Athena Care Office Policies
Responsibility for Payment
Time of Service
I understand I am financially responsible for payment for services at the time of service and am responsible for any charges not covered by my insurance plan. I understand that my co-payment or coinsurance payment, along with any owed deductible amount, is expected at the time of each session. I understand that I must maintain a valid form of payment on file at all times.
Accurate and timely insurance information
I agree to provide Athena Care with accurate and complete insurance information and to communicate any changes to my insurance information in a timely manner. I agree to pay for any cost for rendered services that result from coverage lapses due to failure to provide accurate and timely information or in the event there is a denial or lack of coverage.
In-Network Benefits
Athena Care will bill your insurance on your behalf if we participate in your insurance plan or managed care program. Secondary or supplemental insurance must be presented at the initial appointment.
Out-of-Network Benefits
We will bill your insurance as a courtesy if we are out- of-network with your insurer, however we cannot guarantee coverage for out-of-network services.
Cost Estimates
Athena Care will provide cost estimates for particular services based on current contracted rates; however, these estimates are not guaranteed, and payment amounts are subject to change.
If my insurance company should refuse payment, or provide any other obstacle to reimbursement, I understand that I may be held responsible for payment and may seek reimbursement directly from the insurance provider. Specific CPT (billing) codes are consistent with the standard of care but are sometimes non-covered or subsequently deemed “not medically necessary.” Such procedures include but are not limited to 96130 – 96133 and 96136-96137 (psychological testing), 90791 – 90792 (psychiatric assessments), 99212 – 99214 (office visits), 90833 – 90837 (therapy).
Payment for Minor Patients
I understand that payment is expected on the date of service whether or not a minor is accompanied to an appointment. My form of payment on file will be charged for services rendered.
Prior Authorization
I understand that prior authorizations may be required have occurred for necessary procedures. Athena Care will assist in obtaining prior authorizations where possible, but the patient is ultimately responsible for ensuring that a prior authorization is on file before services are received.
Court-Related Services
Court-related services are not considered healthcare and are billed at a higher rate.
Assignment of Benefits
I allow Athena Care to file for insurance benefits to pay for the care I receive. I hereby assign to Athena Care all medical or mental health benefits to which I am entitled, including Medicare, private insurance, or any other benefit plan. I hereby authorize and direct my insurance carrier(s) to make payment directly to Athena Care for all services rendered to myself and/or my dependents. I authorize Athena Care to submit insurance claims on my behalf for items and services provided to me. I understand that Athena Care will share my medical record information with my insurance company for purposes of treatment and payment. I authorize Athena Care to exercise, on my behalf, any rights I may have under the law for ensuring appropriate payment under my benefit plan(s).
I understand that I am responsible for any amount not covered by insurance.
Outstanding Balances
I understand that billing statements are sent by email and text monthly for any outstanding balance due understand that once my insurance company has provided payment or official response, I am completely responsible for the difference. Balances more than 30 days past due are subject to late fees and those more than 90 days past due are subject to a third-party collection agency.
If I incur a balance, I agree to set up and comply with a payment plan. I understand payment plans include outstanding balances only and any amounts owed at time of service will still be expected.
I understand my clinician may terminate treatment for non-payment.
Reduced Fees
Fees are occasionally reduced when participating in contracted service programs such as EAPs, specific provider referral programs, and sliding scale cash arrangements due to financial hardship. Such arrangements must be made in advance, and insurance companies cannot be billed when using such fee arrangements.
Missed Appointments
Consistent attendance at appointments is critical for the patient’s treatment and all patients should strive to keep all appointments as scheduled. Further, we are unable to offer your appointment slot to other patients when you cancel without adequate notice or miss your appointments. Accordingly, all patients are subject to the cancellation/no show policy below.
Appointments must be cancelled at least two full business days in advance (three business for testing appointments). Patients who miss their appointment without notice, cancel late, or arrive more than ten (10) minutes late to an appointment will be charged a no show fee as listed below. After three missed appointments in one year, your clinician may terminate care.
Medication Management or Therapy Visits:
- Initial visit for therapy or medication management: $100
- Follow up medication management visit: $100
- Follow up therapy visit: $75
- Weekend or after hours visit: $100
Specialty Visits:
Testing appointments must be cancelled at least 3 full business days in advance.
- Initial test consult visit: $100
- Testing appointment: $200
- Spravato or TMS visit: $100
- IOP or PHP visit: $100
I understand that missed appointment fees cannot be billed to my insurance company and consent to the holding of my credit card information on file and the charging of such fees as they occur.
Exceptions may be made for emergency situations at the discretion of the provider and clinic management.
Patient Portal and Medication Refills
The patient portal is not for emergencies. In the case of an emergency, call 911 or go to your local emergency room, do not use the portal. Please contact the office directly with any urgent needs.
Medication providers aim to respond to patient portal messages within 24 to 48 hours of message receipt. This timeframe could be longer if the message was sent over the weekend or if the provider is out of office.
It is the patient’s responsibility to request refills in a timely fashion. Please call the office or send a message through the patient portal for refills at least 3 days prior to being out of your medication. This will prevent you from running out of your medication while the physician authorizes a refill or makes a change to your medication where appropriate. If an appointment is cancelled or missed by you and a prescription is needed, there is a $25 charge associated with that prescription refill.
Copying, Non-Clinical Paperwork, and Releasing Records
Records requests will be responded to within 30 days or less. All records requests may be prompted by a HIPAA-compliant request for Protected Health Information. Consistent with TCA § 36-2-102, we charge a $20.00 fee for medical records 5 pages or less in length and 50 cents per page for each page copied after the first 5 pages, plus the actual cost of mailing. Completion of paperwork not in the course of clinical care and non-reimbursable by 3rd party payers, such as FMLA, Disability, or other documentation needed outside of the required clinical documentation will result in fees which will be patient responsibility. The fee for FMLA forms and letters is typically $25, but the fee may be larger for more time-consuming paperwork and is billed at the clinical rate broken into 15-minute increments.