Jules Steffen, LMHC, CHT, PPN

Individual Client Fee Agreement: (includes Excerpts from a portion of my Disclosure Statement)

The length of my counseling appointments varies depending on your therapeutic need. My fee is $175 per hour. The minimum time frame for a session is one hour (60 minutes) in length. The initial appointment is 1.5 hours in order to complete the necessary paperwork and begin my assessment of your therapeutic needs. Hypnotherapy sessions are at least 1.5 hours in length, and at times, may extend to 2.0 hours if needed. Since health insurance companies rarely allow payment for more than 60 minutes of therapy per calendar day, you will be charged out-of-pocket for the additional half-hour of services ($87.50) beginning with your initial session, and/or whenever 1.5 hour sessions are used. If additional time beyond 1.5 hours is mutually agreed upon, the out-of-pocket expense will be in accordance with the $175/hour fee.

While I do my best to minimize rate changes, from time to time, Re-Source Counseling Center, PLLC may find it necessary to increase the hourly rate. If you are continuing in therapy with me at that time, I will provide you with thirty days advance notice of any such increase. You are not responsible for any costs prior to you being given this notice.

Unless we have made other arrangements, full payment is due at the start of each session. Any co-pay that you may have is due at the start of each session, payable to Re-Source Counseling Center, PLLC. You will be charged in quarter-hour increments for telephone calls to me to discuss issues or concerns between sessions. The same will be true for my telephone interactions with attorneys, physicians, and others on your behalf, and for reports and letters you request me to write on your behalf. You are expected to pay these extra costs at our next session unless specific arrangements are made with me.

Any unpaid balance on your account bears interest at the rate of 12% per annum.

If you will be unable to attend a scheduled session, you will be charged my full fee for the missed session unless you notify me by noon of the prior business day. Health insurance companies will not pay for missed sessions, nor will they pay for telephone calls, reports, letters, or interactions with attorneys and others; you will be solely responsible for payment for these services.

About Insurance
You are responsible for payment of all treatment fees and other costs. If you have health insurance and/or a third party payer, it will usually provide some coverage for mental health treatment. As a courtesy, I will fill out forms and provide you with whatever assistance I can in helping you receive the benefits to which you may be entitled. It is very important that you find out exactly what mental health services your insurance policy covers and what deductibles and co-pay may apply. Please remember that you are responsible for payment of the full cost of services if your insurance does not cover your services, or if your insurance does not cover the full cost of services beyond the initial 60 minutes that will be billed to insurance.

Your health insurance company and/or a third party payer may require that I provide it with information about your diagnosis, treatment plan, and your attendance at therapy sessions. It is rare, but they may require a copy of your entire treatment record. If you are using insurance and/or third party payer, you acknowledge this and you agree to allow these disclosures.

Acknowledgement and Agreement
By signing below, 1) each of us confirms that the above information is from my Disclosure Statement which you signed during the first session of our work together; 2) you confirm your understanding of the information provided specific to your individual payment agreement with me and Re-Source Counseling Center, PLLC – and agree to the terms of this document.

Signed and dated by Client and Jules Steffen, LMHC.

Accepted Payment Methods: Personal Check made payable to Re-Source Counseling Center, PLLC, Health Savings Account, MasterCard, Visa

Accepted Insurance Plans: Premera Blue Cross, Lifewise, Regence, Blue Cross/Blue Shield, Blue Cross/Blue Shield Federal Employee Program, ComPsych EAP, First Choice Health Network, Cigna, Kaiser Permanente of WA (formerly Group Health of Washington), Other insurance plans can be billed, and may or may not pay for out-of-network services.  Please note we cannot bill Medicare, Medicare Supplements or Tri-Care.