Thank you for choosing Afg Guidance Center as your behavioral health care provider. We are committed to you and your family’s treatment being successful. Please understand that the payment of your bill is considered a part of your treatment. The following is a statement regarding our Financial Policy, which we require you to read and sign in order to receive ongoing treatment. Download the complete form.
Payment For Services
- We only accept Blue Cross Blue Shield PPO for insurance.
- For Out of Network clients, full payments are due at the time of service unless other arrangements have been made with your individual provider.
- You will be provided with a receipt that you can submit to your insurance provider for reimbursement. We recommend that you become familiar with the guidelines pertaining to your specific policy in regards to seeking reimbursement when seeing an out-of-network provider.
- Payments in the form of Cash, Checks, or Credit Card (Discover, Mastercard, or Visa) are accepted. Checks should be made out to Afg Guidance Center.
- There is a $30.00 service fee for checks returned for non-sufficient funds, and the client will be required to pay for future sessions in cash.
- PRIOR TO THE FIRST APPOINTMENT, please call the number on the back of your card to find out what your behavioral health coverage includes. Please verify with your company the amounts of coverage for outpatient psychotherapy. Please confirm your Behavioral Health Care is covered by your Blue Cross insurance policy prior to the start of services. If your policy requires preauthorization to receive services, this is your responsibility and needs to be handled before your first visit. You will be responsible for fees due to no authorization being obtained.
- This office cannot accept responsibility for collecting your insurance claims or for negotiating a settlement on a disputed claim.
- Additional fees are charged for lengthy telephone communications (over 15 minutes), court attendance, school observations, and progress report/letter writing. Insurance does not cover this. Rates for these services will be provided to you by your therapist/psychiatrist.
Cancellation & No Show Policy
At Afg Guidance Center, we trust you share our belief that therapy is medically necessary and receiving the prescribed therapy is crucial to a successful outcome for your child. We understand there will be times when your child is sick or other unavoidable events will prevent you from keeping your regularly scheduled medication, assessment, and therapy appointments. If this occurs, we ask that you contact your treatment provider as soon as possible so that they have the opportunity to reschedule the missed appointment and fill your child’s time slot with another appointment. Our doctors and clinicians will do whatever they can to be available to your child and accommodate your family’s schedule when making appointments. It is expected, in turn, that you will schedule appointments in good faith and facilitate adequate time in your schedule to keep your child’s therapy a priority. This policy is effective immediately.
- We require 24 hours notice in the event of a cancellation. It is your responsibility, when you call in, to have an alternative time in mind that will ensure you get the full treatment for that week. In some cases this may not work.
- A No Show is a missed appointment that was not canceled within the 24 hour window.
- We cannot bill your insurance company for No Show appointments. Therefore, you will be responsible for fees associated with this missed session.
- Missed Psychiatric Evaluation and Medication Follow Up Appointments are billed at a no show rate of $240.00 per scheduled hour for the psychiatric evaluation and per each missed medication management appointment.
- Missed Psychological Testing, Neurofeedback, and Therapy appointments are billed at $140.00 per scheduled hour.
- If you have questions regarding this policy, please speak with your individual treatment provider.
- I have read, understand, and agree to this Cancellation & No Show Policy.