Fees and Payment Methods

Session Costs:

$125 per session (1 hour)
I offer a free (15 minute) initial phone consultation

Payment methods:

Visa
Mastercard
American Express
Discover
Paypal
Check
Cash
Health Savings Account

Insurance: As a courtesy to you, we will verify your insurance benefits and file all claims directly to your healthcare provider. It is your responsibility to provide us with up-to-date information, including any changes in your policy while you are receiving services. All required payments (i.e., copayment, coinsurance, deductible) for services are due at the time service is rendered.

Blue Cross and Blue Shield

  • All Kids
  • Blue Choice PPO
  • Federal Employee Program (FEP)
  • Public Education Employees Health Insurance Plan (PEEHIP)
  • Local Government (LGHIB)
  • State Government (SEIB))
  • Anthem Blue Cross Blue Shield
  • BCBS Expanded Psychiatric Services (EPS)
  • Most out of state BCBS policies

Out of Network

Dr. Clark may not have a contract with your health insurance plan. If this is the case, you will be responsible for the out of pocket fee. He can, however, provide you with a “Super Bill” (a detailed invoice for services) that you can submit to your insurance company. Many healthcare policies have an out of network provision, which typically covers a portion of your out of pocket costs.

Cancellation and No-Show Policy

(See ‘Statements of Understanding’ under Forms and Fees)

Intake Forms

Instructions: Please print out, complete, and bring to your first session the following forms: Statements of Understanding and the Family/Marriage OR Adult Intake form. The HIPAA Notice of Privacy Practices is simply for your review.

 

Click to download

Statements of Understanding

Family/Marriage Intake Form

Adult Intake Form

HIPAA Notice of Privacy Practices

Authorization to Release Information