Instructions: For new patients being seen in our office complete Forms 1-3 below. If you and your therapist have made the decision to use Telehealth therapy, please complete the 4th form as well.
You can fill out the forms on your computer, save them, then upload them below OR you can print the forms, fill them out by hand, and bring them with you to your first visit.
Upload Your Paperwork Here:
Please arrive 15 minutes before your first appointment. You will need to bring your ID and your Insurance Card. Please note: A copy of your insurance card is required for us to file your claims. You may email a copy of your insurance card (front and back) before your appointment to email@example.com. If you do not have one you will be considered self-pay until you bring your insurance card in.
A minimum of $25.00 will be due at the time of service for all clients with deductible plans. If a counseling session, evaluation, or assessment is cancelled, a charge may be made of one-half the normal fee, unless cancelled 24 hours in advance.
Fees vary depending on the service provided and the education level of the therapist. You and your therapist will go over fees and treatment at your first appointment. Please remember that payment is expected at the time of service unless arrangements have been made.
-Visa, MasterCard, Discover
College Skyline Center accepts most insurances, and we will file your claims for you. Our office staff will verify your benefits on your first visit. If you would like to know about your benefits before your appointment we encourage patients to call the number for member services on the back of their insurance card and ask what your “Outpatient Mental Health Benefits” are. Insurances are constantly changing names, groups, and benefits. We make every effort to keep up with these changes; however, the most accurate up-to-date information will come from your insurance company.
An employee assistance program (EAP) is an Employer based intervention program some companies purchase for assisting employees anonymously, to resolve personal issues such as marital, emotional, family, and substance abuse that may be adversely affecting the employee’s performance. An EAP is a program that allows a set amount of sessions – at no cost to employee.
Please contact your HR or your benefits coordinator about possible opportunities. Keep in mind that, just like insurance, a clinician must be a contracted provider for the EAP.
Please note: A copy of your insurance card is required for us to file your claims.
If you do not have one you will be considered self-pay until you bring in your insurance card. A minimum Copay of $25.00 will be due since we cannot verify your benefits at the time of service.
If you are having problems making payments, your therapist may be willing to arrange regular monthly partial payments.
College Skyline Center, LLC – “Good Faith Estimate”
Per federal law, all clients of providers at College Skyline Center, LLC have a right to receive a
Good Faith Estimate that enumerates the expenses you can reasonably expect to pay for the mental health care services you receive here if you are not using insurance and/or paying yourself.
The estimate is created based upon the information known at the time the estimate is first created. It does not include unknown or unexpected costs that may arise during treatment. It is possible you may incur more charges than the estimate enumerates if complications or special circumstances arise. For example, your estimate does not include fees for extra-needed sessions, court proceedings, or crisis interventions, if they ever happen.
Your estimate is not a contract. You are not obligated to receive services from any provider here. Our office can provide you with alternative referrals at your request at any time. Below is a schedule of standard fees for clinical services for clients who are self-pay. Reduced fees may be negotiated with your provider (you may have already done this). Psychological evaluations that utilize a diagnostic assessment, psychological or neuropsychological testing, and psychological or neuropsychological testing services will be provided at an agreed-upon fee with the provider, which will serve as your Good Faith Estimate.
90791: Diagnostic Assessment/Intake Session- $165
90837/90834: Individual therapy- $165 for psychologists; $140 for LPCs/LCSWs
90847: Family/Couples Therapy- $165 for psychologists; $140 for LPCs/LCSWs
(Rates are the same for telehealth services)
SERVICE RATE ESTIMATES FOR THERAPY:
Client sees therapist weekly for 50 weeks/year: $8250 for psychologists; $7000 for LPCs/LCSWs
Client sees therapist every other week for 50 weeks: $4125 for psychologists; $3500 for LPCs/LCSWs
Client sees therapist every 4 weeks for 50 weeks: $2062.50 for psychologists; $1750 for LPCs/LCSWs