HIPAA and PHI Policy
The services provided by Friends Counseling Center, Inc (FCC) are performed by Master's level counselors or Licensed counselors by the State of Indiana. A standard session time is 53 minutes.
INSURANCE: If you have insurance that includes Mental Health Benefits, the initial intake session will be billed at $200 and each session thereafter will be billed at $150. You will be responsible for the remaining amount not covered under your Mental Health Benefits. The insurance benefits quoted by your insurance company and/or FCC are not a guarantee of payment. Please note that benefits can change periodically and may affect the amount that your insurance company will pay. The final confirmation of your benefits and copay will appear on the Explanation of Benefits you receive from the insurance company.
SLIDING SCALE: For clients who do not have insurance or choose not to bill services through insurance, we offer sliding scale fees based on the client's annual household income. An additional $20 will be billed for the initial session and yearly intake.
Proof of income must be provided to determine and set the session fee (i.e. a current tax return or the three most recent pay stubs). Clients should report any changes to income and provide supporting documentation. Clients must provide their proof of income via mail, email, fax, or in person prior to or at their first appointment. If proof of income is not received by the first appointment, clients will be charged a $75 fee for the initial session. Clients will not be able to reschedule until proof of income is provided.
Annual Income Fee Annual Income Fee
Under $20,000 $55 $60,001-70,000 $90
$20,001-25,000 $60 $70,001-80,000 $95
$25,001-30,000 $65 $80,001-90,000 $105
$30,001-35,000 $70 $90,001-100,000 $115
$35,001-40,000 $75 $100,001-110,000 $125
$40,001-50,000 $80 $110,001-120,000 $135
$50,001-60,000 $85 Over $120,000 $145
PAYMENT: Payment for counseling is due at the time of your counseling session. No cash will be accepted at the Satellite offices. Checks should be made payable to Friends Counseling Center (FCC). We also accept Visa, MasterCard, and Discover. If you miss two payments, we will not be able to reschedule you until we receive your full payment. Checks returned for non-sufficient funds are charged $25.
SESSIONS and CANCELLATIONS: It is very important to let us know at least 24 hours in advance if an unexpected conflict arises with your appointment time. If you have three late cancellations or no shows, within a 3 month time period you may be terminated as a client. You may be charged a fee of $30 for late cancellations. For no-shows, you may be charged the full fee if you have insurance. Missed appointments cannot be filed with insurance. In case of emergencies, i.e. unexpected weather, you will not be charged.
ADDITIONAL CHARGES:
DRUG & ALCOHOL ASSESSMENT: The fee for a Drug & Alcohol Assessment is $150.
SUB. EDUCATION CLASS: The fee for the 8-hour sub ed class is $150. The Fee for the 12-hour Sub Ed Class is $175.00. This is a self-paid class, insurance is not utilized for this service as it is an educational group.
COURT APPEARANCE: The charge is $175/hr port to port with a minimum of one hour. After one hour, it is billed in 30 minute increments. A $350 retainer fee is required.
REPORT WRITING: When a report is requested the client will be billed $75. *These fees are not billable to insurance or Medicaid.
COPY OF RECORDS: There is a $20 fee for all records that contain 10 or more pages.
PHONE SESSIONS: FCC doesn’t offer Telehealth services. In situations in which a phone session is needed, the client may pay $1 per minute as insurance will not cover this service. Phone sessions are available at the discretion of the clinician and are not to be utilized for on-going treatment.
3565 S. State Road 13, Wabash, IN 46992 | 260.563.8453 | 260.569.0335 FAX
office@wabashfriends.org | www.friendscounseling.org
Wabash | Huntington | Logansport | Marion | North Manchester | Tipton
office@wabashfriends.org | www.friendscounseling.org
Wabash | Huntington | Logansport | Marion | North Manchester | Tipton
