Our Policies

OFFICE BILLING & INSURANCE POLICIES/AUTHORIZATION FOR PATIENTS

I will provide all required insurance information when checking in for my appointment and will update any changed insurance information before the next visit.

I authorize (co) payment in full to be made directly to this provider on the day of the appointment for all rendered services. This can take the form of cash, check or debit/credit card.

I understand that the information my insurance company provides to me or Altman Psychiatric Associates is not a guarantee of the benefits provided or paid by my insurance company. I understand that I am responsible for payment of services I receive, whether or not my insurance company covers these services.

I understand that it is my responsibility to pay any co-pay, deductible or co-insurance amount not paid by my insurance and this is due at the time of each visit. If payment is not made at the time of the scheduled appointment, a $10.00 administrative fee will be assessed.

I understand that there is a $30.00 service charge for all returned checks.

I understand that there is a minimum of $5.00 added to all amounts unpaid within 60 days from the date of service.

Accounts that are 90 days past due or exceeding $200 will be subject to appointment cancellation and possible collections.

There is a minimum $25 charge for releasing medical records plus $0.50/page for every page above 20 pages.

REVIEW THIS POLICY BEFORE YOUR FIRST VISIT

CANCELLATION AND NO SHOW POLICY If you need to cancel your appointment or change your appointment, please do so as soon as possible by calling 484-879-6173. If cancellation does not occur at least 24 hours prior to your appointment, you will be charged $50.00 for that cancelled appointment. If you no show for a scheduled appointment, you also will be charged $50.00.

Appointment reminder calls 24-48 hours in advance may occur for initial evaluations, but these are considered courtesy calls. Thus if no call is received, you are still responsible for payment for a missed visit. Please let the office know if you choose not to receive reminder calls.

Any Form Completions if Doctor’s agreed the Charges Will be  min $25.00 per page.

we don’t do evaluation for legal purposes and for courts.

HIPPA Policy download pdf please review this policy before your first visit with me.

Emails should not be used for urgent communication as they may not always be checked daily. Thus the best form of communication for any urgent issues is by phone or ideally by appointment.

Phone messages will be returned during the same business day. If there is an urgent issue for which you do not receive a phone call as promptly as you feel is necessary, please call 911 or proceed to the nearest emergency room.

Our Forms

REGISTRATION FORM
CC Pre-Auth Form
confidential client info
TELEHEALTH FORM
DRUG POLICY FORM
CONSENT TREATMENT
MR RELEASE FORM
HIPAA COMPLIANCE

Our Rates

MD’S RATE FOR SELF-PAY PATIENT

Adult Initial Evaluation Rate $350.00

Adult Follow Up Rate $110.00

Child Initial Evaluation Rate $500.00

Child Follow Up Rate $150.00

LCSW RATE FOR SELF-PAY PATIENT

$140 for initial evaluation

$120 per 45-52 minute session

$120 per 53-60 minute session

$70 per 30 minute session