FEE-RELATED INFORMATION

You are able to pay for sessions using a cash fee-for-service arrangement or your health insurance. Each therapist is a provider for many insurance plans available. Checks or cash are accepted. Checks can be made out to Kimberly Keiser & Associates.

If you have a health insurance policy, it usually provides some coverage for mental health treatment. Our office manager will submit all claims on your behalf. However, you (not your insurance company) are responsible for full payment of the fee.  Please contact your insurance company to learn about your mental health benefits and co-payments and to determine if pre-authorization is required for mental health services. Please keep the following things in mind:

  • Know your co-pay. Co-pays must be paid at each visit by cash or check or at the end of each month. You are not allowed to carry a balance past 30 days or services may be discontinued.

  • Know if pre-authorization is required before your appointment. Sessions not covered by insurance due to pre-authorization not being made will be billed at the full service fee.

  • Bring your insurance card to first appointment. A photocopy is needed for claim submission.

If you are experiencing circumstances of unusual financial hardship, limited reduced fee slots are available. Availability of these services and the reduced fee rate for service will be determined after discussion with your provider. Payment schedules for other professional services (e.g., meetings, speaking engagements, consultations, litigation, etc.) will be agreed to when these services are requested.

Session Cancellation Policy

Consistent attendance at your sessions is critical to your therapeutic success. The session cancellation policy will be applied in all circumstances. The session cancellation policy is as follows:

  • Once your standing appointment hour is scheduled, you will be expected to pay the full service fee (even if it is missed), unless you provide 24-hours advanced notice of cancellation. If your appointment is on a Monday or day after a holiday, your appointment is required to be canceled 24-hours in advance on the previous business day.

  • Insurance cannot be used for sessions that are missed. In the event that you do not provide 24-hours advanced notice, you will be responsible for paying the full service rate.

All clients must complete the applicable intake forms before beginning treatment. 

Adult Intake Form

Informed Consent Form

Financial Policy Form

HIPPA Privacy Information Form

Release of Information

Psychotherapy Intensive