Insurance

Clinicians at Restorative Pathways Counseling, LLC accept a variety of insurances. We can also bill out of network depending on your benefits. As a courtesy, we get an estimate from your insurance and notify your before your initial session (provided we have necessary information). In order to ensure coverage - confirm with us your insurance provider and then contact your insurance company using our “Questions to Ask your Insurance Company” form.

*Clients are responsible for fees not covered by their insurance company

Questions Form

Billing Out of Network

Restorative Pathways can bill out of network insurance. You are responsible for the full amount at the time of service. Restorative Pathways will then submit a bill to your insurance for you and payments from your insurance company will be sent by check directly to you in the mail. We recommend checking your out of network benefits as not all plans will cover out of network services.

Self-Pay

Client who do not have insurance or choose not to bill their insurance can pay for services out of pocket. For questions regarding our fees for services, please contact our office directly through email or phone.

Initial Intake Assessment - $150
Individual/Couple’s session - $115

Sliding Scale Fee Program

No one will be denied access to services due to inability to pay. There is a discounted/sliding fee schedule available based on household size and income upon request.

Restorative Pathways Counseling, LLC’s Sliding Fee Scale Program ensures that no one will be denied access to mental health services due to their inability to pay the full fee for service. The program is intended to minimize financial barriers to care for our clients that are at or below 200% of the current Federal Poverty Guidelines.

Our sliding fee program allows us to reduce or "slide" the fees for services received. Clients can apply for the program if they need assistance to help them pay for their care. Our program supports clients with or without third-party insurance coverage.

RPC is committed to collaborating with clients to provide necessary care. With the commitment of our clients, we can connect them to the following options to reduce or eliminate financial barriers to care:

Coordination with insurances for prior authorization or one time service agreements

Case Management consultation for support in applying for Medicaid and other financial programs/benefits
Sliding Scale Fee program
Payment plans
Pro bono services (at the discretion of each clinician and practice policy)

Eligibility

Eligibility is solely based on household income and household size and is applied uniformly to all eligible clients (including clients that are uninsured and underinsured).

Income refers to “modified adjusted gross income” (MAGI). For most people, it’s the same or very similar to “adjusted gross income” (AGI). Income includes adjusted gross income plus untaxed foreign income, non-taxable Social Security Benefits, and tax-exempt interest if applicable. Include income for spouses (or financially contributing significant others within the household) and dependents claimed on tax returns.

Household Size refers to the client, spouses (or financially contributing significant others within the household) and dependents claimed on the client’s/couple’s tax return. See below for additional information.

Nominal Fee

Clients are expected to pay a nominal charge, at minimum. The fee for service will be at least $25. The reduced fee is determined by our existing chart based on income and household size.

This minimum amount is due at the time of the client’s visit, as well as payment for any other unpaid balances, through a card on file, card provided, cash, or check. Refusal to pay may result in termination of services.

Refusal to Pay (“Unwillingness to pay”) applies to a client who has made no effort to make any payment for an extended period of time. Effort to pay includes making contact with the billing department, authorizing payment, providing means for payment, establishing a payment plan, making payment on arranged payment plans, and communicating with staff regarding an inability to pay in a timely manner. Clients that refuse to pay may be denied services.

Inability to Pay applies to a client that has a financial barrier preventing them from making payment for services provided. Financial barriers include employment status change, homelessness, loss of health care coverage, sudden divorce, loss of financial support, delay in receiving alimony or child support, delay in receiving benefits, etc. RPC actively works with clients to reduce financial barriers. Regardless of circumstances, a failure to make contact with RPC in a timely manner in order to coordinate payment of services will result in a determination of Refusal to Pay, termination of services, and potential utilization of collection services. Please, remain in contact with RPC regarding any payments owed to avoid this determination.

Application

To apply for the sliding fee, clients complete the Sliding Scale Application and Agreement and provide their most recent pay stubs for the last 30 days, unemployment benefit statement, or other proof of income for proof of financial eligibility. Proof of income must be dated within the past 30 days, if possible. RPC will make exceptions for documents dated within the last 90 days as deemed appropriate.

Approval

Applications are reviewed by RPC as they are received. Income and household size are utilized to determine eligibility based on the existing chart. Following confirmation that the client is eligible, clients are sent a Financial Agreement to be signed. Clients that have insurance must sign an Election to Self Pay form, forfeiting the right to bill insurance for services provided until the election is revoked.

Reviewing Eligibility

Client eligibility is reevaluated at minimum on an annual basis. Clients are responsible for notifying Restorative Pathways if your financial situation changes including in the event of their income increasing or decreasing or their family size changing.

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