Fee Disclosure and Patient Payment Responsibility Agreement
The Rock Counseling Group’s hourly fee is $200 for individual counseling and couples counseling initial sessions and $175.00 for subsequent sessions for both individual and couples. Each clinical hour is usually 45-50 minutes of interaction with 10 minutes allotted for preparation and writing clinical notes for your medical record. You will be expected to pay for each session at the time services are rendered, unless we agree to other arrangements in writing that have been approved by The Rock Counseling Group President/CEO or designee, or there is not a credit on your account that can be used for payment of current fees for services rendered.
The Rock Counseling Group charges $175.00 per hour pro-rated fee for other professional services you may need including but not limited to: Telephone conversations, Consulting with other professionals with your permission, Preparation of treatment summaries, and Time spent performing other services you may request that are not covered by your insurance plan. This time will be pro-rated in 15-minute increments. A minimum of 15 minutes will be charged for other professional services provided and will be the responsibility of the client when the services are not able to be billed to insurance. In the case of multiple emails, text messages, or phone messages, the time will be combined to reflect the total amount of time required daily by the therapist to respond. Payment for these services will be billed to your credit card on file within 1-3 days after services are rendered or an invoice will be mailed to you and payment is expected upon receipt of invoice. Past due balances for other professional services that go unpaid may prevent future services being provided until the balance is paid in full or payment arrangements have been made.
Court Testimony or Professional Opinion Requests
The Rock Counseling Group also requires that for any request for professional opinion or testimony in court that a minimum of $800.00 retainer be applied. The cost of in-person testimony is at a rate of $225.00 per hour. This rate will apply to both in-person testimony as well as time required for travel or waiting in the courthouse. The Rock Counseling Group will make every attempt to minimize your costs when possible.
Payment schedules for unusual financial hardship may be considered upon request and only with written and signed approval from The Rock Counseling Group President, CEO, or designee. If your account has not been paid for more than 30 days and arrangements for payment have not been agreed upon and approved by The Rock Counseling Group President, CEO, or designee, we have the option of using legal means to secure payment through collections and terminating treatment services. When legal means are used to secure payment, we will only release the client’s name, contact information, nature of services provided, and the amount due, and a copy of this signed informed consent and fee agreement.
By signing I agree that I have read and understand the fees and payment responsibility and take full fiscal responsibility to ensure my account is in good standing and payments are made at the time services provided.