HEARTPRINTS COUNSELING LLC

In Person and Telehealth Services:
(Services only available in Washington State)

Optional Meet and Greet 30 Minutes: Free
Initial Intake 90 minute assessment: $265*
Individual 50 minute session: $155*
Individual 85 minute session: $250*

*Telehealth Services are the same rate but may not be reimbursed by your insurance plan.

Full payment is required at the beginning of the session so we can fully utilize the allocated time to focus on your therapy.

Methods of accepted payment:

• Cash
• Check
• Credit card
• Debit card
• HSA/FSA

Out of Network Provider: As an out-of-network provider, you are required to pay in full at each session. By paying upfront at each visit I am able to keep my rates at a competitive fee even for those using insurance. You should be aware that submitting claims to your insurance company requires a mental health diagnosis and carries a certain amount of risk to confidentiality, privacy, and to future capability to obtain health or life insurance. The risk stems from the fact that mental health information is likely to be entered into insurance companies’ computers and is likely to be reported to the National Medical Data Bank.

Superbill/Receipts: A superbill is a special receipt with clinical codes insurances use to verify payment. Not every insurance accepts super bills for reimbursement (i.e. Apple Health, Kaiser, Molina). For others, it depends on your plan. If you would like to use your insurance for reimbursement, I’d encourage contacting them to know what your benefits are for an out of network provider. If using telehealth services, you may check to see if those are also covered under your plan. To expedite reimbursement, superbills may be requested with 24 hour notice. Please do not hesitate to ask about clarification or if special circumstances necessitate a more urgent superbill. Please know phone sessions, telehealth, and missed appointment fees may not be reimbursable by insurance. For credit/debit charges, cash payments, and checks, a written receipt can be given at time of service upon request.

Cancellation Policy: It is important to remember that when scheduling an appointment, the time is set aside specifically for you. Therefore, a 24-hour notice of cancellation by phone is required for a session that will be missed. Sessions that are missed without a 24-hour notice will be billed at full charge. Whoever schedules the appointment is responsible for the fee except for minors. If you do not want your teenager to be authorized to schedule appointments, you must notify me to prevent charges. Parents are welcome to have their teenagers contribute to the missed appointment fee if they feel it is necessary. Further appointments may not be scheduled until the balance has been paid or a payment method has been secured.

Additional services:

• Established Client Phone Consults Wrap-Around Meetings & Observations: Prorated at $140 hr
  (the first 15 minutes are not charged)
• Group Presentations $150 an hour
• Report Writing $300 an hour
• Special Services (i.e. Court testimony, Court Preparation time, Depositions)* $300 an hour.
• Court Appearance $1500 minimum charge

If a subpoena or notice to meet attorney is received without a minimum of 48- hour notice there will be an additional $250 "express" charge. Also if the case is reset with less than 72 business hours notice, there will be an additional charge of $500. All fees are doubled if counselor, Kristal Mathis, had scheduled time off.

In regard to report writing, an approximate retainer is due upon the request of the item. As the requests vary in nature, time and fee is estimated. Upon completion, the final updated fee/credit will be given/received at the time records are released. I do not practice therapy to write reports or letters or evaluations. The increase in fee is due to the additional time it takes away from my clinical work. Please note I do not write letters of recommendations for child custody or visitation schedules. If you or your family is involved in a divorce, custody, or any other litigious proceeding, my role is not to make recommendations to the court concerning custody or parenting issues.

Request of Records: Formerly included in Report Writing, Request of Records follows the following guidelines set by the RCW 70.02.010(37): $1.17 per page for the first 30 pages, .88 for each page following, with an added $26 for clerical and handling fee plus the time taken for me to personally edits confidential information from the record, as required by statute is the usual office visit time fee. As in Report Writing, a deposit is due at the time of request with the fee/credit finalized upon receiving the records.

“No Surprise Act: You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.”