Your agreement to the following clinic policies is required for you/your child to receive professional services.
Confidentiality
There is no guarantee of confidentiality under the following conditions:
- If we suspect you/your child are/is in imminent danger of harm to self or others, or a child or elderly person is being abused or neglected (as we are mandated reporters)
- If a court orders a release of information
- If you initiate a malpractice lawsuit, or a billing dispute with a financial institution
- If your insurance company requests to review your/your child’s case
- If you pay by credit card, our name will appear on your credit card statement
- If you do not pay your bill, your balance due statement (including diagnostic and procedural codes) may be sent to a collections agency or other responsible party
- Between our administrative staff, or colleagues with whom we consult professionally
- You consent to be contacted by email regarding Nema Health services that may be of interest to you in the future.
- You consent to be contacted by email or EMR patient portal for up to one (1) year after your Clinical Evaluation Session in order to determine symptom stability.
Payment
You agree to pay professional fees as follows (unless you’ve agreed upon another amount with a Nema Health staff member):
- $400 for psychiatric evaluation
- $275 per session for approximately 12 sessions of therapy with a Master's level clinician.
Master's level clinician will be assigned during initial assessment with your input. Sessions with an MD or PhD level clinician may be charged at a different rate.
If you would like assistance with out-of-network reimbursements in the form of a superbill, please message your provider in the patient portal.
Please note that medication management services are an additional cost. The provider who completes your Clinical Evaluation will discuss whether medication management is appropriate for you at your Clinical Evaluation.
Payment Schedule and Fees
- The fee for the Clinical Evaluation Session will be charged the morning of your appointment. If all of your intake forms are not completed by 8am Eastern Time the morning of your Clinical Evaluation Session, you will be rescheduled for a later date.
- Fees for therapy sessions thereafter are charged as they are completed.
- Cancellation fees: No shows/rescheduling with less than 24 hours notice will result in a charge for the full session amount. For example, if you or your child’s appointment is on Monday at 4pm, you will communicate your cancellation no later than the previous Sunday at 4pm; if an appointment is on Tuesday at 10am, you will communicate no later than Monday at 10am.
- There is a $50 late fee for balances more than 30 days past due, and they may be submitted to collections after 30 days, along with any associated collections fees
- There is a $100 fee for returned checks (which will also result in your credit card automatically being run for the balance due) and for credit card chargebacks that are unsubstantiated
Legal Fees: If you require that Nema Health or any of its employees participate in any investigation, arbitration, litigation, settlement, mediation, suit, action, or other legal proceeding you will be billed for any time expended on complying with the request at a fee of $350 per hour. You will also be responsible for any legal fees that Nema Health incurs as a result of any required participation.
Out of Session Phone Calls: Nema Health will offer 2 out of session phone calls with your therapist that can be scheduled outside of regularly scheduled therapy hours. After these 2 phone calls, you will be billed a prorated fee at $90 per hour, based on the length of the call.
Non Protocol or Urgent Sessions: For clients that may require more support outside our standard 12 session protocol, up to 2 non-protocol or urgent sessions will be provided and billed at the agreed upon rate above ($80/session). If more sessions beyond the 2 non-protocol sessions are required, we will need to re-evaluate whether Nema Health is appropriate for you.
Extensive Care Coordination: We typically provide care coordination with collateral persons (e.g. psychiatrists, psychologists, medical doctors/PCPs, family members etc.) when necessary at the beginning of treatment and at the end of treatment. If more extensive care coordination (over 4 calls) is required, you will be billed for each additional call at a prorated rate of $80/hour, based on the length of the call.
Re-Evaluation Fee: If for some reason you do not complete treatment with Nema Health (e.g. hospitalization) and then decide you would like to return to Nema Health, we require a re-evaluation to determine whether it is appropriate for you to return. We will also make this decision in conjunction with the appropriate collateral providers you are involved with. The cost of this re-evaluation is $400.
You are financially responsible for all charges, whether or not:
- Insurance pays for any services
- Treatment is successful, for which there cannot be any guarantee
