(Effective 05-01-2017)

RE: Insurance

It is your responsibility to:
1. Know what your deductible is, and whether you have met it each time it changes.
2. It is your responsibility to know what your copay is, and bring it (in cash) to each session.
3. It is your responsibility to present the insurance card that is on file (not expired) at the time of your initial session, and when it renews.

**Please be aware that if you have NOT met your deductible, your services are NOT covered by insurance. Therefore, your expected payment will be $60.00 per session until such time as the deductible has been met. You will receive a receipt for this which you may submit to your insurance to meet that deductible.

*If your insurance requires pre-authorization, it is your responsibility to obtain that authorization and provide the authorization number on your initial session, as well as know how many sessions were authorized.

Tricare holders MUST have, and bring, a doctor referral with them at the time of their initial session. Regardless of what Tricare claims, they are NOT re-imbursing otherwise. If a Tricare holder wishes to be seen without the doctor referral, a payment of $60.00 per session is required, and a receipt will be provided to submit to insurance.

*I only submit to:
Blue Cross, Blue Shield
United Behavioral Health (with authorization).

Any other insurance holder will receive a receipt which may be submitted to their insurance provider.

Thank you for your business, and for your understanding.

Jessie L. Rayl, Ed.D., CFMHE, LPC, ALPS, DCMHS/SA&CD, DCMHS/Trauma