Fees Policy and Payment for Services

FEES AND PAYMENT FOR SERVICES

You may be required to pay for services and other fees. You will be provided with these costs prior to beginning services, and should confirm with your insurance if part or all of these fees may be reimbursable as Out-of-Network coverage. You should also know about the following:

Deposit & Payment for Evaluation Services

• The practice requires a $100 non-refundable deposit for evaluation services due prior to the first appointment. This deposit will be applied to the full cost of the evaluation.

• The practice requires 1/2 the cost of the evaluation ($500 for most evaluations) to be paid after the first testing appointment. The remainder will be due just prior to the feedback appointment. Accounts must be paid in full prior to feedback.

Therapy Services Rates

Staff/Licensed Faculty Psychologist: $120/session (no current openings)

Supervised Doctoral Student Clinician: sliding scale, see below.

No-Show and Late Cancellation Fees

• If you are unable to attend an appointment, you must contact your Provider at least 24 hours before your session. Otherwise, you will be subject to a $25 missed appointment fee. Insurance does not reimburse for fees.

Balance Accrual

• Full payment is due at the time of your therapy session. If you are unable to pay, tell your Provider. Your Provider may offer payment plans or a sliding scale. If not, your Provider may refer you to other low- or no-cost services. Any balance due will continue to be due until paid in full and will result in a pause in services until paid. If necessary, your balance may be sent to a collections service.

Administrative Fees

• Your Provider may charge administrative fees for writing a letter or report at your request; consulting with another healthcare provider or other professional outside of normal case management practices; or for preparation, travel, and attendance at a court appearance. These fees are listed in the fee agreement. Payment is due in advance.

Payment Methods

• The practice requires that you keep a valid credit or debit card on file. This card will be charged for the amount due at the time of service and for any fees you may accrue unless other arrangements have been made with the practice ahead of time. It is your responsibility to keep this information up to date, including providing new information if the card information changes or the account has insufficient funds to cover these charges.

• Cash payments must be made at the time of service. Check payments for evaluations must clear with the bank (allow at least 3 business days) before proceeding with the feedback appointment.

Insurance Information

• WPS does not take insurance, but is able to provide a Superbill that clients may submit directly to their insurance company for out-of-network reimbursement after services have been rendered and paid in full. Please verify coverage and requirements with your insurance company directly, prior to requesting service - including any prior-authorization or referral requirements, which will need to be obtained from a primary care provider. As a non-HIPAA entity, we do not have the ability to provide prior-authorization and cannot guarantee reimbursement from your insurance provider.

Credit Card Payments & Dispute Policy

• Payment is due for professional time, administration, and expertise rendered, regardless of clinical findings or diagnostic outcomes. Filing a credit card chargeback or payment dispute for services that have been completed—including disputes initiated due to disagreement with testing results or diagnostic outcomes—constitutes a breach of this financial agreement.

In the event a chargeback or payment dispute is initiated:

• Outstanding Balance: The disputed amount will immediately become a past-due balance owed directly to Westside Psychological Services.

• Administrative Fee: A $50.00 chargeback processing fee will be added to your account balance to cover administrative costs assessed by payment processors.

• Collections & Legal Recourse: Unpaid balances resulting from improper chargebacks may be referred to a third-party collection agency or pursued in small claims court.

• HIPAA Privacy Exception: Under 45 CFR § 164.506(c)(1), Westside Psychological Services and Roberts Wesleyan University reserve the right to disclose the minimum necessary administrative and financial information (e.g., signed consent forms, invoices, dates of service) to credit card processors, collection agencies, or court officials solely as required to validate or collect the legitimate debt.

• Termination of Services: Westside Psychological Services reserves the right to decline future services or terminate the professional relationship following a chargeback.