Rates and Insurance Information

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FINANCIAL/INSURANCE POLICIES

The amount of  YOUR CO-PAY OR CO-INSURANCE IS EXPECTED IN FULL AT THE TIME OF SERVICE for those utilizing insurance benefits and PAYMENT IN FULL IS EXPECTED AT TIME OF SERVICE FOR SELF-PAY clients unless I have agreed in writing to waive the entire fee. I accept cash, checks and credit cards, including PayPal. If you plan to utilize insurance, it will be important that you are able to verify your benefits prior to your appointment or you will be expected to pay the entire fee and wait for me to reimburse you if/when your insurance plan pays me. I am considered an in-network provider for some insurance plans and out-of-network provider for others. 

When the client is a minor and the parents are divorced or legally separated, the policy is to designate the person who initiated counseling to be the Guarantor. I am not able to bill each parent for his/her “share” of the costs as designated by their divorce decree or other legal document. The expectation is for the parent who initiated counseling to be responsible for the bill and to gain any reimbursement from the other parent.

Fee Schedule: 

For check, cash or credit card payments, insurance is billed at the allowable rate. Co-pays and services not covered by insurance are billed at the following rates:

• Diagnostic Interview/Intake Assessment (CPT 90791): $200.00

• 50-60 Minute Individual Psychotherapy/Counseling Session (CPT 90837): $175.00

• 50-60 Minute Family Psychotherapy (including conjoint), with patient present (CPT 90847): $200.00

• 45 Minute Psychotherapy/Counseling Session (CPT 90834): $150.00

• Psychotherapy for Crisis, First 60 Minutes (CPT 90839): $175.00 

  • Additional 30 Minutes for Crisis (CPT 90840): $150.00​

• Group Treatment (CPT 90853): $40.00 per person

• Phone Conference 5-10 Minutes (99441): $75.00

• Phone Conference 11-20 Minutes (99442): $125.00

• Phone Conference 21-30 Minutes (99443): $150.00

• Courtroom Appearance: $500-$1,000 Per Day

• Review of Records, Report Writing, Faxing Reports, Conferring with Attorneys, etc.: $200 00 Per Hour

• Returned Check Fee: $50.00

• No-show or late cancellation fee: $65.00

Additional Information/Policies:

If I am under a contractual agreement ("in-network") with a given insurance company, I am required to adhere to that company’s fee schedule (which differs by insurance companies) not to exceed the fees posted above. However, if I am not under a contractual agreement ("out-of-network") with a given insurance company, I am not required to adhere to that company’s fee schedule and I am able to "balance bill" the client for the difference between the insurance company’s fee schedule and my fee for services.

To reflect my core values, I set aside a percentage of my caseload for pro bono (free) services upon request on a first-come, first-serve basis and for a limited number of sessions. Pro bono appointments may be restricted to non-peak hours (before 3:00 p.m.) and require execution of a "Fee Waiver" with my signature prior to delivery of service(s).  

Late Cancellation/Missed Appointment/No Show Policies:

Cancellation of appointments is expected at least 24 hours prior to the scheduled appointment time by calling my office at (855) 553-2753 and leaving a voice mail message. If you fail to notify me at least 24 hours in advance, you will be required to pay the full cost of the treatment as booked. The "Late Cancellation" fee is NOT covered by insurance.

If you fail to show up for a scheduled appointment (subsequent to initial intake assessment), you will be required to pay the full cost of the treatment as booked. The "No Show" fee is NOT covered by insurance. In the event I cancel your appointment with less than 24 hours’ notice to you, I will provide you with a coupon that waives one future late cancellation/no show fee that you might otherwise incur.

In the event I cancel your appointment with less than 24 hours notice due to crisis call or personal emergency, I will offer you a a a free counseling session to be used within three months.

I have read, understand and agree to the above Policies by signing below:

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Client/Responsible Party Signature (Parent/Guardian If Client <18)

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Date

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Print Name

Fax: 1-855-5-JEARLE

Scan: cje@cjearle.com 

Mail: 1101 W. 34th St - Suite 256 -Austin, TX 78705