FINANCIAL AGREEMENT

All fees for service are expected to be paid in full when making a scheduled appointment with our company and therefore just prior to the actual delivery of clinical services. Except in the case of minors or when other arrangements have been made, the person receiving the psychological service is financially liable. Global Insomnia Solutions LLC does not initiate billing to any insurance carrier, whether it is primary or secondary. As such, patients or their representatives are solely responsible for all clinical fees.

Insured clients are expected to take care of the entirety of their service fee at the time of scheduling their appointment with Global Insomnia Solutions.  However, your health insurance may help you recover some of your treatment costs. Most group policies, but few individual policies, cover telepsychology services provided by a licensed clinical psychologist. If desired, patients are welcome to seek reimbursement from their primary or secondary insurance carrier.

Most insurance carriers require pre-authorization prior to the actual appointment date.  If interested in trying to receive reimbursement for your appointment, it is important to notify you insurance carrier prior to scheduling your appointment.  Please verify with your insurance carrier company the amounts of coverage for telepsychology services if you are interested in submitting your bill for reimbursement. If you are required to submit information to them prior to payment, this is the sole responsibility of the patient.

 

REFUND POLICY

Clinical service fees are collected when you make your scheduled appointment.  However, unavoidable circumstances do happen in our lives. If you need to cancel your appointment, please notify our office by e-mailing or calling us.  A “no-show” or “late-show” on the day of your appointment time may inconvenience other individuals who may need to access our service. Please review the following for our company policy regarding missed appointments.

*Cancellation of scheduled appointment at least 24 hrs. prior to appointment time:  FULL REFUND

*Cancellation of scheduled appointment within 24 hrs. of appointment time:  ONE-HALF OF FULL CHARGE

*No Show – No Phone Call to cancel appointment:  NO REFUND

 

How to Cancel Your Appointment:  To cancel your appointment, please send an email to info@globalinsomniasolutions.com or call 847-986-6201. If you are unable to reach our staff, please leave a detailed message on our voice mail.  If you would like to reschedule your appointment, please leave your name and phone number.  We will return your call promptly.

 

No Show Policy:  A “no-show”, is a patient who misses an appointment without canceling it.  A failure to be signed into our video conference platform as directed in our appointment confirmation mail, at the time of a scheduled appointment will be recorded in the patient’s chart as a “no-show”.

A “no-show” status becomes effective 20 minutes after your scheduled appointment if you have not signed into our video conference platform. If you are having technological difficulties accessing the video conferencing platform, please call our phone number before the 20-minute ‘grace-period’ to avoid any unnecessary charges.

 

Consent Regarding Patient Responsibility for Payment:  By scheduling your appointment on our website and by clicking the checkbox regarding this agreement when you enter your new patient information, you are acknowledging that you have received and agree with the terms of this financial agreement and refund policy as set forth herein by Global Insomnia Solution, LLC.

You are agreeing that if you have not obtained any necessary authorizations from your insurance, or are not eligible at the time services are rendered, you are still responsible for full payment even if the determination for insurance reimbursement is made subsequent to when services are rendered. All clients should remember that professional clinical services are rendered and charged to the client and not to the insurance company.

You are also authorizing release of the identifiable information concerning your account (including billing information) to our office and that credit, debit or PayPal payment for services may come directly to our office. This agreement supersedes all prior agreements signed, including all mediation or arbitration agreements and acknowledge that any prior mediation or arbitration agreements signed previously related to financial arrangements are null and void.

Global Insomnia Solutions, LLC
1-847-986-6201
info@globalinsomniasolutions.com