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Client Policies
Payment
Payment is due at the time of service. We require a credit card on file to book all appointments. We accept insurance, credit cards, and cash payments. Clients receiving mental health services and medication management services must comply with our automatic payment policy, which can be found below under “Automatic Payment Authorization and Policy” section. Clients with unpaid balances for 30 days will be referred to our collection agency for resolution. If clients’ accounts are sent to collections, they will no longer be permitted to schedule appointments or receive services from our providers.
Clients must provide a valid insurance card and government-issued photo identification immediately before scheduling an appointment. Appointments will not be confirmed until both documents are received. This ensures accurate billing and verification of benefits before services are rendered.
New Clients
New clients must sign consent forms, provide credit card information, and authorization before an appointment is scheduled. All intake paperwork must be completed 48 business hours before the appointment. These forms can be completed via email or a text link. Your appointment will be canceled if you do not complete these required documents. If you have questions or need help with your intake paperwork, please contact our office coordinator, Valerie.
You must be a minimum of 13 years of age to consent to treatment. If you are between the ages of 4 and 12, additional consent forms are required for treatment. Clients ages 12 and under are required to have parental or legal guardian consent. We abide by WA state laws and HIPAA rules regarding consent for treatment for all clients.
Cancellation Policy
We require a 48-hour notice for appointment cancellations. If you cancel your appointment within 24 hours of your scheduled appointment time, you will be charged the full fee for your scheduled service. Late cancellations will result in a $140 fee. Exceptions to this include emergency and inclement weather (virtual appointments are available during these circumstances). Insurance does not cover late cancellation fees.
If you cancel consistently (regardless of following the 48-hour rule) and miss 50% or more of your scheduled appointments, you cannot schedule appointments in advance. You can only schedule same-day appointments, be placed on our waiting list, and call if there is an opening.
If your treatment provider cancels your appointment due to illness or personal emergency, we will do our best to reschedule your appointment promptly. Virtual appointments may be offered if your treatment provider is ill. We do not offer monetary compensation or a reduced rate for service fees if your appointment is canceled.
Missed Appointments
Missed psychotherapy and medication management appointments will incur a $140 fee. We provide text, email, and phone confirmations and reminders of your scheduled appointments. Please check these reminders in the patient portal to ensure you arrive at the correct time. If your reminder indicates a different day or time than scheduled, you must contact us immediately.
Late Policy
If you are more than 15 minutes late to your scheduled appointment, you will be asked to reschedule and charged the missed appointment fees described above. If you miss the start of your appointment due to being late, your provider/clinician will not add extra time to your treatment. You will still be charged the full fee for your appointment if you are late.
Refunds
Refunds are not available for retail items or fees for medical services. If you are dissatisfied with your treatment or retail purchase, please notify us via email. We will work towards a reasonable resolution to the best of our ability.
Right to Refuse Service
We reserve the right to refuse or cancel services for any nondiscriminatory reason towards team members and/or other clients.
Children and Guests
Children and guests are not permitted to wait in the clinic while you are receiving services. Please plan to ensure that you have a positive experience.
Safety Protocol
All clients and team members are required to follow safety guidelines. Do not enter the clinic if you have any cold or flu symptoms. Masks are optional in our treatment rooms. Please let us know if you prefer your provider to wear a mask before your appointment.
Our cleaning and sanitizing protocol is extensive and rigorous. There may be times when extra cleaning tasks lead to a delay in the start of your treatment. We ask for patience and understanding if this occurs.
Confidentiality & Privacy
All team members must sign a privacy and confidentiality agreement at the start of their contract or employment. Your information will not be shared without your consent. We use HIPAA-compliant software (Simple Practice) to schedule and maintain electronic health records. Paper documents with confidential information are always stored in locked file cabinets. A security system protects the clinic during non-business hours. We have taken these precautions to comply with Washington state laws and protect your information as best we can.
We use Simple Practice to manage mental health and psychotherapy scheduling and records. If you need medical records, you must sign a consent form specifying the type of records you seek. While we strive to minimize hard copy paperwork, any written or signed documentation is stored in separate locked file cabinets.
*Psychotherapy record requests have specific rules and regulations. If you have questions about this, please read the consent form for psychotherapy or contact Dr. Mabry at Ashley@BalancePsychiatric.org
Expectations
Balance Psychiatric Clinic and Balance Psychiatric and Wellness Clinic provide a safe, nurturing environment where individuals feel heard, understood, and supported throughout their healing journey. We strive to provide a professional, welcoming, and peaceful atmosphere. Please remember these expectations while engaging in clinic services and utilizing waiting areas. Please inform us of any concerns or provide feedback to help us improve.
We look forward to assisting you!
Automatic Payment Authorization and Policy
Effective Date: May 1, 2025
At Balance Psychiatric Clinic, we are committed to providing high-quality care while ensuring a smooth and efficient billing process for our patients. To support this, we require all patients to have a valid payment method on file and authorize automatic payment for services rendered.
Policy Overview:
- Payment Authorization:
- By signing the automatic payment authorization form, you agree to allow Balance Psychiatric Clinic to securely store your payment information and charge your account for all outstanding balances, including copayments, coinsurance, deductibles, missed appointment fees, and services not covered by insurance.
- Timing of Charges:
- Your stored payment method will be charged after claims have been processed by your insurance provider and your financial responsibility has been determined.
- If you are self-pay or out-of-network, your payment method will be charged on the day of service unless otherwise agreed upon.
- I understand that the timing of the payment will take place in the evening between 12:00 AM and 2:00 AM after the invoice is created. Example: Invoice received on 9/8/23 at 10:00 AM. It will be automatically charged on 9/8/23 between 12:00 AM and 2:00 AM.
- Notification:
-
- You will receive a statement summarizing any patient responsibility before making the charge.
- An email notification and/or text reminder will be sent at least 48 hours before any charge for balances over $200
- I understand that I will receive an invoice detailing the charges on the day they are created. All invoices can be found in the client portal. Because insurance takes 2-8 weeks to process claims, you will see charges for copays, coinsurance, and deductible amounts AFTER we receive the insurance payment and notice of your required amount due. You will not receive an invoice on the day of service, as we must wait until your insurance processes your claim and reports the balance you owe.
- Disputed Charges:
- If I dispute any charge, I agree to contact Balance Psychiatric Clinic and Balance Psychiatric and Wellness Clinic within 10 business days of the invoice date to resolve the issue. Contact information for billing disputes or charges: Sandra@SLSBillingCredentialing.com
- Methods of Payment Accepted:
- We accept major credit cards, debit cards, and Health Savings Account (HSA) cards.
- Updating Payment Information:
- It is your responsibility to maintain a valid payment method on file. You may update your payment information anytime by contacting our administrative office.
- I agree to provide updated card information in the event of a change in my credit/debit card details (e.g., new card number, expiration date).
- Declined Payments:
- If a payment is declined, we will notify you. A $25 fee may be applied for declined or returned payments. Failure to resolve outstanding balances may result in the suspension of services.
- I acknowledge that I am responsible for any fees or charges incurred due to insufficient funds or declined transactions.
- Cancellation of Authorization:
- You may revoke your automatic payment authorization in writing at any time. However, payment for any outstanding balances will still be due under the terms of your financial agreement with the clinic.
- Good Faith Estimate:
- I understand that I will receive a Good Faith Estimate before starting treatment if paying out of pocket for services.
- Confidentiality and Security:
- All payment information is stored securely in compliance with HIPAA and PCI-DSS standards. We prioritize the protection of your personal and financial information.
Acknowledgment:
I understand that if I do not agree to the terms of automatic payment, I MAY be provided alternative referrals to providers outside of Balance Psychiatric Clinic and Balance Psychiatric and Wellness Clinic.
By receiving services at Balance Psychiatric Clinic, you acknowledge and agree to the terms of the Automatic Payment Policy.
For any questions or assistance regarding billing or payments, please contact our office at (360) 358- 3039 or Sandra@SLSBillingCredentialing.com.