COVID-19 ADDENDUM

In an effort to continue to provide our clients with the emotional and mental supports needed during the COVID-19 Crisis, River City Integrative Counseling Services will be offering all outpatient therapy services either face-to-face in our office or via telehealth. Our telehealth services will be provided using “Google Hangouts “which is a HIPAA compliant audio/video software. We can easily send you the “link” so that you can download before your session with our Therapists. Our clients who may not have access to a computer or a smart phone, will be eligible to receive all outpatient therapy services over the phone. In order to ensure that our clients get the care and services they need, during this state of emergency, we are working collaboratively with our insurance payers to ensure the appropriate reimbursements occur.

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.