Thank you for considering Back on Track as your mental healthcare provider. The services you seek imply a financial responsibility on your part. This responsibility obligates you to ensure payment in full for the services you receive.
Self-pay rates are based on the service you are requesting and the clinician who will provide the services. A Good Faith Estimate of your out-of-pocket costs will be provided to all self-pay clients.
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, healthcare 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.
Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
You are ultimately responsible for all payment obligations arising out of your treatment or care and guarantee payment for these services. You are responsible for deductibles, co-payments, co-insurance amounts or any other patient responsibility indicated by your insurance carrier or our Policies, which are not otherwise covered by supplemental insurance.
You are responsible for knowing your insurance policy. For example, you will be responsible for any charges if any of the following apply: (i) your health plan requires prior authorization or referral by a Primary Care Physician (PCP) before receiving services at Medical Associates, and you have not obtained such an authorization or referral; (ii) you receive services in excess of such authorization or referral; (iii) your health plan determines that the services you received at Back on Track are not medically necessary and/or not covered by your insurance plan; (iv) your health plan coverage has lapsed or expired at the time you receive services at Back on Track; or (v) you have chosen not to use your health plan coverage. If you are not familiar with your plan coverage, we recommend you contact your carrier or plan provider directly.
You will be required to follow all registration procedures, which may include updating or verifying personal information, presenting verification of current insurance, providing signatures, and paying any co-pays or other patient responsibility amount at each visit. Your card or other insurance verification must be on file for your insurance to be billed. If we do not have your card on file, or are unable to verify your eligibility for benefits, you will be treated as a self-pay patient. As a self-pay patient, our fee is expected to be paid in full at the time of service. If the insurance card or other necessary information is furnished after the visit, we may file a claim with your insurance; and, if paid in full by your insurance, you will be reimbursed. If you are not prepared to make your co-pay or other patient responsibility amount, your visit may be re-scheduled by Back on Track.
Back on Track accepts a number of insurance plans including:
**We currently do not accept Medicaid and Medicare plans.
Even if we are not in-network with your provider, services may still be covered in full or in part by your health insurance plan. Back on Track will provide you with a superbill that you can submit to your provider and you will receive your benefits directly from your insurance provider. Please check your coverage carefully. If you choose to use a Back on Track clinician who is out of network with your provider, you will be considered a self pay client and will receive a Good Faith Estimate of your out of pocket costs to Back on Track.
Cash, check and credit/debit cards are accepted for payment. You can put a credit card on file using the Client Portal or you can login to the portal and make a payment before each session. Payments are due at the time services are rendered.
If you must cancel an appointment, please be courteous to other clients and to your therapist by calling in advance. There is a $100 fee for failure to keep a scheduled appointment without cancellation. Late cancellations with less than 24 hours notice will incur a $55 fee.