Financial Policies (Counseling)

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Effective 6/4/2025

The private-pay fees for therapy services at The Mind Body Soul Collective (hereafter referred to as “The Practice”) are as follows:

• Individual Therapy Session (53 minutes): $150
• Telehealth Session (53 minutes): $150
• Initial Diagnostic Intake (53 minutes): $200
• ADHD Assessment (90 minutes): $400

Note: Fees are subject to change with prior notice. You will be informed of any fee adjustments in advance of your next scheduled appointment.

Credit Card on File:
All clients are required to keep an active credit or debit card on file. This card will be securely stored and used to process payments as follows:

• Private-Pay or Copay Clients: Payment will be charged at the time of service.
• Insurance Clients: If we submit claims on your behalf, your card will be charged once we receive the Explanation of Benefits (EOB) from your insurance company indicating your financial responsibility (copay, coinsurance, deductible, or denied claims).

We are committed to transparency and will provide notice of any amounts owed based on your insurance’s determination. If you have any questions about your EOB or charges, please contact our office prior to the transaction.

As a courtesy, The Practice will submit claims to your insurance company on your behalf. It is important to understand the following:

• Verification of Benefits Is Not a Guarantee of Payment: We will do our best to verify your benefits, but your insurance company makes the final determination of coverage and your financial responsibility.
• Client Responsibility: You are ultimately responsible for any portion of the fee not covered by your insurance. This includes copays, coinsurance, deductibles, and any services not covered.
• Denials or Delays: If your claim is denied or not paid in a timely manner, you will be responsible for the full session fee, and payment will be processed using the card on file.

Please keep your insurance information up to date to avoid delays in processing.

Please note that the amount submitted to your insurance company may be higher than our private-pay rate. This is common practice in healthcare and does not impact what you owe.

• Why the Difference? Insurance companies often negotiate different reimbursement rates based on their contracts with providers. The higher billed amount reflects the standard market rate for services and allows for insurance adjustments, discounts, or denials.
• Your Financial Responsibility: You are only responsible for the amount determined by your insurance company as your portion—this may include a copay, deductible, or coinsurance. You will never be expected to pay more than what your insurance specifies, unless the service is not covered.

If you have any questions about what was billed or paid by insurance, we’re happy to review your Explanation of Benefits (EOB) with you.

If a balance remains unpaid after 60 days, your account may be sent to a collections agency. You will be responsible for the outstanding balance as well as any associated collection fees.

Please refer to our Attendance Policy for information regarding late cancellations, no-shows, and rescheduling procedures.

If you are experiencing financial hardship, please speak with your provider. We are committed to supporting access to care and may be able to offer reduced rates on a case-by-case basis.

Failure to maintain payment may result in the discontinuation of services. If you anticipate difficulty continuing therapy due to financial constraints, please inform us so we can explore alternative support options with you.

By signing below, you acknowledge and agree to the terms outlined in this Payment Agreement and Financial Policy. You understand and accept your responsibility to maintain up-to-date billing and insurance information, keep a valid card on file, and communicate any concerns regarding payment or claims processing.

For questions please contact us at:

 The Mind Body Soul Collective

3201 Pioneers Blvd., Ste. 306 

Lincoln, NE 402.450.2317 

info@the402collective.com