Thank you for choosing us as your health care provider. The following is a statement of our Office Policies.
Usual and Customary Rates:
The office currently utilizes usual and customary fees for this area. An insurance contract is an agreement between you, the patient, and your insurance carrier; therefore, you are responsible for payment regardless of any insurance company’s determination of rates. In the event that an authorization from your insurance company is not obtained, you will still be responsible for payment of services rendered. All patients may receive an invoice and other documentation to provide any information necessary to assist in your own effort to obtain insurance reimbursement. Please be aware there may be additional charges for phone calls, refills between visits, completing forms, and other services.
In-Network Insurance Coverage:
Patients who are members of BCBS PPO who have co-pay insurance policy will be required to pay a co- payment, which your insurance company requires us to collect at the time of service. With any deductible plan, your visit will be billed to your insurance carrier and any remaining balance will be the patient’s responsibility.
Self-Pay and Out-of-Network Insurance Policy:
For all patients who are self-pay or have out-of-network insurance, payment for services rendered are due in full at the time of service. Patients with out-of-network insurance benefits can receive reimbursement directly from their insurance company as this office is not currently contracting with any companies other than BCBS PPO.
Some consultations/sessions may be conducted via telehealth. To participate in telehealth, both the patient and provider agree (1) not to record the session and (2) to participate in a private location alone, unless an alternate arrangement is agreed upon prior to the session. Both the patient and provider can discontinue the session in the event of technical issues or interruptions. Patient must be physically located in the State of Illinois at the time of the session. Billing for these sessions will occur at the same rate as in-office visits.
Patient accounts with no payment activity or those with previous payments arrangements that are not being adhered to, will be considered past due after 30 days and your credit card on file will be charged around the 21st of each month. Your account may be referred to an outside agency for collection, and any costs associated with this action will be the responsibility of the patient. Accounts with balances past 90 days will be subject to a finance charge of 1.5% per month. Patients with delinquent bills may also be dismissed from the practice.
The office currently accepts payments by cash, credit cards or by check. However, if an account is paid for by check or credit card and the check is returned or the credit card charge is disputed inappropriately the account will be subject to a $25 returned item fee plus any additional fees incurred by either banking institution.
Mental Health law dictates that we can neither confirm nor deny that a patient is being seen or has been seen at our practice without written authorization from the patient, which includes any and all family members unless the patient is less than 12 years of age. *Please be advised that questions regarding billing matters can be discussed with the patient, guardian or insurance policy holder without written authorization.
Phone calls will typically be returned only when the office is open. These times and/or days are subject to change, especially if they fall on a holiday. When your provider is out of the office, the answering service will be available for emergencies, and the office phone will be available again on the following regular hours business day. Phone calls with your provider, whether or not they are placed during business hours, may also be billed to the patient (not their insurance company) at the provider’s discretion.
If your situation is an emergency and you need immediate attention, please call 911 or go to your closest emergency room. Dr. Lott can also be paged by the answering service for matters that are urgent and require immediate attention; however, calls paged to Dr. Lott may be subject to a $50.00 fee for the first ten minutes of a call and $25.00 for every ten minutes thereafter. *Charges for these Phone Call Fees are not billed to insurance and will be applied to the credit card on file.
The office requires at least 2 business days’ notice from the patient for refills to be processed. Refills will only be accommodated when the provider is in the office. Controlled Substance medications are monitored by the DEA and for regulatory reasons, controlled medications will only be mailed to the patient by Certified Mail. This is a fee that must be paid by the patient before the prescription is mailed out. Prescriptions outside of an appointment as well as misplaced prescriptions will not be issued to patients on a regular basis and may be subject to an additional $30 prescription fee. Please contact the office regarding these events if they occur.
Failed Appointment/Late Cancellation Policy:
Regular appointments are an important part of your treatment. Scheduled appointments must be cancelled by noon on the previous business day or you will be charged a Late Cancellation Fee. For appointments on Mondays or days after a holiday, this means that the cancellation must be made before the appointment time on the most recent regular business day (i.e. Monday appointments typically must be cancelled before the appointment time on the preceding Friday).
Arrivals of more than 10 minutes late may need to be rescheduled and will also be charged a Late Cancellation Fee. Should you fail to show up for an appointment you will be charged a Failed Appointment Fee. Your credit card on file at the office will be charged for any of these fees; if the card is declined the fee must be paid prior to your next scheduled visit. These charges are not billed to your insurance company. Fees are currently $100 for therapy appointments or medication treatment sessions over 1 hour, and $75 for other visits, but these are subject to change.