Notice of Financial Policies
As a professional social worker I am committed to providing caring and professional mental health care. As part of the delivery of mental health services, I have established this Financial Policy that provides payment policies and options to clients/patients.
This Financial Policy is designed to clarify my payment policies and billing practices.
Fees and Services: My fee for professional service(s) is $125.00 per session. The intake assessment is charged at $150.00 per session. I provide individual psychotherapy focused on the assessment, diagnosis, and treatment of mental health and substance use disorders in the mild to moderate range. Activities requiring clinician’s time outside of regular office visits are billed based on the pro-rated hourly fee
Insurance: I am a Medicare Part B Mental Health Provider and accept assignment.
For All other insurances and health plans I am an Out of Network provider.
I may accept payments from your Medi-Gap or Supplemental Insurance Policy but will not be able to continue this courtesy if there are any significant delays or problems. A Medi-Gap plan typically pays 30 days after Medicare has paid and forwarded the claim to them. The Patient is ultimately responsible for payment of all applicable Medicare cost sharing including co-pays, coinsurances and or deductible.
Medicare Supplemental insurance otherwise known as Medi-Gap is an insurance plan that provides additional payments for Medicare covered services after Medicare has issued payment. Medicare will pay the claim as the primary insurance and then the supplemental insurance will make payment on the remaining balance according to the benefits offered by that insurance.
Once a claim has processed through the Medicare system and paid according to the Medicare allowed amount, the Medicare claim will then "cross over" to the supplemental insurance company through the Benefits Coordination & Recovery Center (BCRC) for the supplemental insurance payer to process the remaining balance for possible payment.
The supplemental insurance company is responsible to set up the beneficiary information for their subscribers to their supplemental policies at the BCRC.
The beneficiary is responsible for supplying insurance information for updating their primary and secondary insurances with the BCRC. The beneficiary may update the information by contacting the BCRC at 1-855-798-2627 (TTY/TDD: 1-855-797-2627 for the hearing and speech impaired).
For more information about your Medicare Part B Benefits, cost-sharing, and MediGap / supplemental insurance please review CMS's Official Website:
Medicare Part B Mental Health Benefit:
How Medicare Works with Other Insurances:
What is Medicare Supplemental Insurance or MediGap:
Your insurance policy, if any, is a contract between you and the insurance company; I am not part of the contract with you and your insurance company.
Out of Network provider:
As a courtesy to you, I may bill insurance companies and other third-party payers on your behalf but cannot guarantee such benefits or the amounts covered. If I bill your insurance company for you then I will provide you with an invoice for the amount not covered or not reimbursed by the insurance company or health plan. Even if I bill your insurer (as a courtesy to you) it should be understood that the Patient is the person ultimately responsible for payment and is financially responsible for payment for all services rendered.
In some cases insurance companies or other third-party payers may consider certain services as not reasonable or necessary or may determine that services are not covered. The Patient is ultimately responsible for payment for all services provided. I charge a usual and customary fee of $125.00 per session. The intake assessment is charged at $150.00 per session. Clients or Patients are responsible for payments regardless of any insurance company’s arbitrary determination of usual and customary rates.
The Patient or Client is the Person Responsible for Payment and will be financially responsible for payment for all services provided. The Person Responsible for Payment is financially responsible for paying funds not paid by insurance companies or third-party payers after 60 days. Payments not received after 120 days are subject to collections. A 1% per month interest rate may be charged for accounts over 60 days past due.
All insurance benefits will be assigned to David A. Resnikoff MSW, LCSW (by insurance company or third-party provider) unless the balance for each session is paid in full.
Clients are responsible for making payments and may do so by check at the time of the appointment or by mail to: David A. Resnikoff MSW, LCSW PO Box 514 Santa Cruz, CA 95061-0514.
An additional fee of $25.00 is charged for any canceled or returned check.
Missed appointments or cancellations less than 24 hours prior to the appointment are charged a fee of $25.00 as noted in the Treatment Agreement.
