Payment Information

Payment Information

We accept self-pay either by cash, credit card, or check.  We have funding with the United Way Fairfield County and Fairfield County ADAMH Board.

FEES (Effective July 1, 2017):

Fees vary according to the time involved and are subject to change; current fees will be posted in the reception/waiting area at each agency site. You are expected to pay at the beginning of each session at the Medicaid discounted rate unless we have verified that you currently have Medicaid or some other verified payer.  If you do not pay at the time of the session, you will be billed at the full usual/customary rate.  Please discuss with our billing staff any problems you may have meeting this requirement.  Some or all of the fees for treatment services may be covered by your health insurance, local mental health board (ADAMH), Medicaid, or Medicare; please find out the details of your coverage from your insurance company.  However, you are responsible for payment, not the insurance company.  For additional authorization for services not covered by commercial insurances and/or Medicare you will be required to complete the Client Payment Responsibility Agreement.

SERVICE USUAL/

CUSTOMARY FEE

MEDICAID RATE/

TIME OF SERVICE

PSYCHIATRIC DIAGNOSTIC EVALUATION $175.00/HR $130.72
PSYCHOLOGICAL TESTING $110.00/HR $59.26/HR
INDIVIDUAL PSYCHOTHERAPY $150.00/HR $120.36/HR
PERSONAL GROWTH INTAKE $175.00/HR $130.72
PERSONAL GROWTH COUNSELING $150.00/HR $120.36/HR
CASE MANAGEMENT GROUP COUNSELING $45.00/HR $35.96/HR
CASE MANAGEMENT (Coordination of Care) $90/HR $78.16/HR
THERAPEUTIC BEHAVIORAL SERVICES (Community Based) $150.00/HR $114.36/HR
THERAPEUTIC BEHAVIORAL SERVICES

(Office Based)

$110.00/HR $89.99/HR
INTERACTIVE COMPLEXITY $13.81/HR $13.81/HR
PSYCHOLOGICAL EVALUATION $1,000 to $2,000* Not covered by Medicaid
FORENSIC EVALUATIONS $600.00* Not covered by Medicaid
INDEPENDENT REVIEW $150.00 $120.36
TRAVEL FEE FOR COURT APPEARANCES $135.00/HR DOOR-TO-DOOR Not covered by Medicaid
COURT APPEARANCES $135.00/HR DOOR-TO-DOOR Not covered by Medicaid
CONSULTATION SUMMARY/REPORT WRITING $90/HR Not covered by Medicaid
REVIEW OF CASE RELATED RECORDS $90.00/HR Not covered by Medicaid
* Fees for Evaluations may be increased in complex cases or cases with more than one legal or referral question.

If you become involved in legal proceedings that require agency participation, you will be expected to pay for all of our professional time, including preparation and transportation costs, even if agency staff is called to testify by another party.  You will be charged $135 per hour for these activities.  Insurance, Medicaid and Medicare do not pay for these services.  If you request that other documents be completed for other entities, you will also be charged $90 per hour for the completion of these documents.

You will receive a monthly statement itemizing all charges and payments if you owe a balance.  If there is a balance due, it must be paid in full, unless other payment arrangements have been made with the agency billing department.  Your services may be suspended if your balance is more than $350.  Once you have paid off your balance your treatment may resume.    Accounts overdue by more than 60 days may be sent to a collection agency and may result in termination of treatment.

Misunderstandings about money can arise.  If there are payment problems that have not been discussed, you and your clinician may become uncomfortable and your work together may suffer.  Our contract is that the clinician helps you work on your problems and you pay for that service.

BILLING AND PAYMENTS:

You will be expected to pay for each session at the time it is held, unless we agree otherwise or unless you have insurance coverage that requires another arrangement.  Payment schedules for other professional services will be agreed to when they are requested.

If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, we have the option of using legal means to secure the payment.  This may involve hiring a collection agency or going through small claims court which will require the agency to disclose otherwise confidential information.  In most collection situations, the only information we release regarding a client’s treatment is his/her name, last known address, the nature of services provided, and the amount due.  If such legal action is necessary, its costs will be included in the claim.

 

Additionally below is a list of accepted insurances:

We accept the following insurances within the policy limits:

  • Aetna MyCare (Medicaid/Medicare)
  • Buckeye Health
  • CareSource
  • Molina
  • Paramount
  • United HealthCare Community

We are contracted with your insurance carrier, however we strongly encourage you to contact your carrier to determine your possible out of pocket and/or co-pay cost.

  • CareSource Just 4 Me
  • Caresource Marketplace
  • CoreSource
  • Health Ohio Network
  • Medicare (Red/White/Blue Card)
  • Molina Marketplace
  • Optum
  • Paramount Marketplace
  • UMR- United HealthCare
  • United Behavioral Health
  • United Health Care Dual Complete
  • United HealthCare
  • United HealthCare (Medicare)

We have successfully billed with your insurance carrier, however we strongly encourage you to contact your carrier to determine your out of pocket and/or co-pay cost.

  • AETNA
  • Aetna Medicare
  • Aetna Insurance
  • Affinity Health Plan
  • Allied Benefit Systems, Inc.
  • Anthem Benefit Administrators
  • Anthem Blue Cross and Blue Shield
  • Aultra
  • Benelect
  • Blue Cross Blue Shield
  • Champva
  • CIGNA
  • Cigna Behavioral Health
  • Cigna HealthCare
  • Employee Assistance Programs (EAP)
  • Golden Rule insurance company
  • Health Net Federal Services, Inc
  • HealthPartners Claims
  • HealthReach
  • Healthscope Commercial
  • HealthSmart Benefit Solutions
  • High Mark Blue Shield
  • Jp Farley Corp
  • Key Benefit Administrators
  • MCBH/INTERACT
  • MedBen Med. Benefits Administrators
  • Medical Mutual Of Ohio
  • Medigold (Medicare)
  • Mount Carmel Health Plan Medigold (Medicare)
  • Nippon Life Insurance Co Of America
  • Ohio PPO Connect
  • OhioHealthy Medical Plan
  • OMAHA Insurance Company
  • Optimed Health Plans
  • Quality Care Partners
  • Self-Funded Insurance through Employer
  • SuperMed PPO
  • Thrivent Financial Health Claims
  • Tricare
  • VALUE OPTIONS
  • Western & Southern Financial Group
  • WPS Tricare For Life

We believe this carrier has no out of network benefits.  We strongly encourage to check with your carrier to locate a participating provider or you will be responsible for the entire cost of care.

  • Anthem Blue Cross Blue Shield HMO (Medicare)
  • Humuna HMO (Medicare)
  • MedMutual Advantage Choice HMO (Medicare)
  • Ohio Qualified Medicare Beneficiary
  • Tricare HMO