All payments are due prior to or at time of service. Accounts with a balance are not considered eligible for service unless prior arrangements have been made.

Co-Pay: A set amount pre-determined by your insurance company for a particular service

If our initial verification of your insurance coverage indicates a co-pay is due, you will be responsible for making this payment at time of service.  This amount is assumed correct and ongoing until your insurance provider reports otherwise.

Deductible or Co-Insurance: Amount you must pay before insurance will share cost of care. After deductible is met, you are responsible for a percentage of costs. The percentage is determined by your insurance company.

If our initial verification of your insurance coverage indicates a deductible applies the full amount of a session ($160/$140) will be required prior to your first appointment.  We will modify the amount of your payment per session once your insurance company reports the exact amount you are responsible for after processing the first claim(s).  Any money left over from your first appointment payment will be credited to a follow up appointment or refunded in the way it was paid.

Missed Appointment Fee & Late Payments

A fee of $100 will be charged for missed appointments or late cancellations as indicated on our cancellation policy. A late payment fee of $25 will be charged if no payment is received within 30 days of the first statement.  These fees are not covered by insurance.

Payment

We accept cash, check, or card payments. Card payments can be made online at any time at www.AffiliatedCounselingServices.com/Payment. Cash or check payments can be dropped in our locked mailbox on the East side of our building or mailed. If you would like to make payment arrangements, please contact Nicole via phone or text at 814-315-3152 or by emailing Nicole@affiliatedcounselingservices.com

My signature below indicates I have agreed to the terms and conditions listed above and have read and understood them.  I understand that these policies are subject to change over the duration of my treatment.  A copy of this policy is available to me online or by request at any time.