top of page
ACS head squared_edited.png
ACS no square_edited.png

Office Policy

We are committed to providing you with the best possible care. In order to achieve this goal, we need your understanding and

acceptance of our policies. Please thoroughly review the following and give us a signed copy.


We typically provide services on an appointment basis. If your situation is an emergency, please go to the nearest emergency facility.

During normal working hours, your telephone calls to our office are answered by us. Charges may be made for appointments cancelled

without 48 hours’ notice.


We are participating providers with virtually all insurance companies. If we do not participate with your insurance plan, we will do our

best to join. Most insurance companies cover, at least in part (and in some cases fully), the cost of our services. We honor the rates

that “allow” for their “covered” services. They may not “cover” all services we provide. In most cases, we are required to file with your

insurance carrier for you as part of our contract with your company. You must realize, however, that the failure of your insurance

carrier to pay for services rendered by any of our staff does not relieve you of your responsibility to pay us directly.


Insurance companies are now routinely and unpredictably changing what services they “cover,” the amounts they pay and other

factors. Insurance companies differ substantially in the services they “cover” and they amount they pay. Further, in this computerized

world, we are forced to use “procedure codes” when submitting claims to these carriers. These procedure codes, as well as diagnosis

codes, may carry vague and general definitions that do not always exactly correspond to the symptoms of the patient or specific

services we, and other clinicians, provide. Be aware that the services we provide may not fit the specific descriptions associated with

the procedure codes and we may be forced to select a procedure code that seems to fit best, but perhaps is not an exact description of

the services we provide. The same is true of diagnostic codes. Our billings reflect time spent by any of our staff in direct contact with

the patient; however, billings can also include time spent by any of our staff in other activities including, but not limited to, telephone

conversations, scoring and interpretation of evaluations/tests, report writing, time spent filling out forms and writing letters, and

general preparation. These may include billing time when the patient is not in the office, especially testing and collateral contact.

Before engaging in services with us, please understand that we do not always listen to recorded phone messages and do not always

read emails, text messages, and social media. Note that certain elements of these forms of communication may not be confidential.

You can email us at: info@associatedclinical.com


The term “telehealth” refers to any type of service delivered by electronic means, and typically insurance coverage is exactly the same

for telehealth services as it is for face-to-face services. Again: you may be charges for time spent on your case even if you are not in the

office.


With the exception of special services testing (e.g., testing for forensic purposes), Dr. Carter and other clinical psychologists at this

practice generally bill 16 units for full assessments/evaluations, and this includes time spent on numerous activities. Again: This

includes billable times that patients/clients are not in the office (e.g., for test scoring, test interpretation, and report writing).

Testing/assessments typically involve services covered by your health insurance, but certain elements may not be covered. Our testing

sessions may also involve therapy services and you should feel free to discuss topics of concern during testing sessions. Often, testing

requires that we obtain separate, ongoing, and multiple authorizations from insurance companies. Sometimes this can create delays

and elongate the testing process.

Some services may not be covered benefits eligible for payment by insurance companies/HMO’s (for example, time spent processing

disability claims or activities associated with legal issues). You will be asked to pay for any service not covered by or paid by your

insurance carrier, for any staff member of our office including non-covered amounts, deductibles, and copays/coinsurances. We will

bill for the time of any nature spent on your case by any member of our staff, and some insurance companies may not cover all billable

time.


If information concerning you is required by third parties such as lawyers, the Social Security Administration, court representatives, and

schools, we reserve the right to charge you directly. Please expect to have to pay, yourself, for paperwork we are asked to fill out for

you, expect that which is associated with normal billing and record keeping. If you are applying for benefits (e.g., from Social Security

or disability carrier) and we are contacted, expect to have to pay.

Should you engage in any activity which results in interference or disruption to our receiving payments from any third-party carrier (e.g., your insurance company, EAP provider) or causes recouping of money already paid to us, you are responsible to pay the full amount we charge for the services and a fee of $500.00, plus any attorney’s fees we have to pay. While this hardly ever happens, please be careful in your dealings with your insurance company and immediately notify us of any insurance changes or other issues you may have.


If financial problems arise, er encourage you to contact us promptly for assistance in the management of your account. Returned checks and balances older than 30 days will be subject to an interest charge at a rate of 1 1/2 % the total amount due per month. In any case where an account is turned over for collection, you will be responsible for, and we will bill you for, our collection cost as usual. At the initial session and on a periodic basis, the treatment plan for you will be discussed. You can agree or disagree with the plan. By signing below, you agree to the treatment plan and to be treated. Please advise us if you disagree with the treatment plan. We will never deny you any treatment of an emergency nature because of nonpayment of your account. You are liable for any out of office appearance by Dr. Carter (and potentially other staff/providers) which is in any way associated with your case at the rate of $310.00 per hour with a minimum charge of $1240.00. All forensic-related services, including preparation and research by Dr. Carter (or other staff), which are associated in any way with your case, are billable for $310.00 per hours. You will be asked to provide a retainer to reserve time for out of office and/or forensic services. Discounts are available but are not effective unless confirmed in a written statement signed by Dr. Carter (or another licensed clinician).


In many cases, there is some need for us to exchange information with other parties, such as other treating physicians, schools, and various family members. If you do not wish to give us permission at this point in time to exchange information with other parties, please cross out this paragraph. If you have any doubts about granting this permission, please cross out this paragraph and we will ask you to sign separate permission forms when and where appropriate.


Please note there are some limitations to confidentiality and some occasions when information must be released to others without your permission (e.g., subpoenas, imminent hard situations, and national security threat circumstances).


You can request copies of our records that pertain to you. Certain records cannot be released to you directly (especially “raw” test data) but can be sent directly to a clinical psychologist you designate. Healthcare entities are allowed to impose a cost-based fee which shall include the cost of supplies and the labor of copying the requested information, postage, and, when requested in writing, preparation of an explanation and summary. Be prepared to pay if you request records.

We strive to provide excellence in patient care within the context of a teaching facility. Patients benefit from a diversified and eclectic clinical staff able to handle virtually all types of patient problems. Thorough diagnostic services are available, and the staff utilizes the latest testing and evaluation procedures to address patients’ concerns involving their emotional, social, cognitive, vocational, and educational functioning. By utilizing a variety of treatment modalities including individual, group, family, and couples therapy specialized programs allow for flexible, effective, and efficient treatment that is coordinated with other patient health care providers. As a teaching facility, residents, interns, externs, and other assistants are involved in all levels of care and provide patients and senior staff with access to fresh knowledge and perspective. Immediate consultation and supervision are provided, both electronically and on site, affording a multidimensional multi-staff approach to patient care. Sliding scale charges are available for non-covered services upon request.


If you have any questions, please ask staff members for assistance and clarification.


I have read and agree to the above provisions and consent to treatment.

bottom of page