Elgin, IL60170
Office: (224) 856-5988
PRIVATE PRACTICE POLICIES / Terry (Tracy) Wright, MA
Licensed Clinical Professional Counselor
#180-004869
NPI #1588626766
Counseling
Services
FEE SCHEDULE: My standard fee for a 60-minute session is $130.00 and a 75-minute session is $165.00. (Initial session is $165.00.) This fee is for individual, family and/or marital therapy. Phone calls are charged on a prorated basis in ten (10) minute increments after the first ten minutes. Payment is expected without a 24-hour notice for cancelled appointments. Missed/cancelled without 24 hr. notice appointment charge is $50.00.
PAYMENT POLICY: Payment is due at time of session. Checks should be made out toRenewed Hope Counseling.
INSURANCE: If you have a major medical policy that covers counseling, please note the following: As your therapist, I am not responsible for confidentiality procedures employed by other parties, e.g., insurance companies, managed care monitors, etc. Because other parties often create computerized records, I am unable to guarantee the confidentiality of your records should you use your insurance company to subsidize the cost for therapy. Procedures followed by your insurance company should be discussed with them.
INSURANCE FORMS: Unless we agree otherwise, I will be responsible for completing and filing insurance claims. If you file your insurance, I will give you a statement that you can file with your insurance company for reimbursement. Your signature on this form authorized Terry (Tracy) Wright, Renewed Hope Counseling Services, to release required diagnostic and treatment authorizations to your insurance company.
PAYMENT RESPONSIBLITIES: Please note that under all circumstances, the client remains responsible for payment in full. It is my policy that you, the client, remain responsible for payment in full when treatment exceeds third-party coverage or financing. Renewed Hope may use a collection agency if account goes past 3 months and payment arrangements have not been made.
APPOINTMENTS: Appointments can be scheduled Monday through Friday 9 AM to 5 PM. Office staff will be happy to assist you with scheduling an appointment. Office phone is (224) 856-5988.
EMERGENCIES: I believe clients in outpatient therapy are able to be self-responsible (e.g., autonomous, functioning and not in need of day-to-day supervision.) The scope of my private practice prevents me from being responsible for a client’s day-to-day functioning. Agencies and hospitals are more equipped to deal with this. If you have expectations about after hours care, please discuss this with me upon intake so that if necessary, other appropriate referrals can be made.
I can be reached by telephone through office (224) 856-5988 or cell phone (847) 913-3673. I respond to messages within 24 hours under most circumstances, excluding weekends. I notify clients in advance when I take extended vacation. If you are in need of emergency assistance and believe that you are in a life or death crisis, you are encouraged and responsible to go directly to your nearest hospital emergency room or call 911 to seek immediate attention.
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