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Dorian Angebrandt, LCSW (dba Choices in Counseling, LLC) Financial Agreement: (Abstract From Client Rights & Responsibilities)

Insurance Reimbursement:

Dorian Angebrandt, LCSW (dba Choices in Counseling, LLC) will submit claims to most major insurance companies on your behalf. Please contact Dorian Angebrandt, LCSW directly to discuss your individual coverage(s).

Coverages:
Current insurance coverages for Dorian Angebrandt, LCSW (dba Choices in Counseling, LLC) can be found on the “About" page or by contacting your insurance provider directly.

Current Rates:
The following are the current billable rates for service and are effective from January 1, 2022 thru December 31, 2022:
1. Initial Assessment: $175.00/Hour
2. Ongoing Individual, Couples and Family Therapy: $125.00/Hour

*Actual allowable, adjusted, and client co-pay/co-insurance amounts vary based on individual insurance coverage(s). Dorian Angebrandt, LCSW (dba Choices in Counseling, LLC) will adhere to the approved allowed reimbursement amount indicated by insurance providers and will
never attempt to collect any differences between billed and stated allowable reimbursement amounts.*

*In the absence of “Active” insurance coverage(s) at the time of service Dorian Angebrandt, LCSW (dba Choices in Counseling, LLC) is entitled to the full billed claim amount(s) payable by the client to Dorian Angebrandt, LCSW (dba Choices in Counseling, LLC) for services rendered.*

Reports, Court Appearances & Requests for Records:
Additional charges will apply to the preparation of reports, preparing records for third party entities and for attending court hearings depending on the nature of the request(s).

The standard hourly rate of $125.00 per/hour will be applied for the generation of reports. Most insurance companies will not reimburse clinicians for report writing or the preparation of records. Fees associated with these services will be the responsibility of the client. In general, Licensed Clinical Social Workers
do not complete Disability Determination Paperwork for Medicaid, Medicare or Social Security. Typically psychologists are required to conduct these type of assessments. A list of area psychologists is available via the ”Links” page.

Reports are typically recommended in lieu of formal court appearances. When required, court appearances are typically billed at a rate of $190.00 per/hour to cover out-of-office travel and expenses up to 100 miles to and from the court house in Franklin, IN.

Requests for the preparation of hard copies of records for individual and/or third party use are subject to fees in accordance with the State of Indiana Insurance Regulations (Title 760 Department of Insurance). The following fees will be assessed through Choices in Counseling, LLC:

1. $20.00 initial preparation fee per records request (Includes up to 10 individual pages).
2. $0.50 additional preparation fee per additional individual page in excess of 10 pages (pages 11-50).
3. $0.25 additional preparation fee for all pages 51 and higher.
4. Mailing materials and postage costs will be billed to the individual/company requesting records.
5. Rush orders or other special circumstances may incur additional fees up to $20.00 per records request.

NOTE: Due to confidentiality reasons, we are typically unable to email or fax records. Records will be mailed to the individual/company requesting records. 

Call Cancel/No-Show Policy:
Choices in Counseling, LLC and Dorian Angebrandt, LCSW will make every effort possible to remind you via phone, text or email
at least 1 day prior to your appointments. If you are unable to keep a scheduled appointment a minimum of a 6 hour notice is expected to allow other clients to be notified of this available appointment time and to maintain your future scheduled appointments. If you miss an appointment without calling ahead your ability to schedule advance appointments may be limited. A missed appointment fee of $50.00 will be assessed at the clinician’s discretion if advanced notice of a cancelation is not given.

Payment:
Co-Payments are expected at time of service and will be verified with your primary insurance provider. For your convenience Choices in Counseling, LLC accepts VISA, MasterCard, Discover, money orders, cash and personal checks for payments/co-payments.

Sliding Scale Fee/Reduced Rates:
Due to the nature of our contracting with private insurance companies, we are not able to offer reduced rates or utilize a sliding scale fee with our clients. We will make every possible accommodation for those in need of services by offering very low monthly payment plans when needed and by offering mental health coverage through Medicaid, the Healthy Indiana Plan, and other State and Federal programs when possible. Please contact us directly to discuss payment options that may be available to you.

Collections:
We will make every effort to work with you and your family regarding your bill. Failure to make timely payments or honor your individual repayment plan may result in your account being sent to collections. If your account is sent to collections, additional charges may be applied to the overall balance on your account to cover collections costs, attorney and court costs and associated fees. For more information regarding our collections policy please contact our office directly.