The following are practice guidelines and policies I have set up in an effort to efficiently manage my psychotherapy practice. This information is offered to bring clarity around mutual responsibilities for the therapeutic relationship you are entering into. There is a positive correlation between clarity in expectations and success of relationships. A helping relationship is equally influenced by such clear expectations and understanding.

Insurance Authorization and Financial Obligation: I encourage you to verify your mental health benefits with your insurance provider. Note that most insurance plans require prior authorization for mental health services. It is your responsibility to obtain authorization for these services. Services rendered without proper authorization will be billed in full to you at a "self-pay" status.

Fees: Initial Assessment $150.00-Adult, $165.00-Adolescent. Individual Psychotherapy $120.00 per 45 minute session. Couple/Family Psychotherapy $135.00 per 45 minute session. Group Psychotherapy $40.00 per 90 minute session.

Billing:  I can provide you with a monthly statement of your account if requested. In most cases in which I am a participating provider, I am able to bill your insurance company directly. In other cases, which we can discuss, it will be your responsibility to submit this information to your insurance provider for reimbursement of payment for which you may be authorized. If you need to submit session information directly to your insurance company, your statement will include all necessary information to assist with filing your claim.

Payment: Payment and/or co-payments, (determined by your insurance company), are due in full at the time services are rendered. Methods of payment may include cash or check (made out to Thomas Fronczak). Payment and/or co-payment is due at time of session. Any payment/co-payment that needs to be billed will be subject to a $20.00 administrative fee. Missed session fees must be paid in full before a follow-up appointment will be scheduled. Whether services are covered or not by your insurance, you must remember that you are ultimately responsible for payment for services. I realize that temporary financial problems may at sometime affect timely payment of your account. If this should occur, I encourage you to contact me promptly for assistance in the management of your account. If your account should go unpaid and be without a payment arrangement, you will be subject to referral to a collection agency and/or legal action, as well as an additional administrative filing fee of $50.00 per incident.

Returned check and interest charge: Returned checks will be subject to a $29.00 service charge. Please note that an interest charge will be applied at a rate of 1.5% per month (18% annual percentage rate) on any outstanding balance you owe over 14 days.

Missed Appointments: I ask that if you need to change or cancel an appointment time that you kindly give 48 hours notice by phone, as others may be able to utilize that time slot. Regardless of reason, you will be charged in full for sessions canceled or missed with less than 48 hours notice.  I have 24 hour phone service with voice mail available for convenience if you need to cancel or reschedule an appointment.  It is important to note that your health insurance will not reimburse for missed sessions. If there are 2 missed appointments without notice your therapy will be terminated with this office and you will be given a referral to other qualified mental health providers. If you will be late for an appointment, please let me know as soon as you are aware.

• Group Members: All members in ongoing groups are asked to make an 8 group session attendance commitment. If sessions are missed, they will need to be made up, up to the 8 sessions. Missed sessions will be assessed a missed appointment fee, (equal to the fee per session), up to and including the 8 sessions and thereafter, regardless of when I am informed of missed group. After the 8 session attendance commitment is complete, ongoing group members are allowed 2 missed group sessions without a missed appointment fee. 

Emergency/Crisis Contacts: In the event of a psychiatric emergency immediately go to the Emergency Department of the nearest local hospital. You may dial 911 for assistance.  My after hours contact number is (401) 431-2953, for emergent situations only. Please note professional fees ($120/hr. or prorated) apply for emergent phone contact after first 5 minutes. If I will be out of the office for an extended period of time, I will have licensed professional backup whose judgment I trust for any urgent need that may arise.

Report, Letter or Email Writing Fees: There will be a professional fee applied ($120/hr. or prorated) for reports, letters or emails reviewed or written on your behalf to other providers, agencies, or organizations. There is no fee for the initial or follow-up letters to your primary care provider around your participation in therapy or coordination of medication management issues. Please note insurance does not cover report or letter writing fees.

When I change my Practice Guidelines and Policies, I will promptly change this notice and post it on my office door and on this website.

Updated September 25, 2009