General Policies and Financial Obligations for Our Patients and Their Families

The Doctor/Therapist you have chosen is a member of a psychiatric practice called "Village Family Psychiatry, PLLC". He/she ascribes to the general policies and procedures developed by that group in the items that follow.

Please review this carefully as you will be asked to sign a financial agreement attesting that you agree to abide by these policies. (Downloadable form here)

  1. A financial information form containing billing and insurance information is completed at the time of your initial appointment. You are required to complete and sign a financial agreement with your Doctor/Therapist and Village Family Psychiatry and sign a release which allows us to bill and provide necessary clinical information to your insurance company to qualify for coverage.
  2. Most insurance companies reimburse a large percentage of the costs of our services. Our billing department will automatically file your claim but if you are required to submit information to them prior to payment, this is your responsibility. If you are not using insurance, payment in full is expected at the time of your appointment.
  3. PLEASE BE AWARE: You are ultimately responsible for your bill, not the insurance company.
  4. Missed appointments will be charged at the usual rates if that are not cancelled at least 24 hours in advance. (Monday appointments must be cancelled no later than the previous Friday morning). Your special time is for you only. A 24-hour notice may give us a chance to allow another patient to use that time, as appointment time is limited. Insurance companies do not pay for this time and you will be held personally responsible for the entire fee for missed appointments.
  5. Some of you may belong to an HMO or PPO and your fees will be automatically discounted according to your contract. You are responsible for all co-pays and deductibles at the time of service. Be prepared to pay this each time you come to the office. If you/we are unaware of co-pay amounts at your initial visit, a minimum payment of $30.00 on your account is required.
  6. Our Doctors/Therapists provide all the usual services within the sessions that are scheduled. Patients with children being seen who have questions or concerns should let the Doctor/Therapist know of their need at the start of the session time. If refill prescriptions are necessary, let the Doctor/Therapist know at that point.
  7. The Doctor/Therapist or one of their associates is available 24 hours a day, 7 days a week for emergency telephone contact. He/she can be reached through our office or the on-call service. Please give the service your name and inform them that it is an emergency. We value your contact in real emergencies as it may smooth your treatment, allow them to adjust your medications appropriately or help prevent unwelcome hospitalization. However, routine clinical updates or questions should await your session. Billing or other clerical matters can be handled through our support staff or the Village Family Psychiatry billing office during our regular weekday business hours.
  8. In case of divorced parents, we are aware that often the non-custodial parent is responsible for payment of medical bills. However, if the legally responsible party does not respond, the responsibility for the payment falls to the parent who arranged for our services.
  9. Patients with large outstanding bills will have their accounts reviewed and may not be eligible for further services. Please keep your accounts current and up-to-date to insure that there is no disruption in your treatment process. If accounts are not paid in a reasonable time, collection services are utilized and you will be responsible for additional charges accrued in this process. Returned checks will add an additional $30.00 service charge.
  10. The following fees correspond to the service provided for the level of training and licensure of our clinicians:

    Psychiatrist/MD Psychologist/LCP Master’s Level/LCSW/LPC
    Initial Assessment $325.00 $190.00 $150.00
    Medication Management/Follow-up Visit $110.00 N/A N/A
    Individual/Family Therapy N/A $150.00-$175.00 $110.00-$135.00
    Psychological Testing Per Hour N/A $175.00 N/A
    Legal/Court Fees Per Hour $600.00 $300.00 $300.00-$450.00
    Note: Waiver of Missed Appointment or Late Cancellation Fees Occur only at the discretion of the clinician you are seeing and our office staff are unable to help with this issue. If a valid reason can be provided, you can bring this up in your next appointment with your doctor or therapist.

  11. Services provided outside of regularly scheduled visits may be charged at an additional rate. In general, additional fees are based on the amount of time a clinician needs to spend on your request. Your insurance pays for your medical and therapeutic treatment. For example, it does not cover time spent interfacing with school personnel, drafting letters, or completing disability claim forms. At the discretion of your practitioner you may be billed for these services and will be informed in advance of these charges. You have the right to rescind your request for these services if you so chose. Our Physicians may charge you for prescriptions written outside your appointment time based on the time required for chart review and prescription call-in or preparation ($15.00 to $25.00).

We appreciate your careful review of this document and understand that it can seem "inflexible" or "overwhelming". It is through our combined decades of clinical experience that we have come to understand the importance of clarifying policies and procedures as succinctly and clearly as possible at the initiation of treatment.

We are aware that the emotional issues that may have brought you to treatment do not need to be further compounded by confusions, uncertainties or lack of clarity in regard to our policies in the office. Please talk to us directly if you have concerns about what you have reviewed. As well, our support staff are always ready to be of assistance to you in clarifying what has been outlined.