Insurance Pre-Authorization | Payment | Financial Policy | Statement Information | Cancellation or "No-Show" | Changes in Client Information | Confidentiality
If I participate with your insurance, please be sure to:
- Contact you health insurance provider prior to coming in for your first appointment. Many insurance companies require pre-authorization for Mental Health benefits. Failure to contact your insurance company may significantly reduce your benefits.
- Please bring to your first appointment the following information:
- Referral/authorization number
- Number and type of visit(s) authorized
- Deductible and co-pay information
- Insurance card for the Executive Administrator to make a photocopy for your file.
I ask that you pay at the time of your visit unless other arrangements are made with your therapist. Payment can be made by cash or check. Checks should be made payable to Dr. Greenspan.
You are personally responsible for your entire bill regardless of any amount that may be covered by your insurance or third party payer. Please call your insurance company and confirm your “outpatient mental health” benefits. As a courtesy, I will submit a claim to your primary insurance company. I do not bill secondary insurance plans. If I am a “Preferred Provider” for your insurance plan, I will abide by their contracted rates.
Your co-payment is due at the time of service. This office takes cash or checks. Credit cards are not accepted. There will be a charge of $20.00 for any returned check due to insufficient funds. If you are being seen due to a court order or other legal matter, it is not certain that insurance will cover the services. Please inform Dr. Greenspan if these circumstances pertain.
In the event your account carries a balance, statements are sent monthly.
CANCELLATION OR “NO SHOW”
Because your appointment time is set aside specifically for you, there may be a charge of $80.00 for any missed appointment, except for illness, if not cancelled at least 24 hours prior to the time of the appointment. The required notification releases you from financial responsibility.
CHANGES IN CLIENT INFORMATION
If you are a current client, please inform the Executive Administrator or myself of any address, telephone number or insurance changes so that you may be better served.
This section is condensed from the Idaho Notice Form for HIPAA. State law, and professional ethics, requires therapists to maintain confidentiality, except for the following situations:
1. If there is suspected child abuse, elder abuse and/or dependent adult abuse.
2. “Tarasoff” situations in which serious threat to a reasonably well-identified victim is communicated to the therapist.
3. When threat to injure or kill oneself is communicated to the therapist.
4. If you are required to sign a release of confidential information by your medical insurance.
5. If you are required to sign a release for psychotherapy records if you are involved in
litigation or other matters with private or public agencies. Think carefully and consult with an attorney before you sign away your rights. We can discuss some foreseeable possibilities together.
6. Clients being seen in couple or family therapy are obligated legally to respect the confidentiality of others. The therapist will exercise discretion (but cannot promise absolute confidentiality) when disclosing private information to other participants in the treatment process.
7. I may, at times, speak with professional colleagues about our work without asking permission, but all identities will be disguised.
8. My Executive Administrator has access to locked records, but is legally charged with confidentiality.
9. Clients under age 18 do not have full confidentiality from their parents.
10. It is also important to be aware of other potential limits to confidentiality that includes the following:
• All records may be subject to court subpoena under certain circumstances. All records are stored in locked files.
• Cell phones, faxes and emails are used on some occasions; any electronic communication may malfunction, thus resulting in compromised confidentiality.
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