Rightpathcounselingservices.com 608-449-7201 [email protected]
Information and Forms
Therapist is currently licensed in:
California 29109
Wisconsin 8198-123
North Dakota 6242
Arizona 20498
Insurance currently accepted:
Anthem Blue Cross/Blue Shield-Medicaid-Wisc
Anthem Blue Cross/Blue Shield-Wisc
Badgercare/Forward Health-Wisc
United Behavioral Health now Optum Health Behavioral
UMR
Choice Plus
Medicare VACCN (Veterans)
Wisconsin Medicaid
MediCal-Medicare
IEHP
Managed Health Network (MHN)
Medicare
United Healthcare
ICare
Private Payment arrangements
Please check with your insurance provider regarding whether or not you have copayments. Additionally, I will need a copy of your insurance card (front and back) to obtain prior authorization at the first session.
I do accept private pay clients and the fees are on a sliding scale. Please contact me if you wish to pay privately.
FORMS:
When you begin this journey there are several forms that must be completed and discussed. It is helpful and saves time if you are able to complete these forms prior to your first appointment. If you are able to do this please contact me prior to your first appointment and I will mail them out to you. I will go over all the forms with you and answer any questions you might have.
*NEW CLIENT FORM
*SERVICE AGREEMENT
The following forms will provide information about privacy policies and your patient rights:
*HIPPA PRIVACY NOTICE
*PRIVACY POLICIES AND PROCEDURES
It is important to sign release of information (ROI) forms to allow me to coordinate your care with other professionals , i.e. your psychiatrist/doctor, schools, insurance providers. I will ALWAYS obtain your written permission prior to releasing any information, and, with a signed release only provide what is necessary.
*RELEASE OF INFORMATION (ROI)
Policies:
Missed or Cancelled Appointments Policy
Please reach out to me at (608) 449-7201 by call or text at least 24 hours in advance of your appointment to cancel. Insurance will not cover the cost of missed appointments and I am unable to offer your appointment time to other clients if you have not cancelled at least 24 hours in advance. If you have not provided the 24 hour advance notice the full fee for service will be charged. Should you miss more than two appointments without 24 hour advance notice in a six month period can result in termination of services and I will believe you are just not ready for this journey at this time.
Insurance
If using insurance the fee or copay established by your insurer is due at the time of service. Please check with your insurers to fully understand your benefits. I will obtain a copy of your insurance card (front and back) prior to the first session to enable me to verify coverage.
California 29109
Wisconsin 8198-123
North Dakota 6242
Arizona 20498
Insurance currently accepted:
Anthem Blue Cross/Blue Shield-Medicaid-Wisc
Anthem Blue Cross/Blue Shield-Wisc
Badgercare/Forward Health-Wisc
United Behavioral Health now Optum Health Behavioral
UMR
Choice Plus
Medicare VACCN (Veterans)
Wisconsin Medicaid
MediCal-Medicare
IEHP
Managed Health Network (MHN)
Medicare
United Healthcare
ICare
Private Payment arrangements
Please check with your insurance provider regarding whether or not you have copayments. Additionally, I will need a copy of your insurance card (front and back) to obtain prior authorization at the first session.
I do accept private pay clients and the fees are on a sliding scale. Please contact me if you wish to pay privately.
FORMS:
When you begin this journey there are several forms that must be completed and discussed. It is helpful and saves time if you are able to complete these forms prior to your first appointment. If you are able to do this please contact me prior to your first appointment and I will mail them out to you. I will go over all the forms with you and answer any questions you might have.
*NEW CLIENT FORM
*SERVICE AGREEMENT
The following forms will provide information about privacy policies and your patient rights:
*HIPPA PRIVACY NOTICE
*PRIVACY POLICIES AND PROCEDURES
It is important to sign release of information (ROI) forms to allow me to coordinate your care with other professionals , i.e. your psychiatrist/doctor, schools, insurance providers. I will ALWAYS obtain your written permission prior to releasing any information, and, with a signed release only provide what is necessary.
*RELEASE OF INFORMATION (ROI)
Policies:
Missed or Cancelled Appointments Policy
Please reach out to me at (608) 449-7201 by call or text at least 24 hours in advance of your appointment to cancel. Insurance will not cover the cost of missed appointments and I am unable to offer your appointment time to other clients if you have not cancelled at least 24 hours in advance. If you have not provided the 24 hour advance notice the full fee for service will be charged. Should you miss more than two appointments without 24 hour advance notice in a six month period can result in termination of services and I will believe you are just not ready for this journey at this time.
Insurance
If using insurance the fee or copay established by your insurer is due at the time of service. Please check with your insurers to fully understand your benefits. I will obtain a copy of your insurance card (front and back) prior to the first session to enable me to verify coverage.