This practice is an Out of Network Provider. I do not bill your insurance company and therefore payment is due at each session. However, I will provide a “super bill” if you are eligible for reimbursement from your insurance company. Services may be covered in full or in part by your health insurance company or employee benefit plan. Sliding Scale and fee increases are determined at Elisa Elkin-Cleary’s discretion.
For sliding scale agreements and contract fees, a separate form will be provided and signed at the initial session.
Occasionally, I may increase my standard fee. If you are in therapy when an increase is to occur, you will be notified in advance. At that time, your fee will be adjusted to the new fee, this fee agreement will be terminated, and you will be asked to sign a new agreement which reflects the new fee. Any prepaid sessions or original sliding scale fee arrangements will continue to be honored at the original rate until they are used.
I have read and understood the above fee agreement, and I agree to abide by its terms.