Private Payment. If the Resident does not have a third party payment source in place, his/her care will be billed at private pay rates. The private pay room and board rate (“Daily Basic Rate”) is $ per day for a private room and $ per day for a semi-private room. Ancillary services are not included in the Daily Basic Rate. Ancillary services, such as physician services, rehabilitation therapies, oxygen, dental and diagnostic services, laboratory, x-ray, podiatry, optometry, medications, urinary care supplies, trach and ostomy supplies, surgical supplies, parenteral and enteral feeding supplies, transportation services, and extraordinary rehabilitative devices, are not included in the Daily Basic Rate and will be billed separately according to the Facility’s and/or the service providers’ charge schedules. Rates of payment to the Facility may differ for individuals with additional sources of payment such as third party coverage. A copy of the Facility charge schedule for ancillary services is attached to this Agreement and included in your admission package. In addition, certain items and services, such as beauty/xxxxxx services; personal telephone, newspaper delivery etc. (see Attachment A - “Non-Clinical Service”) are not covered in the Daily Basic Rate or by health insurance plans and the Resident is responsible to pay for such services. Room and board charges are billed monthly on a one- month advance basis. Ancillary charges are billed in the month following the month that the services were provided. Bills are generated at the end of each month and cover the next month of room and board charges (“Monthly Advance Payment”) and the previous month’s ancillary charges. All payments are due upon receipt of the monthly bill. The Daily Basic Rate and charges for ancillary and/or additional services are subject to increase upon thirty (30) days’ written notice to the Resident, Resident Representative and/or Sponsor.
Private Payment. If the Resident is paying privately for the cost of his or her care, and part or all of such payment is not covered by a third party payor, the private room rate for room and board is $600.00 per day for a semi-private room and $635.00 per day for a private room In addition, the Resident will be billed for ancillary services including, but not limited to, urinary care supplies, trach and ostomy supplies, surgical supplies, parenteral and enteral feeding supplies, occupational, speech and physical therapy, physician services, prescription medications, laboratory tests, x-rays and other diagnostic services, ambulance/ambulette services, beauty and xxxxxx services, and newspaper delivery and extraordinary rehabilitative devices according to the Facility’s and/or the service providers’ charge schedules. However, rates of payment to the Facility may differ for individuals with additional sources of payment such as Medicare, Medicaid and third-party insurance. A copy of the Facility charge schedule for ancillary services is attached to this Agreement and included in your admission package. Payment must be made to the Facility upon receipt of the bill by the Resident, Designated Representative and/or Sponsor. The private pay room and board rate and additional services charges are subject to increase upon thirty (30) days written notice to the Resident, Designated Representative and/or Sponsor.
Private Payment. If the Resident is paying privately for the cost of his or her care, and part or all of such payment is not covered by a third party payor, the private room rates for room and board are as follows:
Private Payment. You agree to pay us our monthly rate for each day of residential care and services we provide to you. Such payment shall be made one month at a time, one month in advance. Payment for a portion of a month shall be based on the number of days in the month we provide care and services to you. The basic monthly rate includes payment for nursing services, use of a bed and the room in which the bed is located, linens, bedding, diapers and other incontinence supplies, routine laundry service, regular meals and snacks, certain equipment, social services, activities, and routine personal hygiene items which are required to meet your needs. Certain items and services are not covered in the basic daily rate. Extra charges for those items and services are set forth in Appendix A to this Admission Agreement.
Private Payment. If the Resident is paying privately for the cost of his or her care, and part or all of such payment is not covered by a third party payor, the private room rate for room and board is $1000 per day. In addition, the Resident will be billed for ancillary services including, but not limited to, urinary care supplies, trach and ostomy supplies, surgical supplies, parenteral and enteral feeding supplies, occupational, speech and physical therapy, physician services, prescription medications, laboratory tests, x-rays and other diagnostic services, ambulance/ambulette services, beauty and xxxxxx services, and newspaper delivery and extraordinary rehabilitative devices according to the Facility’s and/or the service providers’ charge schedules. However, rates of payment to the Facility may differ for individuals with additional sources of payment such as Medicare, Medicaid and third-party insurance. A copy of the Facility charge schedule for ancillary services is attached to this Agreement and included in your admission package. Payment must be made to the Facility upon receipt of the xxxx by the Resident, Designated Representative and/or Sponsor. The private pay room and board rate and additional services charges are subject to increase upon thirty (30) days written notice to the Resident, Designated Representative and/or Sponsor.
Private Payment. Our basic daily rate is shown on page 1 of this Agreement. You agree to pay us our daily rate for each day of nursing facility care and services we provide to you. We charge the basic daily rate for the day of admission and the day of discharge except when prohibited by law. Payment for a portion of a month shall be based on the number of days in the month we provide care and services to you. The basic daily rate includes payment for nursing services, use of a bed and the room in which the bed is located, linens, bedding, incontinence supplies, routine laundry service, regular meals and snacks, certain equipment, social services, activities, and routine personal hygiene items which are required to meet your needs. Local telephone, cable and Internet service are also included in the basic daily rate. Certain items and services are not covered in the basic daily rate. Extra charges for those items and services are set forth in Exhibits A and A-1 to this Agreement or they may be billed to you directly by the provider. Account statements are mailed prior to the first of each month for that month’s care. Statements also include the actual charges for any services not included in the daily rate during the prior month. These statements are payable as set forth at Section (B)(6), below.
Private Payment. Our daily rate is $ . You agree to pay us our daily rate for each day of nursing facility care and services we provide to you. Such payment shall be made one month at a time, one month in advance. Payment for a portion of a month shall be based on the number of days in the month we provide care and services to you. The basic daily rate includes payment for nursing services, use of a bed and the room in which the bed is located, linens, bedding, diapers and other incontinence supplies, routine laundry service, regular meals and snacks, certain equipment, social services, activities, and routine personal hygiene items which are required to meet your needs. Certain items and services are not covered in the basic daily rate. Extra charges for those items and services are set forth in Appendix A to this Admission Agreement.
Private Payment. If you would like to pay without using insurance,we accept private pay. Our standard fee for the initial intake is $250.00. For additional sessions, the rates are as follows: follow up 20 minute session with medication $120.00; follow up 30 minute session with medication $150.00; follow up 45 minute session with medication $220.00; follow up 45 minute session without medication $185.00, this is is the only service without medication and this service is for patients who do not require medications from beginning to the end of treatment, which is at the provider’s discretion. Our rate for a psychiatric consultation is $250.00. A face to face refill appointment is $50.00. Our rates are subject to review. You are responsible for paying at the time of your session unless prior arrangements have been made. Payments must be made by check, cash or credit card. A statement will be provided at your next session, upon your request. Any checks returned are subject to an additional fee of up to $25.00 to cover the bank fee that is incurred. Patients who are delinquent with payments or who refuse to pay your debt, Psychiatric Wellness Center reserves the right to use an attorney or collection agency to secure payment. In addition, the Psychiatric Wellness Center has grounds for termination. Your provider will refer you to another mental health provider including local community health clinics. Patients who are delinquent with payments are not entitled to medication refills after termination. It is up to the provider’s discretion pending your diagnosis and treatment plan. In addition to scheduled sessions, it is the center’s practice to bill the hourly rate of $250.00 amount on a prorated basis for other professional services that you may require such as report writing, telephone conversations that last longer than 15 minutes, attendance at meetings or consultations which you have requested, or the time required to perform any other service which you may request of your provider. If you anticipate becoming involved in a court case, it is recommended that you discuss this fully before you waive your right to confidentiality. If your case requires your provider’s participation, you may be expected to pay for the professional time required even if another party compels me to testify. If requested, our providers will supply you with a receipt of payment for services, which you can submit to your insurance company for reimbursement.
