New Light's Financial Policy
Every New Light client receives and signs a copy of our financial policy as part of their standard intake paperwork. Please feel comfortable to discuss any questions you may have with your therapist.
I hereby acknowledge that I am personally liable for all fees for services performed on my behalf by New Light. These fees include full session charges for those without insurance; co-pays for those with co-pay insurance plans; and all unreimbursed insurance claims, including amounts that fall within client’s deductible. I understand my co-pay, co-insurance, deductible, or fee difference is due at time of service and will be processed accordingly. Accepted methods of payment are check and credit card. Checks should be made payable to: JPA. I will be provided a receipt after payment is processed ONLY at my request.
While New Light files insurance as a courtesy, I understand that I (not my insurance company) am ultimately responsible for my bill. If my insurance company denies a claim filed on my behalf, then I am responsible to pay New Light for the difference between New Light services rendered and the amount paid by my insurance company. New Light will submit any and all insurance claims within 24 hours of client session date(s). I irrevocably agree that any bill that is unpaid, denied, or not in process of being paid by my insurance company 30 days after the date of my session(s) will be charged to my credit card on file. New Light currently accepts and processes insurance payments through Blue Cross and Blue Shield of Illinois PPO only. I will receive a receipt after payment is processed ONLY at my request.
If you are unable to keep an appointment, our office requires 24 hours as an acceptable notification of cancellation. This courtesy on your part will make it possible to give your appointment to another client who needs it. In the event that you are unable to give such a notice, you will incur a no-show or late cancellation fee which is equivalent to the full cost of your scheduled session.
I authorize release of any medical information to my insurance company for the purpose of accessing my claim benefits. I authorize the credit card company listed below to recognize and approve charges against the credit card listed below as submitted by New Light. I certify that the below listed card is issued to me, and/or that I am an authorized signatory on the account; and that said card is currently valid. I agree to always keep on file with New Light a valid credit card.