PACIFIC SPEECH AND LANGUAGEPOLICIESWelcome to Pacific Speech and Language! Please read and sign the following policies. You will receive a copy of this document. If you have any questions, please ask before you sign. General Policies
When you arrive, please enter suite B and wait in the waiting area with your child, siblings, and visitors until called for your child’s session. Most of the time, it is preferable to stay in the waiting room with siblings rather than bringing siblings into the session, as they can often be distracting to your child receiving treatment. However, if it works for your child’s program, we may decide to have you and the sibling attend for at least part of the session. During your child’s session, please feel free to observe the session, wait in the waiting room, or run some errands. Even if you have to interrupt the session to do so, please notify us if you are leaving the building. If you leave the building, we ask that you leave a cell phone number where you can be reached in an emergency, if possible. Please return to pick up your child 15 minutes before the end of the hour (within 45 minutes of the beginning of the session). Please do not be late, as sessions are often scheduled back to back. If you are late picking up your child, you will be charged for the appropriate portion of the hour. This late pickup charge is not billable to insurance. Many children demonstrate better attention and progress with the parent out of the room, especially with motor speech or P.R.O.M.P.T. therapy. However, you are always welcome to observe the session. Treatment strategies and progress will be shared with you in the last few minutes of the session, whether or not you choose to observe. Sessions are 50 minutes in length unless otherwise agreed upon. This standard procedure allows for clean up, chart notes, and setup for the next session. All appointments begin at the agreed time. If you and your child arrive late for the appointment, the session will be billed at the hourly rate starting from the original appointment time. Please call us if you are running more than 10 minutes late. Any notes or emails to team members or parents/caregivers that are requested by you will be written within your child’s session time (e.g., a 50-minute session will end in 45 minutes to allow for an email). If appropriate for your child, we ask that you provide an extra diaper or two (for “emergencies” only) if you leave the building during the session. If your child is potty learning, please provide a change of clothing in case of accidents. If you are present and your child needs a diaper change, clothing change or bathroom break, you will be asked to take your child to the restroom. Cancellations/No-Shows Please call to cancel if your child has any of the following symptoms:
It is very important to call us if you are not sure whether to bring your child for the session. Working with a sick child poses a health risk to clinicians and other clients. If your child arrives for the appointment with any of the above symptoms, he/she will not be seen and the session will be billed at the private pay rate of $102.00. This charge cannot be billed to your insurance company and must be billed to you. If you need to cancel an appointment, please call us at (206) 522-6464 at least 24 hours in advance. Please do not cancel by email unless you are giving at least 48 hours notice. Canceled appointments may be made up as time permits, but a make-up session cannot be guaranteed. If your child is ill on the day of the appointment, please call as soon as possible, but no later than 8:00 am on the day of the appointment (if your child has an 8:00 am appointment, you are required to call by 6:30 am). You may leave a voice mail message 7 days a week, 24 hours a day. Appointments that are canceled with less than 24 hours notice, or later than 8:00 am on the day of appointment (6:30 am if appointment is at 8:00 am) in the case of sudden illness, will be billed a cancellation fee of $50.00. Failed appointments or “no-shows” will be charged $102.00. Charges for canceled or failed appointments cannot be billed to your insurance company and so must be billed to you. Payments Fees for speech-language pathology services with Pacific Speech and Language are as follows:
Amounts that are billed to you due to insurance denials will be subject to a 15% private pay/out-of-pocket discount. Fees adjust as follows: treatment sessions, meetings/consultations, progress reports: $102, evaluations: $204. Private pay discount does not apply to copays or coinsurance payments. Payments can be made by cash or check only. Rates are subject to change upon two weeks written notice. Pacific Speech and Language holds a billing contract with Aetna, Premera Blue Cross, and Regence Blue Shield. PSL is not able to bill Medicaid/DSHS/Molina. PSL billing staff will bill your insurance company directly, but you are ultimately responsible for any bills that are denied by your insurance company for any reason. If insurance denies payments, billing staff will attempt to resolve the issue. You are responsible for any copays, coinsurance payments, and deductibles required by your insurance company. Copays are due at the time of service. Deductibles and coinsurances will be billed to you after payment is received from your insurance. Checks returned for insufficient funds will incur an additional charge of $25. Overdue bills past 30 days of date of invoice shall incur a late fee of 1% of the total charge per month, $1.00 minimum. Overdue bills may be sent to collections per Washington State Law R.C.W. 19.250, with collection costs added as allowable by law. The above policies become effective as of the date of signature below. These policies supercede any previous policies, both verbal and written. You will be given a copy of this document after you sign. I have read and agree to the above policies. Signature of Parent or Legal Guardian _________________________________________ Relationship to Child _____________________________________ Date ________________________________ Child’s Name _____________________________ Child’s DOB ____________ (c) 2006 Pacific Speech and Language |