Developmental Diagnostics Billing Policy I. PAYMENT FOR SERVICES: You are responsible for your charges. Monthly statements are sent to keep you informed about your account; please pay your portion upon receipt. You can choose from these payment options available: Self-Pay or Insurance. Each of these options has advantages which may suit your needs. Precertification: Some insurances require treatment plans or contact from your neuropsychologist to precertify evaluations. We will verify if this is needed for your insurance and notify you of this if applicable. NOTE: If you are unable to complete your therapy due to financial hardship, you can discuss these concerns with our office. It may be possible to work out a payment plan that is more suitable to your financial situation without jeopardizing the financial operation of the clinic. Advantages and Policies of each option SELF-PAY Accounts Cash*Check*Credit Card ADVANTAGES: A. Protects your privacy by avoiding insurance industry access to information concerning your treatment. B. Frees your neuropsychologist to pursue an evaluation without restrictions or delays due to policies of your health plan. POLICIES: Clients who pay for appointments at the time of service and are not using insurance will be given a 10% discount. A Payment plan can also be arranged, please discuss this option with the office. CREDIT CARD Upon receipt of statement, mail in credit card information with payment stub or call in information and we will mail you a receipt upon request. II. CHECK-IN PROCEDURE: When you arrive at the office for an appointment, please check in at the reception window. This is the time for you to make any payments. III. CANCELLATIONS & NO SHOWS: A 24 hour notice must be given or $75.00 may be charged (insurance will NOT pay for this). Additionally, failed appointments may jeopardize continued service at Developmental Diagnostics. Any request for exception to a failed appointment charge needs to be sent in writing to the office. IV. DELINQUENT ACCOUNTS: The following apply to past due accounts: 1. INSURANCE ACCOUNTS In most cases we will be able to bill your insurance company directly. However, this is a service we provide for you and it carries no guarantee of third party coverage. You always remain responsible for your bill. 2. ADVANTAGES: Overall costs may be reduced to copayments/coinsurance and deductible amounts. Policies: Most insurance does not cover 100%; therefore, a co-payment or coinsurance is due from you on the Date of Service (DOS). If you elect to have us bill your insurance company, you will have 90 days from the DOS to pay the balance in full, regardless of whether or not your insurance company has responded (most insurance companies reimburse within 60 days of billing). Insurance requires a medical diagnosis and, if so, you will be responsible for charges. Note: Most testing is not insurance reimbursable. Check with our office for clarification. V. Interest Rate: A monthly 1.5% interest rate will be applied to the balance of all accounts following a 90-day grace period. Finance charges are the responsibility of the client. Maximum Balance: (For Therapy Clients Only) A client can maintain no more than a $500.00 balance without jeopardizing the use of clinic services. We reserve the right to terminate services with a client who is failing to maintain his/her financial responsibility. Exception can be made for clients who have communicated with the office and have established an alternative payment plan. ACCEPTANCE OF CLINIC POLICIES: You have received the Developmental Diagnostic Billing Policy and it is understood that you are responsible for the account and agree to abide by the terms of said policy.