Questions or Concerns | Central Behavioral Healthcare

Central Behavioral Healthcare, INC (CBH)
Services Policies

FEES: Our current fee is $200.00 per session. The initial session is $225.00. Court-related cases are $250.00 per session, and court testimony and travel time is $350.00 per hour. The duration of a session ranges from 45-60 minutes. Payment arrangements will be determined at the time of your first visit. Any changes in this agreement must be approved by CBH.

OTHER CHARGES: We will charge for phone calls or preparation of insurance claims only if they become too time consuming. We will inform you of any such charges. Any service provided under subpoena will be charged at court testimony rates.

When psychological tests are administered, or if reports of any kind are prepared for another party or you, there will be an additional charge. If you are not sure if this applies to you, please ask your therapist.

There will be a $35.00 charge for returned checks. A finance charge of 1.5% per month will be calculated on all balances of over 90 days due.

MISSED & CANCELLED APPOINTMENTS: Missed appointments and cancellations less than 24 hours prior to the scheduled appointment may result in a charge for that time. Our phone is answered 24 hours per day and a message is sufficient notice during times when the office is closed.

FAILURE TO PAY YOUR BILL: Financial hardships may occur to any of us. These hardships should be discussed with your therapist, so that necessary changes in your payment agreement can be made. Non-payment may result in collection efforts or legal action. This is a regrettable action used only when other efforts have failed. If an account is sent to collection, you will also be held financially responsible for all ordinary collection fees assessed to our CBH.

CONFIDENTIALITY: Information revealed in your session is confidential and will not be released to others without your permission. There are some exceptions to this policy. If you were referred by your physician for consultation, we usually send information back to your physician so your complete physical and mental health can be coordinated. If you health insurance is a managed care program, we are required to provide information to them so payment for services rendered can be approved. If you have concerns about this information, please discuss it with your therapist. Some legally required exceptions to confidentiality include situations of potential harm to oneself or others, incidents of child abuse (Ohio has mandatory child abuse reporting law) and instances where a court may order records.

Payment Agreement

I will pay for all professional services at the time they are offered. I will file my own insurance claims and request that CBH provide me with statements and receipts. (Note: All court-related services fall into this category. Court-related services are not health care services.)Using this method

I participate in a health insurance plan. I understand that CBH will bill my insurance company directly for all professional services.Using this method

I understand that my required co-payment at the time of each scheduled appointment will be:

OtherUsing this method

If other was selected above please specify below:

I understand CBH's fees and payment policies and agree to these conditions. I understand that payment by my insurance company is not guaranteed. I also understand that CBH determines payment amounts on the basis of information provided by my insurance company. Therefore, these amounts are APPROXIMATE and may be changed to accommodate actual insurance payments. The coordination of payments between two or more insurance companies is determined by those insurance companies and CBH is not responsible for such rulings.

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Central Behavioral Healthcare, INC (CBH) Services Policies

Payment Agreement

Central Behavioral Healthcare, INC (CBH)
Services Policies