Forms & Pricing
Resources
Please download and complete your required intake packet, and don’t forget to bring it to your first appointment!
Please download and complete the required Release of Information forms if requested by your therapist.
Sessions
Reading /responding to emails
and phone calls | $25 per 15 minutes
Fees
No Show, Late, or Cancelation
(Less than 24 hours notice)
Full fee of insurance contracted
rate or self-pay rate
Failure to pay within 10 days
of denied insurance claim | $25
Court appearances, preparation, and
third party conferences | $225 per hour
School expulsion assessment | $225
Please Keep in Mind
The fees mentioned above may be different if you chose to utilize insurance benefits.
**HSA cards accepted
It is also your responsibility to call your insurance company to determine benefits, deductibles, copays and any limits to number of visits for mental / behavioral health.
Insurance
Clients are responsible for knowing their policy benefits. If you have a high deductible or a co-pay, this is due at the time of service.
***If you have not done so already, we recommend that all new clients contact insurance to verify eligibility and for information regarding benefits and costs. Our tax ID is 823092676, and our NPI is 1366957003. We use billing codes 90791, 90837, or 90834. We bill under "TCP of Ohio, LLC" or "The Counseling Professionals" - not by individual therapist name. Some clinicians may not show as an in-network provider, but they bill under supervision by in-network providers: Karen Barnes, Melissa Kappes, or Tonya Chatlos.***
Notice: Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees. Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.
Thank you.
For more info, visit: www.cms.gov/nosurprises