New Client Intake Forms
Please download individual forms below, and mail completed forms to scimmet@manymoonstherapy.org.
Billing and Payment Policies
Initial Consultation:
The cost for the Initial Parent Consultation is a flat rate of $120.00, regardless of insurance coverage or income. You only pay for this appointment if you choose to proceed with services here. This enables families to have an opportunity to learn about the costs, review and submit the paperwork, see the appointment availability, and to be matched with your/your child’s individual clinician.
Your Out-of-Pocket Costs:
Even if you have private insurance, most families' costs are established by our income-based sliding fee scale. If/when insurance starts covering, your out of pocket costs might remain the same. Please see Balance Billing for further details.
Insurance Billing:
If you have private insurance, we are happy to check on your benefits and receive any necessary authorizations. Although we are out-of-network providers, we are happy to submit claims on your behalf. If you have a deductible, our claims would be applied to that. We are not able to dictate how much of our billed rate is actually applied toward the deductible or used to calculate your percentage covered.
Insurance can take 6-10 weeks for claims to be processed. Therefore, we ask families to pay based on our sliding fee scale while waiting to receive the first insurance claim statement (EOB). We receive payments from families (via credit card) within 7 days of service.
Balance Billing:
Once coverage starts, we use what is called Balance Billing. This means that your cost is calculated based on the full billed rate on the claim (reflected on the EOB), minus the insurance portion. Our claims reflect the full rate of service, not your income-based rate. In the event that insurance starts to cover and the payment is enough to reduce your out-of-pocket cost, we would refund any overpayments that you've made or re-allocate the credit to a future session.