Insurance & Fees

If your insurance company is not listed contact the office to check possible options, 

including us going through the process of becoming in-network with your insurance company!

Psychotherapy 53+ minutes (90837)

$170.00

SAP Evaluations $475 (not covered by health insurance)

When Scheduling a Session

When filling out our Appointment Request Form on our HIPAA-compliant software, you will be asked for your name and phone # or email. This information is used to create you as a client in our software. This form should be filled out by the person who is requesting services.

Please submit the form even if you do not answer every question if you would like us to contact you.

This is the best first step to creating a connection with your new therapist.

All answers on this form are 100% confidential.

Sliding Fee Discount Program Policy for Maitri Path to Wellness

Policy Statement:

Maitri Path to Wellness is committed to providing affordable behavioral health services to individuals and families who may face financial constraints. Our Sliding Fee Discount Program aims to ensure that our services are accessible and inclusive to individuals from all socioeconomic backgrounds. This policy outlines the guidelines and procedures for the program, addressing key areas to promote transparency, fairness, and compliance with applicable laws and regulations. No one will be denied access to services due to inability to pay. There is a discounted/sliding fee schedule available based on family size and income.

Sliding Fee Schedule Policy

Patient Eligibility

The Sliding Fee Discount Program is designed to assist individuals and families who fall within designated poverty levels. Eligibility for the program will be evaluated on a regular basis to ensure continued compliance. The frequency of patient eligibility re-evaluation will be determined as per regulatory requirements and best practices.

Income Definition

To determine patient eligibility, Maitri Path to Wellness requires valid documentation for income verification. Acceptable documents include recent tax returns, pay stubs, or official letters from employers or government agencies. The income level will be calculated based on the participant’s reported income and verified through the provided documentation. Income levels to qualify individuals and families must have annual incomes at or below 200% of the most current Federal Poverty Guidelines. These can be found in the Sliding Fee Schedule Table below.

Family Size Definition

The program recognizes that family size impacts an individual’s financial circumstances. Therefore, the income levels in the program will correspond to specific family sizes. Family size refers to the total number of individuals living in a household. Participants with larger families will have higher income thresholds to qualify for the same discount percentage. The additional person amount provided in the table should be added to the income level for each additional family member beyond 8 individuals in the family.

Documentation and Verification Requirements

To ensure the accuracy and integrity of the Sliding Fee Discount Program, Maitri Path to Wellness requires participants to provide proper documentation and undergo income verification. These measures are in place to prevent potential abuse or misuse of the program and to maintain compliance with regulatory standards. All information provided for income verification will be treated with strict confidentiality. Only authorized personnel involved in the Sliding Fee Discount Program administration will have access to this information.

Discount Calculation

The discount percentage will be determined based on the participant’s income level and the corresponding poverty level percentage in the table. The discount will be applied to the standard therapy session cost.

Family Size Consideration

The income levels in the table correspond to specific family sizes. Participants with a larger family size will have higher income thresholds to qualify for the same discount percentage. The additional person amount provided in the table should be added to the income level for each additional family member.

Example Calculation

For instance, if the therapy session cost is $170 for a 1-hour session and the participant’s income level falls within the 110% poverty level, they will receive a 90% discount. Therefore, the discounted session cost will be $15.00.

Nominal Charge Explanation

The Sliding Fee Discount Program allows for an allowance for a nominal charge and a discounted service fee to be established for participants based on their income level and family size. The policy clearly defines the nominal charge as $35 and outlines the procedures for establishing and collecting it with each individual during the initial consultation with potential clients. Payment, collection, and refusal to pay details are in the following section. There will be no surprises about what discounted rate a potential client qualifies for because the Fee Schedule Table will not change throughout the year and is available to everyone. Payment whether it be a nominal charge, or a discounted fee is not a threshold for receiving care.

Collection Policies for Outstanding Debt and Refusal to Pay

In the event that a participant incurs outstanding debt related to the Sliding Fee Discount Program, Maitri Path to Wellness will establish clear collection policies through open communication with the client. We accept payments in the form of insurance reimbursement (all state insurance programs including MCOs, and most private insurance), cash, check, electronic funds transfer (EFT), credit card, or debit card, special arrangements may be made if other payment options are necessary. These policies should outline the steps taken to address outstanding debt, including any legal recourse that may be pursued. A refusal to pay refers to the absence of any attempts to make a payment or arrange a payment schedule within 30 days of the invoice’s due date, or a 30-day lapse in communication between the organization and the client without payment. The invoice due date is uniformly set at 14 days after the client’s session, irrespective of the client’s participation in the Sliding Fee Schedule Policy. It is crucial to adhere to applicable debt collection laws and regulations to protect both the rights of the organization and the interests of program participants.

Patient Non-Discrimination Policy

Maitri Path to Wellness is committed to providing services without discrimination. Our Patient Non-Discrimination Policy reflects our dedication to equal treatment and access to care for all individuals. We do not discriminate in the provision of services based on an individual’s inability to pay, their coverage under Medicare, Medicaid, or the Children Health Insurance Program, or their race, color, sex, national origin, disability, religion, age, sexual orientation, or gender identity. Maitri Path to Wellness will periodically assess the effectiveness of the Sliding Fee Discount Program in meeting the needs of individuals with financial constraints. Feedback from participants will be encouraged to improve the program’s accessibility and efficacy.

Advertisements and Promotion

Maitri Path to Wellness recognizes the importance of effectively promoting the Sliding Fee Discount Program to increase awareness and accessibility. We will actively advertise the program through various channels, including our website at maitripathtowellness.com/insurance-fees/, and during initial consultations with potential clients. By adopting comprehensive advertising strategies, we aim to reach individuals in need of mental health services and ensure they are aware of the available financial assistance.

By implementing the Sliding Fee Discount Program, Maitri Path to Wellness aims to create an environment that promotes fairness, accessibility, and compliance with legal and regulatory requirements. The program guidelines provide clear eligibility criteria, income verification processes, advertising strategies, explanations of nominal charges, and collection policies. Additionally, the Patient Non-Discrimination Policy reinforces the commitment to treating all individuals equally and respecting their rights and privacy.

Please note that this policy is subject to change, and any modifications will be communicated to program participants in a timely manner.

A copy of this policy is available on our website at maitripathtowellness.com/insurance-fees/