Services may be covered in full or in part by your health insurance or employee benefit plan. If you wish to utilize your insurance coverage, River City will submit claims on your behalf. You will be expected to make your co-payment, deductible, or any amount not covered by your insurance company or referral/funding source at the time of your appointment. Pre-authorization from your insurance company is not a guarantee of coverage, and you will be responsible for payment of any services that were not covered by your insurance company. You are required to notify River City of any change of insurance PRIOR to your next scheduled appointment. If you do not notify our office of new insurance information, you will be required to pay in full for your visit. Please notify us of any change in address or phone number so that we may contact you if needed.
I, the undersigned, agree to the contents contained within the River City Integrative Counseling’s COVID-19 addendum and consent to receive telecommunication services.