Payment is Due as Services are rendered:
Insurance: As a convenience to our clients, we will gladly process your claims, but we request that you pay your estimated portion at the time of the session. The remainder of the session will be billed to your insurance company. If you have a secondary insurance you may be responsible for having those claims processed. If any changes are made to your policy/coverage, it is your responsibility to inform Augustine Counseling.
Verbal verification of your insurance does not guarantee payment by your insurance company. It is your responsibility to know your benefits and to notify Augustine Counseling immediately of any changes in co-pays, deductibles, annual limits, authorizations and/or pass-through visits. Any discrepancy that results in lack of payment will be the responsibility of the client.
Cancellation Policy: All cancellations require a 24 hour notice. Failure to do so may result in a $65.00 No Show fee.
I have been informed of, read, and understand and agree to the above terms.
