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Services Agreement

DC VA Counseling Psychotherapy, LLC

200 Little Falls St., 306, Falls Church, VA 22046

703-231-7991

Services Agreement


General Information

Hours. Appointments are made according to your therapist’s schedule and your availability.  Individual therapy sessions are generally 50 minutes in length and are scheduled on weekly basis, unless arranged differently with your service provider. If recommended, more or less frequency can be arranged. Couples or family sessions can be 60-90 depending on each case.

Cancellations. Continuity is crucial to the effectiveness of the services you receive. An appointment spot is reserved for you every week or as mutually decided. If the times and dates need to change, it should be arranged in advance with your provider. If you need to cancel your appointment for any reason, you may do so at no charge with 48 hours advanced notice. If you need to cancel within 48 hours, we offer the possibility to reschedule within the same week if we can mutually find a convenient hour in which to reschedule. If it is not possible, you are responsible for full payment (your OON provider fee or insurance fee).  For people using insurance, it is important to note that insurance companies do not pay for missed sessions.

During inclement weather, online sessions will be offered unless internet or power reasons impede to keep the session. RECURRENT travel, work meetings or any other last-minute changes will incur full payment as stated above. On case-by-case basis, we offer a free first-time cancellation fee.

Psychotherapy Services

Out of Network Fees. All payments are due at the time of service (Session cost plus credit card fee). Please keep in mind that credit payments charges might be on the date of service or monthly basis. If you need other arrangements, please discuss with your therapist/practice. Fees might vary depending on training and years of experience by therapist.

For out of network clients, we will provide you with receipts will all the necessary information so you can submit to your insurance carrier for reimbursement, per your request.

All payments are processed and store via Square Up app (plus transaction fee). Checks and cash are only accepted for in person services and at the beginning  of each session. Keep in mind that an active credit card is required for our records at all times (Credit card information needs to be provided with all the other forms prior to beginning therapy). Client is responsible for providing new payment information if requested on time in order to continue services. Unpaid balances of up to 3 sessions, will incur in pausing of services until further notice. After 30 days, if payment hasn’t been resolved, we will have to discontinue services and you will no longer have a reserved spot.


(If you are an Out-of-network client, you can skip to - HSA & FSA)


Insurance Clients:

We are only in network with Carefirst BCBS Anthem plans. We are in network but we cannot determine the specifics of each plan prior to submitting to insurance. Clients can and are encouraged to call insurance directly to get more information about health insurance coverage of clinical services received through DC VA Counseling, LLC, if applicable before initiating therapy (deductibles and copays). Please keep in mind that provider’s portal sometimes doesn’t have most updated or accurate information and that representatives on the calls might not provide correct information either. Therefore, the final cost will be the one reflected on the actual claims. If anything isn’t correct, we would appeal to insurance with client’s consent and support.  DC VA Counseling, LLC is responsible for submitting claims to your insurance at least once a month if not right after services (it is at the practice discretion).

Please provide your insurance card picture on or before your visit so we can submit. If no insurance card is provided, full fee rates according to clinician’s rate will be considered. Insurance coverage and processing will count since the date client provided insurance information to the provider under DC VA Counseling Psychotherapy, LLC and not since the date that therapy initiated.

If there are insurance changes or finalizes, client will be responsible for letting therapist know about new plan and agree to pay any fee differences. If insurance does not cover certain sessions or is processing a case, client is responsible for full payment or percentage that insurance didn’t cover within 30 days of services. Refunds would be made if needed.

Please notice that until we process insurance and receive actual claim we cannot guarantee coverage. It is client’s responsibility to clarify with insurance and complete payment to therapist for services rendered within 30 days.

 

Billing Outsource for Licensed Therapists in Network with BCBS:

In order to serve you better, we are outsourcing insurance billing to a third-party HIPAA compliant billing system called Headway (It will show up on your EOBs under their legal name, “New York Medical”). However, not all clinicians are on this platform. Please consult with your clinician, if they aren’t using Headway, please skip to the next section.

Headway will manage everything related to insurance and payments related to it. The Headway team will reach out to you via email for account verification and forms acknowledgement after you submit to us all DC VA forms required prior to starting therapy. Please keep in mind that this services agreement is between client and DC VA Counseling, LLC. We don’t have access to all information provided to Headway. Therefore, we still need you to fill out all forms required by DC VA Counseling, LLC forms (including payment information and insurance card). This way, we can also provide any direct assistance you might need if any issues arise with Headway. Client or therapist can then fill out that information on the Headway portal. Client is responsible for acknowledging Headway forms, otherwise, payments aren’t processed. One of the benefits of  accessing the Headway platform, is that you’ll be able to see your cost per session ahead of time and you can check your benefits any time there as well. If you have any problems verifying your insurance on Headway, don’t hesitate to let us know.

Please keep in mind that in order to proceed with therapeutic services, all forms (DC VA Counseling, LLC and Headway) need to be filled out. There would NOT be credit card fees through Headway, therefore no other form of payment is necessary or accepted. Make sure credit card and insurance information are up-to-date at all times with Headway and DC VA Counseling, LLC for services to not be interrupted.

You can reach the Headway team directly at hello@headway.co. They can help with any insurance, billing, or account questions. If situation isn’t resolved, don’t hesitate to contact us.


Health Savings Accounts and Flexible Spending Accounts

If you are using a Health Savings Account (HSA) or Flexible Spending Account (FSA) payment card, please be aware that even if your payment goes through and is authorized at the time that we run your card, there is a possibility that your payment could later be denied. In the event of this happening, you are responsible for ensuring that full payment is made by other means.

Contacting Therapist. If you need to contact us, please leave a message on your therapist’s voice mail or send us an email to the information provided above. We check messages at least once a day.

Emergencies. We DO NOT provide 24-hour emergency service. If you are a current client in crisis, you should contact the nearest emergency room or dial 911, 1-800-SUICIDE or 1-877-2433 from anywhere in the USA immediately. Leave us a voicemail and we will return your call as soon as possible.

Privacy and Ethics. Our practice strictly adheres to the principles and standards of the profession. The services you receive are confidential, and your written permission is required for the release of any information about you. Possible exceptions, as specified by law, include situations of clear and imminent danger to yourself or another person, child abuse or neglect, and court order. Please review the Notice of Privacy Practices provided to you at your first appointment.

Discontinuing Services. Ending is an important part of the therapeutic process. Please discuss with your therapist any plan or desire to discontinue therapy.


I have read and have understood the above policies. I give my informed consent to receive services.


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Working days

  • Weekdays 9:00 - 20:00
  • Friday 9:00 - 20:00
  • Saturday 10:00 - 18:00
  • Sunday Closed

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