Pediatric and Adult Behavioral CounselingFee Agreement

Updated on January 6, 2022

Please review Pediatric and Adult Behavioral Counseling (PABC) rates below and contact us if you have any questions. You will be provided with an updated Fee Agreement if any rates are changed. You may also check our private pay rates on our website at www.pabcounseling.com at any time.

INSURANCE ACCEPTED FOR SERVICES:

  • BCBS and BCN
  • United Health Care (UHC)
  • Oscar
  • Oxford
  • Aetna
  • Cigna
  • Out of Network
  • HSA
  • Private Pay

INSURANCE: We recommend contacting your insurance provider if you have any questions about your insurance plan prior to attending your scheduled appointment. We will bill your insurance provider for services. Deductibles, copays, and any additional fees will be charged to your credit card on file. If you are a member of an insurance company we are credentialed with and wish to pay privately, please contact our main office at 248-973-7958.

PRIVATE PAY FEES AND SESSION LENGTH: The below rates apply only to PRIVATE PAY and Out of Network. Insurance rates and time lengths may vary.

  • Initial Consultation / Assessment: 45 minutes: $200.00
  • Individual/Parent Consult 16-37 minutes: $100.00
  • Individual counseling 30-45 minutes: $150.00
  • Individual counseling: 55-60 minutes: $175.00
  • Family counseling with or without client present 45-55 minutes: $200
  • Crisis Intervention 60 minutes: $175
  • Parent Consulting / Coaching: 30-45 minutes: $150
  • Parent Consulting / Coaching: 55 minutes: $175
  • Couples / Relationship / Marriage Counseling: 30-45 minutes: $200
  • Couples / Relationship / Marriage Counseling: 55-60 minutes: $225
  • Executive / Leadership Coaching – Emotional Intelligence for Organization: please consult for fees
  • Life Mentoring: 30-45 minutes: $150
  • Life Mentoring: 55 minutes: $175
  • $50 for every extended 15 minute session period
  • $75 for every extended 30 minute session period
  • $175 for every extended 60 minute session period

Late Fee: $35 fee is assessed per invoice for every third days past due

CANCELLATION / NO SHOW POLICY:

Please see cancellation / file closure policy. Late cancellation and no show fees are not covered by insurance and charged to your credit card on file.

CANCELLATION / NO SHOW FEE:

No call / No show / Late Cancellations are charged full appointment fee.

Initial intake assessment is charged $200 for No call / No show / Late Cancellation

$35 additional charge assessed for No call / No show / Late Cancellation for appointments missed on weekends andafter 5:05 pm on Friday.

$35 additional charge assessed for No call / No show / Late Cancellation for appointments missed on Monday through Thursday after 7:05 pm

$35 additional charge assessed for No call / No show / Late Cancellation for appointments missed Monday through Friday before 8:55 am

Outstanding Payment: If we have not received payment for a session after 45 days, your Clinician may cancel scheduled appointments and discontinue services until payment or payment plan is made. Your services may continue upon receipt of payment, creation of payment plan and Clinician discretion. Please note that we cannot guarantee the same availability. If we have to submit your bill to collections, the individual responsible for billing will be responsible for covering any attorney fees, collection fees and anything related to monies owed to Pediatric and Adult Behavioral Counseling.

COURT OR SUBPOENA CLAUSE: It is not within the scope of practice for any of our Clinicians at PABC to testify on behalf of clients or families. Our Clinicians do not provide custody placement recommendations. This agreement states that you understand that should you or a third party subpoena any practicing Clinician at PABC as a factual case witness or involve in court-related processes, there is an ***upfront, non-refundable retainer fee of $5,000 plus an additional charge of $350.00 every hour ***involved in case preparation, research, paperwork, phone calls, travel, and witness time. This does not include the cost of scheduled psycho-therapy appointments. You understand that if a subpoena is issued with or without approval that your subpoena will be directly turned over to our attorney and a bill will be rendered for an immediate attorney’s retainer fee. This fee is separate and in addition to PABC services. You will also be billed accordingly and agree to pay all attorney’s fees plus therapist’s fees as invoiced up front in order for any services to be rendered. You understand that if a minor who is in therapy and has any custody agreement, this must be furnished upon starting services.

MEDICAL RECORDS: Request for medical records can be made at hello@pabcounseling.com. (a) An initial fee of $35.00 per request for a copy of the record. (b) Paper copies as follows: (i) One dollar per page for the first 20 pages. (ii) Fifty cents per page for pages 21 through 50

Clients using insurance: I am responsible for contacting my insurance company, if applicable, to determine what my out-of-pockets costs may be. I authorize insurance benefits to be paid directly to PABC and that PABC may release any information to my insurance provider required for processing my claims. I also acknowledge that cancellations not made within time frames above will be charged to my credit card on file.

The client, parent, or legal guardian is responsible for all copay, coinsurance, deductibles and no show / late cancellation fees. If insurance does not cover a service, you are responsible for any out of pocket costs. If your insurance should change, you are responsible for providing your Clinician with updated information. Insurance does not cover the cost of no show or late cancellations.

Payment and Fees:

  • I provide authorization for the above service fees to be automatically charged to my credit card on file. If billing through insurance, I understand that I am responsible for all copays, deductibles and late cancellation/no show fees.
  • I provide authorization to be automatically charged to my credit card on file at the beginning or anytime following scheduled appointment time.
  • I will provide a valid and current credit card on file at all times and update my card on file upon expiration
  • My signature confirms that I have read the above fee agreement policies and agree to the above terms included in this document.