Counseling Billing Agreement

APPOINTMENTS: Our services are unique and set up differently than traditional therapy.  Treatment is conducted over a one to two-week period, depending on the needs identified in the consultation, Monday through Friday (usually). Therapy sessions are provided in person only.

All scheduling has to be done in advance.  You will be asked to pay 50% of the fee to secure the agreed upon dates.  The week(s) will not be guaranteed until the money has been received.  Fees are based on the entire treatment week, except for those 6 and under.  All fees quoted are in United States dollars.

FEE AND GENERAL SCHEDULE:

Adults: $5,500.00 per week – Typical treatment hours are two 2.5-3-hour periods each day M-F of the treatment week.

7-17:    $3,000.00 - Treatment hours are shorter due to their particular attention spans and speed of processing trauma.  Typically, one 2.5-3-hour period is conducted each day of the treatment week M-F.

6 and under: $175.00 per hour Children this age generally work very quickly – the schedule will be determined on a case by case basis but usually no more than an hour or two a day.

DEPOSIT: The fee includes the initial consultation. 50% of the fee is paid to secure the dates of treatment and is NON-REFUNDABLE.  If you reserve the date and are not able to attend, we do not have time to secure another client for that week.  The remainder of the payment is due on the first day of treatment. 

PAYMENT:  Fees can be paid through the ‘Payment’ button in the upper right corner of our website (www.sacredhearthealingministries.com) or by check made payable to Margaret Vasquez. 

Payments must be made in U.S. dollars.

INSURANCE:  Most insurance plans do not cover this type of intensive treatment.  Currently there are no insurance billing “codes” that cover this type of intensive treatment, therefore we do not bill to insurances.  However, we are happy to provide you with a receipt you may submit to your insurance company.

POST ADOPTION SPECIAL SERVICES SUBSIDY:  Many states have special funding for post adoptive families.  Check with your state and county to see if funds are available for this specialized treatment.  Ohio generally funds this treatment. 

Please note, even if using PASSS funding, the deposit must be made to secure your week.

LODGING AND OTHER EXPENSES: All travel, lodging and food expenses are your responsibility. We can make recommendations for lodging but do not endorse any particular place. 

MINORS:  A parent or legal guardian must accompany a minor and consent to treatment, unless otherwise stipulated by law.  Parents or legal guardian must comply with the terms of this billing policy. 

CANCELLATION/NO SHOW POLICY:  Cancellations of the scheduled week needs to be received 4 weeks in advance of the week scheduled.  At that point, we will keep your deposit so you can schedule another week.  If you cancel within the four-week period or do not show for your scheduled week the deposit is NON-REFUNDABLE or transferable.             

I have read and understand the “Sacred Heart Healing Ministries Billing Rights and Duties”, and have received a copy and agree to abide by its terms.  I accept full responsibility for the balance on my account.