Clients of DSM Therapeutic and Wellness Center LLC are required to be up to date on all payments for all completed services rendered.
• We will collect all payments at the start of each session.
• If you are using your Medical Insurance to pay for services, it is your responsibility to be up to date regarding Medical Insurance coverage, and to work with your Medical Insurance for prompt and correct payment.
• If you are paying out of pocket, you agree to the fee set by your Therapist.
• We also accept Cash, Checks and Credit Cards.
• There is a $30.00 Service Fee for any returned checks.
• You agree that DSM Therapeutic and Wellness Center LLC and your Therapist has the right to seek legal recourse to recoup any unpaid balance on your account.
• When seeking these measures, DSM Therapeutic and Wellness Center LLC will disclose ONLY biographical information and the balance amount owed, in order to maintain confidentiality of your medical information.
• We do not allow anyone to have a carry over balance.
This is a notice of ADDITIONAL FEES for services that may not covered by your Medical Insurance. These are additional fees that the client must pay out of pocket.
• Missed appointments and Late cancellations (without 24 hours of advance notice): $75.00 for holding an appointment slot. This is not a fee that your insurance company will cover.
• Written Reports/Letters/Forms: Pro-rated at my hourly rate. Fees are discussed in session.
• After Hour Phone Calls (Non-Emergency) or consultative phone calls with other professionals: Pro-rated at my hourly rate. Fees are discussed in session.
• Any meetings, Phone conferences or Court hearings that I am requested to attend will be charged at my pro-rated hourly rate. Fees are discussed in session.