Billing, Payment, Attendance, & Cancellation Policies
The following is the current Fee Schedule and Payment Policy for services to be provided to your child by Rollins Speech Therapy, LLC. Please understand that I reserve the right to change and/or modify the fees set forth below, but you will receive thirty (30) days advanced notice of any increase in such fees. All fees and costs shall be due and payable in accordance with the Agreement to Terms of Payment.
Billing and Payment Policies
Payment:
· PAYMENT IS DUE AT THE TIME OF SERVICE. Sessions will not continue if payment is not received.
· Each payment will include 4 30-minute session increments, or 3 60-minute increments.
· An invoice will be given the last week of the month for the following month’s sessions.
· Payment can be made with cash or check.
Insurance:
We do not accept or bill insurance. However, we will provide invoices that you can give
to your insurance companies for reimbursement. IF YOU CHOOSE TO BILL YOUR INSURANCE COMPANY, YOU ARE COMPLETELY LIABLE AND RESPONSIBLE. WE DO NOT COMMUNICATE WITH OR BILL INSURANCE COMPANIES.
Pricing
Private Therapy Sessions:
· 30-minute session: $35
· 60-minute session: $60
Attendance & Cancellation Policies
Be On Time:
· Please be ready for your scheduled session. The appointment will end on-time
regardless of when you and your child are ready for your session to begin. No refunds will be given for tardiness.
Canceled Sessions:
· Please call, text, or email the therapist a minimum of 12 hours prior to an appointment if you need to cancel the appointment. FAILURE TO DO SO WILL BE CONSIDERED A “NO SHOW.”
· Appointments may be canceled without penalty if the child is sick. If your child is ill, please cancel the appointment.
· Each child is allowed two canceled appointments not due to illness per 6-month period without incurring a penalty. Each canceled appointment after the first two appointments will be charged 50% of the price of the session.
· Credit for canceled appointments is given on the following month’s invoice.
No Show:
· It is considered a “no show” if your child misses an appointment and the speech therapist was not notified at least 12 hours before the missed appointment. NO SHOWS WILL BE CHARGED THE FULL PRICE OF THE SESSION, AND NO MAKE-UP SESSIONS ARE AVAILABLE.
Adult Attendance:
It is highly recommended that an adult attend and stay with the child for the duration of the session. It is critical to the success of the child's therapy that an adult understand and implement therapy techniques at home. The more a child practices at home, the faster they will improve, ultimately resulting in fewer therapy sessions. If you are unable to attend for the duration of the session, please arrive to pick up your child 5 minutes before the conclusion of the session so that the therapist may review homework exercises for the week.
** For the safety of our therapist, she will not enter the home with an unaccompanied male. In the event that a session must be canceled due to an unaccompanied male, it is up to the discretion of the therapist on whether or not that session will be rescheduled.
Other Children:
· If possible, please leave your other children at home, as they can be distracting during the session. However, if no other arrangements can be made, you may bring your other children. They will need to sit and play quietly during the session. Please bring quiet activities for them.
Homework Policies
The therapist gives nearly all clients weekly homework to practice techniques learned in therapy. It is expected that parents practice homework assignments daily with their
child. Speech Therapy is much like taking piano lessons: the purpose of the therapist is to teach new techniques, but mastery of techniques is done through diligent and consistent home practice. Just as children will not learn to play the piano without consistent practice, children will not make progress with their speech and language skills without practicing at home.
Practice should be completed daily for 5-10 minutes. Frequent, short practice sessions are much more effective than infrequent, longer sessions. Your child will make much more progress by practicing every day for 10 minutes rather than once a week for 60 minutes.
Remember, failure to practice at home will result in limited to no progress with your child’s speech and language skills, resulting in frustration and wasted money. Don’t let your valued dollars go to waste! PRACTICE MAKES PERFECT!
Agreement to Terms of Policies
I, ______(print name) acknowledge and accept full and complete responsibility for payment of all services rendered to my child or any child under my care by Rollins Speech Therapy, LLC. I acknowledge that I have received written explanation of the fee schedule, cancelation policy, and payment policy, and I agree to all policies.
I understand that health insurance policies are an arrangement between my insurance company and myself, and there may not be coverage for speech therapy services. All services rendered to my child or any child under my care, are charged directly to me and I am personally responsible for full payment. I understand that agreements regarding fee schedules and charges for cancelled appointments are between myself and Rollins Speech Therapy, LLC, and are not related to potential insurance coverage. I agree to release all that is necessary for Rollins Speech Therapy, LLC, as to any information that may be requested for insurance purposes.
______
Date
Print name: ______
______
Signature of Parent or Legal Guardian
Rollins Speech Therapy, LLC
______
BY: Kassaundra Rollins, M.S., CCC-SLP
Its: Member
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