FINANCIAL RESPONSIBILITIES 

- PSYCHOTHERAPY - 

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The following information is provided to help you understand anticipated costs of treatment, payment expectations, and additional costs and fees that may apply in specific situations. This version of the document was last updated in April 2026, so please do due diligence to ensure that you are referencing the most-up-to-date version to ensure accurate information is being relayed.

 

 

INSURANCE

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If you elect to use your applicable insurance plan, neither the clinic nor your therapist determines what you will owe. Only following each appointment does the insurance company give the clinic the exact information regarding your balance. It is ultimately your duty to know what your contract is with your insurance plan.

 

Cost sharing expectations, including deductibles, copays, and co-insurance are part of the coverage agreement between you and your insurance provider. Actual coverage is determined when the insurance plan receives a claim for processing. Please note: It is possible that there may be a difference in the actual copay or coverage once the claim is processed; you shall be responsible for any difference in this amount.

 

We strongly recommend that before beginning treatment you call the member services number on the back of your insurance card and ask relevant questions, such as:

• Do I have active outpatient mental health coverage?

• Is there a deductible (and what is it)?

• What is my co-pay or coinsurance?

• Are there any in network / out of network benefits for this therapist’s clinic? [Rachel Beaver and Associates - Type 2 Group NPI is 1366076226]

 

As of April 2026, Rebecca Seidemann PLLC, via Rachel Beaver LMSW & Associates [Type 2 Group National Provider Identification (NPI) is 1366076226], is credentialed with Blue Cross Blue Shield [NOT Blue Care Network (BCN)] and Aetna.

 

Relating only to in-network insurance plans: The clinic or therapist may offer verification of benefits, and may submit claims directly to in-network insurance providers, and may attempt to understand denials or other issues as a courtesy to you.

 

Our practice has no direct relationship with any insurance company and may receive limited or inaccurate information. Every policy is different, and ultimately it is the client’s responsibility to understand their benefits and communicate with their insurance provider as necessary.

 

Any explanation of benefits that we receive is only a quote of benefits, and not a guarantee of payment. Actual coverage is determined when the insurance plan receives a claim for processing.

 

Please note: It is possible that there may be a difference in the actual copay or coverage once the claim is processed; you shall be responsible for any difference in this amount.

 

Your insurance policy is a contract between you, your employer, and the insurance company. We are NOT a party to that contract. Our relationship is with you, not your insurance carrier.

 

Cost sharing expectations, including deductibles, copays, and co-insurance are part of the coverage agreement between you and your insurance provider. Your therapist or clinic is expressly prohibited from waiving, negotiating, or otherwise modifying these fees.

 

If the insurance company does not pay your balance in full within 30 days we ask that you contact the carrier to request prompt payment. Please inform our office of the carrier's response.

 

If your insurance provider continues to deny the claim, or if payment is not received within two months of the date of service, you will be billed and responsible for the full rate for service directly. You may choose to address this later on directly with your insurance company.

 

If you fail to provide accurate, up-to-date insurance information to the clinic, you will be responsible for the full cost of care. It is your responsibility to notify our office immediately when there is a change in your insurance. Failure to notify the office of a change in insurance, or if your insurance is denied due to policy termination or due to a lack of authorization for services, will result in you being responsible for the outstanding balance as well. Furthermore, if insurance companies retroactively take back fees previously paid for service, you will become responsible for payment, even if this occurs after you have terminated treatment.

 

In summation: while your clinic or therapist may try to assist you in navigating your insurance coverage as a courtesy, the cost of care and financial responsibility is ultimately yours.

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BALANCES & PAYMENTS 

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Full payment is due at the time of service. Prices of services are subject to change; clients will be given reasonable warning to the extent possible in these circumstances. Client’s portion of payment, as well as any past due balances, are due at the time services are rendered unless prior arrangements have been made with Rebecca Seidemann PLLC. We accept cash and all major credit cards for payment.

 

Credit card information may also be safely stored in your client portal for automatic payments. 3rd party credit card apps such as Venmo, Zelle, or PayPal are not HIPAA compliant and therefore not payment options at this time.

 

The therapist or clinic reserves the right to cancel upcoming appointments or client / therapist relationships due to unpaid balances, failure to provide an active payment method, concerns around fit, or other details that may threaten the effectiveness or sustainability of a client / clinician relationship. 

 

If the credit card the client has on file belongs to a parent, spouse, or any other person, and you are not an expressly authorized user as recognized by the issuing bank, you must ensure the authorized individual has consented to its use. This is an agreement between you and the authorized individual. The responsibility to reconcile charges once the card is on file / has been charged remains on you. 

 

I understand that I am financially responsible for all charges incurred while receiving services. This authorization is in effect for all future sessions unless revoked in writing or overwritten by a new such document provided by the therapist or clinic and signed by myself or an authorized representative. 

 

Client fees may be waived at the determination of therapist or clinic in certain cases where relevant emergent information was involved (such as sickness, accidents, emergencies, etc.). 

 

Returned checks may be subject to a $25 surcharge 

 

Balances unpaid 90 days after the service was provided may be subject to late fees of $5 per day - with a maximum late fee (per appointment) not exceeding said appointment’s out-of-pocket cost. [i.e. An unpaid $175 session may be subject to late fees up to $175, leaving a total of $350 due for said appointment]. Unpaid services are subject to collection via collection agency, attorney, or small claims court. 

 

We understand that temporary financial problems may affect timely payment of your balance. We encourage you to communicate any such problems so that we can assist you in the management of your account.

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SLIDING SCALE 

 

If the client would like to discuss the availability of a sliding scale agreement, this must be discussed and agreed upon prior to the rendering of services. Sliding scale agreements will be dependent on client, therapist, and clinic circumstances. You may be asked to submit relevant information regarding your income, assets, and wealth (such as tax return, payslip) if you request a sliding scale agreement. After service has been rendered, costs and aforementioned fees are non-negotiable. Sliding scale offers are at the determination of the therapist and clinic. 

 

If you have worked out a sliding scale plan with your therapist, you will be provided with a Good Faith Estimate that will document anticipated fees in accordance with your specific agreement. 

 

MISSED SESSIONS & CANCELLATIONS 

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If you cannot make a session, please inform your therapist or clinic as soon as you are able. If a therapist is unable to attend a planned session, they will likewise inform the client as soon as they are able. In the latter case - bar other otherwise-stated concerns - a session will be rescheduled at an agreed-upon date. 

 

Please be advised that keeping track of appointments and scheduling is the responsibility of the

client; it is not the responsibility of the therapist or clinic to remind clients of previously-agreed-upon appointments – be they stand alone appointments or recurring slots. Please communicate promptly if there is confusion surrounding an appointment or appointment slot. 

 

Clients are obliged to the clinic’s policy for late cancellations & missed sessions. Consequences of late cancellations and missed sessions may include, but are not limited to a fee. The exact fee will be adjusted over time at the discretion of the therapist or clinic. Insurance does not cover the cost of missed sessions or late cancellations. This policy is applicable to all clients. 

 

For these purposes, definitions are as follows: 

 

Late Cancellation: A cancellation that occurs within 48 hours of the scheduled appointment slot (including one-time appointments, make-up appointments, recurring appointments, emergency appointments, etc.).

 

Missed Session (due to “no show”): When the client does not attend the session and does not communicate a cancellation ahead of time 

 

Missed Session (due to tardiness): If the client is 20 or more minutes late to the session, the session will be considered missed and the slot will no longer be available. Fees will apply and, unless otherwise discussed, the client will need to reschedule.  

 

Partial sessions that have been delayed due to client tardiness (of <20 minutes) will still end at their original time. Additional time may be granted as a courtesy - at the sole determination of the provider.

 

If the therapist or clinic believes that repeated tardiness, missed sessions, cancellations, and /or lack of rescheduling is interfering with the therapeutic process, they retain the right to terminate the therapeutic relationship. 

 

ADDITIONAL SERVICES 

(Additional services are not covered by insurance) 

 

Text Support: At present, there is no service existing around text communication. The therapist will answer texts at their discretion; clients are asked to be mindful that text support is not guaranteed and may or not be available at the time a client reaches out. Appropriateness of texting relationships may be discussed as needed. Please refer to local emergency services as needed. 

 

Phone Support: At present, there is no service existing around phone communication. Please refer to local emergency services as needed. 

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Legal Services: Neither the clinic nor your therapist makes a practice of engaging in the legal processes of our clients or their families. However, in the instance that clinical therapy records and/or court appearance is mandated by subpoena, the out-of-pocket hourly fee schedule will apply to all time spent on this. The client whose attorney subpoenas the therapist will be expected to pay the fees unless the court orders otherwise. The fees for court preparation and appearance are set regardless of insurance co-pay or adjusted fee. Neither the clinic nor your therapist can testify in court without being subpoenaed per clinic policy. The client will also be responsible for any fees, mileage, and transportation costs the clinic or therapist incur as a result of their participation. Anticipated costs may be charged prior to court appearance - payment is expected. If the therapist is asked to block off a certain period of time for the courts, this will be charged according to the fee schedule. Travel mileage for therapist will be reimbursed at the current federal reimbursement rate. All time-related charges will be rounded up to the nearest 15-minute increment. 

 

Letters: Clients may request letters or documentation to notify their school or work of a diagnosis or disability. If the letter is created in the course of a regular session, no additional fees will apply. If the letter is created outside of a session, the hourly fee schedule may apply. This service is not covered by insurance. 

 

Consultations: (such as IEP meetings, extensive coordination of care) will adhere to the hourly fee schedule, rounded up to 15-minute increments. This is not covered by insurance. 

 

Medical Records Requested by Client: will adhere to the hourly fee schedule, rounded up to 15-minute increment. The client is expected to pay for any associated costs or fees incurred by the therapist or practice (such as postage, envelope). 

 

Other: If any service not listed herein is required, similar rates will apply and will be discussed as needed. Insurance will not cover such services. 

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