide and you will be able to resolve these issues if you have courage, persistence and faith.