Frequently Asked Questions

 Co-pays vary between and within insurance companies. Clients who are unsure of their co-pay amount can call the member services number on the back of their insurance card and ask. Some insurances have PCP co-pay amounts on the front, and this is generally (not always) the co-pay amount for behavioral health services. 

Some insurance companies give percentages of what they will pay towards claims. In these situations, and those where co-pay amount is unknown at the time of service, a $30.00 fee is billed to the client.

 Once an insurance company pays out on the claim, the insurance company will adjust the co-pay amount to reflect what the client will owe for future services (see Insurance Claims for more information). This information is different when there is a deductible.

 In an insurance policy, the deductible is the amount paid out of pocket by the policy holder (the client) before an insurance provider (i.e., your insurance company) will pay any expenses. If you have a deductible, once this amount is paid, then the client pays only the co-pay amount (see Co-Pay for more information) and the insurance company covers additional costs.  

We at Calm Gardens Therapy implement boundaries with out clients as part of the service delivery, including holding clients accountable for time management. 

We do understand situations may arise and aim to work with our clients. We also need to adhere to practice policies and procedures and at times flexibility may not be available or appropriate to the situation.  

For late cancellations, clients have up until 24 hours prior to an appointment to cancel. Anything under 24 hours is a late cancellation and client will be responsible for the fee. Clients may cancel using ANY of these methods: calling, leaving a voice message at the front office or with the provider directly, through email, text, and clients can even go through their client portal and cancel their own appointments (see EMR).

A no-show is when a client does not make it to an appointment OR arrives 10 minutes or more after the start of a session time. Clients who notify the provider that they are running late will be given 15 minutes after the start of session time to arrive. Even if a client arrives late to an appointment, after any of the times above, they will not be seen and they will be billed the no-show fee.  

Both of these options are available to clients.  Unless working specifically with a Telehealth therapist, all other appointments are scheduled for the in person office settings. 

Client's interested in Telehealth must request this option prior to or at the time of scheduling an appointment with the provider (see Appointment Reminders for telehealth link information). If not requested, it will be assumed the appointment will be in person.

Telehealth may not be appropriate for some individuals and it would be up to the discretion of the provider to 

Appointment reminders, text, e-mail, or voice call, are sent (1) at the time that an appointment is scheduled, and (2) again, 48 hours prior to an appointment as a courtesy.  (***Client's will receive notifications should they select this option when filling in their information from the new client portal link***)

It is the client's responsibility to keep track of their own appointments and to reach out for clarification regarding any concerns; particularly appointment days or times. 

It is the client's responsibility to reach out to the therapist, utilizing a contact method that will promote quick communications, as soon as possible, to work through resolving the issue (e.g., should a connection issue arise via phone, telehealth, or other non face-to-face sessions). For client's receiving telehealth and who have signed up to receive courtesy e-mail reminders, a link will be sent in the e-mail reminder 48 hours prior to the appointment. 

Moreover, for face-to-face sessions, if a client is late or is struggling with any concerns, not limited to locating the office or making it to the appointment on time,  these need to be addressed, if not prior to the appointment, no later than 10-minutes past the start of the session time. If not addressed, the client will be responsible for the no-show fee.

Providers are not always immediately available by telephone.  Providers do not answer phones, texts, or emails when they are with clients or otherwise unavailable. At these times, you may leave a message with the front office (702) 608-7290 and your call will be returned within 24 to 48 hours. Emails and texts are also responded to within 24 to 48 hours. 

Providers establish their own times of availability during the weekdays and weekends. Typically, responses to client communications are not done past 7PM during the weekdays. It is up to your provider to respond to client communications over the weekends; please reach out and ask them what their response times may look like for weekday, weekends, and holiday's.

If you feel you cannot wait for a return phone call from the provider, contact the National Suicide Hotline at 800-273-TALK (8255) or if it is an emergency situation, call 911.

 If a provider is unavailable for an extended period of time, they will provide the name and number of another qualified clinician whom you may contact if necessary.

 When a client reaches out for scheduling, a client profile is made in our EMR system (see EMR below). This profile allows us to send out, via email, new client documents to these clients. There is a section for a debit or credit card to be put on file. While we do accept cash pay at the time of service, we do require a card to be on file to bill for for any missed appointments (e.g., late cancelled or no-showed) and/or for easier billing for any outstanding fees. 

Payment is collected at the time of service. 

 Insurances are billed as a courtesy to our clients. If a claim is rejected, it will be sent out a second time. If the claim is rejected a second time, the client will be held responsible for the full amount for services rendered.  Additionally, any clients who are using insurance and have not completed the insurance information in their client portal and/or provided front and back images of their insurance card to the provider, will be contacted and will have 48 hours to make this correction to allow for insurance billing. If no correction is made, the client will then be identified as a self-pay client and will be responsible for the out-of-pocket rate for services. Information from the Outstanding Fees section may apply to these situations.   

 With regards to outstanding fees, these may occur due to insurance adjustments to the co-pay or deductible amount due at the time of service (see Insurance Claims for more information). Any and all outstanding fees must be paid prior to the next appointment and no later than 48 hours before the next scheduled appointment. An outstanding fee that is not paid off or where an arrangement to pay towards it has not been made will result in the cancellation of any future appointments until they have been paid. Once payment or payment arrangements have been established, clients are able to schedule appointments. 

Finally, with regard to outstanding fees, clients will be provided a courtesy email from the office, or text through the EMR system (see EMR below), notifying them of the amount due and if any options for arrangements are available. The client has no more than 48 hours to respond. If a client has not contacted the office back, to either pay the fee in full or make arrangements, the office will charge the amount due. 

To briefly describe, an insurance claim is a bill that is sent out to your insurance provider to pay towards the full amount due for services rendered to the client. If a client has a deductible, the client is responsible for paying anywhere from $80 to $100.00+ towards their deductible amount. 

If a client is unsure of what their co-pay is, they will be billed $30.00. When the insurance provider pays out on a claim, they may adjust the amount to reflect what the client owes for their co-payment. Any adjustments that reflect a co-pay amount that is less than the $30.00 billed for services, a credit will be applied to the client's account and may be used towards future sessions. Similarly, any adjustments that reflect a co-pay amount that is more than $30.00, the client will be responsible for those fees (see Outstanding Fees). **Please note that insurance payments on claims may range anywhere from 2 weeks to 3 or 4 months after the date of service. 

 EMR, or electronic medical records, is a software that we use to create client profiles, schedule and/or manage appointments, billing, etc. Our EMR system is called Simple Practice. When a client reaches out for services the front office and/or provider will create a new client profile where the client is emailed a welcome statement, important information about scheduling and completing documents, AND a link to their client portal. The client is portal is where clients are able to mange their own appointments, such as to request or cancel them, select if they want to receive the courtesy reminders via text, email, and/or voice call, and pay invoices. Providers may also use this software to communicate through text with the client, and the client to their provider.  

EAP stands for Employee Assistance Program that may be offered by employers. This program allows coverage for a certain number of sessions (on average between 3 - 5 sessions) before an individual would use their insurance. 

While EAP does cover the cost of sessions, it does not cover the cost of late canceled or no-shown appointments and clients would be responsible for these fees as an out-of-pocket expense. 

EAP session claims are filed through the EAP only while the EAP is covering the cost of sessions. Once an individual's EAP coverage expires, due to being used or for being outside of a prior authorized timeframe, we start filing claims to individuals' insurance companies. As a result, we do require insurance information as part of our 'Client Onboarding Process' so that we can verify insurance information to avoid any unnecessary billing issues from arising. 

*Please note, with all insurance coverage, verification of eligibility does not guarantee coverage of services rendered by CGT by the insurance company. If any adjustments are made on claims after being filed to the person's insurance company, the individual may be notified about any costs they are responsible for. 

**Most of the information found in this section comes from our contract that clients are responsible for reading and sign off on acknowledging their awareness of the policies and procedures of our office.