Thank you for considering Valley Psychiatry & Counseling as your health care provider. We are committed to building a successful physician-patient relationship with you and your family. Please understand that payment for service is a part of that relationship. The following is a statement of our Financial Policy. For any billing questions, please contact Kaizen at 630-655-3131.

Patient Information

A fully completed current patient registration form will be on file in the patient chart during the time in which the patient is considered an active patient. Patient registration will be updated by the patient yearly and will include where the patient can be reached by phone. A signature by the responsible party is required.

Insurance Claims

We will file claims with the patient's insurance upon the patient's submission of proof of insurance (i.e., insurance card indicating coverage, identification number and group number). In the event the patient has insurance coverage but cannot provide documentation, payment is due at the time of service. Upon receipt of the insurance card, we will submit the health insurance claim form to the insurance company.

Patient Financial Responsibility

If no insurance is to be filed by us (cash patients), or if we are not a participating provider in your insurance plan, full payment is expected. Co-payments, deductibles, co-insurance and payment for non-covered services are due at the time of service. We accept cash, checks and credit cards. A fee of 30 dollars will be charged for returned checks.

Past Due Accounts

Any outstanding balance after insurance has paid, will be invoiced to you on a statement. Payment is due upon receipt of the statement. A late fee of 10 dollars will be charged every month per statement thereafter. Prolonged delinquency in payment will result in preparation of account to be sent to a collection agency. This may result in a discharge from the practice.

Method of Payment

Acceptable methods of payment are cash, check, VISA, MasterCard and Discover Card. Credit card payments can also be accepted by phone or fax.

Cancellation / No Show / Rescheduling Policy

It is essential you are on-time for your appointment and call at least 24 hours in advance when you are unable to keep your scheduled appointment. Failure to show up for your appointment or cancel without 24 hours notice will result in a $50.00 charge.

Minors / Dependents

Children under the age of 18 will require the signature of a responsible party on the registration form and an accompanying adult for the appointment.