Helpful Information

 

To save time please use these downloads to print the initial paperwork. Please bring these completed forms to your first appointment:

New Client Information Form

Disclosure Statement SFCC.pdf


Telehealth Disclosure Statement

Covid 19 Informed Consent


Other helpful downloads:
Notice of Privacy Practices
AAMFT Code of Ethics


What to Expect


Location


Payment Information / Good Faith Estimate
To make counseling more affordable, I am a provider for many insurance plans and can file your insurance on your behalf. In accordance with the No Suprises Act, you are entitled to receive a written good faith estimate of expected charges, upon request. In general, total cost is based on the number of sessions you attend. Therapy is a very unique journey for each individual; therefore, the frequency of sessions will vary by individual. Session frequency is dependent on many things including: your schedule & life circumstances, ongoing life changes, the nature of your challenges & how you are coping with them, and therapist availability. As we work together, we will continue to evaluate the appropriate frequency of therapy and to determine when you have met your goals and are ready for discharge. Most therapy begins as weekly but biweekly or monthly can be discussed in person. In general, most clients attend six to twenty sessions per goal.

Specific CPT Codes used in most situations are:

  1. •90791 Psychiatric Diagnostic Evaluation (Initial Session)                                       $180

  2. •90837 Psychotherapy - 55-60 min sessions (weekly, biweekly, or monthly)    $160

  3. •90844 No Show / Cancellation with less than 24 hours notice                            $80

If I am a provider for your health insurance network, your cost will be based on your health insurance policy. Variables such as deductible, co-insurance, and copay will guide your cost and can be determined by your policy. Most clients only pay their co-pay for each session.

If I am out of your health insurance network, your cost may still be impacted by your policy, as you may have some out of network coverage. But ultimately whether out of network of uninsured you are responsible for the full cost of sessions as outlined above per session.  Payment for services is expected at the time of service for any portion not covered by your insurance. For your convenience, I accept cash, check, HSA accounts, or credit card (via Square).


I would be happy to check your health insurance benefits and eligibility for you. For this service, simply email me a copy of the front and back of your insurance card, with your name and date of birth. Typically, sessions are weekly, however, I am open to working with you to create an arrangement that respects your budget.

Accepted Insurance Plans:

  1. •Aetna

  2. •Anthem

  3. •BlueCross and BlueShield

  4. •Cofinity

  5. •Group & Pension Administrators

  6. •Indiana University Health

  7. •Multiplan

  8. •New Avenues / Midwest Behavioral Health

  9. •PAI

  10. •Pro Health

  11. •Sagamore Plus

  12. •Unified Group

  13. •Out of Network Insurance plans can also be billed for your convenience