Fees/Forms

Fees & Insurance

Fees: I charge $120 per 55-minute session for clients paying out of pocket.   I accept cash, checks and credit/debit cards and expect payment at the time of your appointment.

Insurance: I currently accept Excellus Blue Cross Blue Shield, Fidelis Care, POMCO Select, and Medicare insurances. In order to use insurance for psychotherapy, I must make a diagnosis.  I like to discuss this with you in early sessions.

To confirm your coverage and copay, please call O’Brien’s Billing at 315-437-1451 or email them at https://obriensbilling.com/contact-us/patients/.   You must do this before scheduling your first appointment even if you know your mental health benefits.

I am also an out-of-network provider for many other health insurance plans.  I’ll provide you with receipts of payment for my services so that you can submit claims to your insurance company for available reimbursement.  O’Brien’s Billing can also confirm out-of-network benefits for you.

I recommend you check with your insurance company by calling the number on the back of your insurance card and asking:

• Do I have out-of-network mental health insurance benefits?

• What is my deductible and has it been met?

• How many sessions per year does my health insurance cover?

• What is the coverage amount per therapy session?

• Is approval required from my primary care physician?

Forms

Before your first session, please read the Psychotherapy Agreement and complete the Client Information form below.  Feel free to bring any questions you have before signing the Psychotherapy Agreement.  If you are using health insurance, please also complete O’Brien’s Billing Intake Form.  Bring all completed forms to your first appointment.

Here’s the Psychotherapy Agreement.

Here’s the  New Client Form.

And here’s the O’Brien’s Billing Intake Form for all clients using health insurance.

Cancellation Policy

Keeping your appointments is an important part of therapy.  If you miss your scheduled appointment or don’t provide 48-hours notice to cancel, you will pay your full session fee.  Exceptions are considered for genuine emergencies, severe illness or weather.