This is a plain text copy of the standard financial agreement you will receive as a new client:

By your signature, you agree to authorize Christina Skuburdis, LLC, to receive or release any health-care information to your insurance company, physician, dentist, orthodontist, allied health-care provider, school or any other parties you authorize (please state) involved in your child's care.

While family emergencies and illness do arise, bear in mind that in order to get the best results for your child, prompt and regular attendance to scheduled therapy sessions is critical.

CANCELLATION:
If your child is unable to attend a therapy session, please call me as early as possible. If you cancel less than 24 hours before your appointment, you may be charged for a full session.

NO-SHOW:
If you do not show up for a scheduled appointment, you will be billed a no-show fee. Therapy services will be terminated for clients with three no-show visits -- or whose overall attendance is below 70 percent.

This is a plain text copy of the standard financial agreement you will receive as a new client:

It is your responsibility to pay Christina Skuburdis, LLC, directly for services. You will receive an invoice on a monthly basis. Payment is due within 30 days.

Missed or canceled appointments -- Christina Skuburdis, LLC, reserves the right to charge a fee if you do not keep an appointment, and have not provided at least 24-hours' advance notice.

Cancellation of services -- If you are unavailable for a scheduled appointment three times without calling to cancel at least 24 hours in advance of your appointment, Christina Skuburdis, LLC, retains the right to discontinue treatment and to terminate services. Additionally, at the discretion of Christina Skuburdis, LLC, excessive cancellations (70 percent or less average attendance) may result in termination.

If you decide to discontinue services with me, you agree to give me 30 days' notice.

If treatment is discontinued for any reason, you are responsible for paying for all services that were provided.

By signing this form, you agree to the following:

1. Your payment will be made directly to Christina Skuburdis, LLC, for services rendered, within 30 days of the invoice date.

2. Unresolved financial disputes for non-payment could result in the discontinuation of services and assignment of your account to a professional collection agency. Therefore, you agree that if it should become necessary for Christina Skuburdis, LLC, to forward your account to a collection agency, you also will be responsible for the fee charged by the collection agency for the costs of collection.

3. You have received a copy of the Attendance Policy

What do you charge for your services?

Please phone me and I will provide that information to you as charges vary depending on the type of therapy required. Overall, my rates take into account standard national professional rate guidelines, as well as my over fifteen years of highly successful outcomes in my practice.

Included in my rate are all the therapy tools, media and food and other support materials I will use to work with your child.

Telephone conferences [up to 30 minutes] with parents, physicians, other therapist, tutors and teachers are also included.

When is payment due?

Payment is due within 30 days of receiving your invoice.

Do you accept my insurance?

I am not able to accept insurance.

However, I will provide you with a statement to submit for reimbursement to your insurance carrier or to your flexible spending account.

How often will I be billed?

You will receive an invoice from me approximately every month.

Does my insurance cover your services?

It depends on your plan. I recommend that you review the speech-therapy benefits information in your health-plan documents. Please do this before your child begins working with me so that you are clear about whether - and how much -- you will be reimbursed.

If your insurance plan does not cover your child's speech therapy, consider using your flexible benefits -- the voluntary program offered by many employers that allows employees to use pre-tax dollars to pay for speech therapy and other health-related expenses not paid by your medical insurance.

You will receive a monthly health claim form/receipt from me to submit to your insurance carrier or to your flexible spending account for reimbursement.


If my insurance covers speech therapy for my child, how do I submit a claim?

"    Fill out the claim form from your health plan
"    Attach any required documentation, such as my treatment plan or your physician's referral
"    Keep copies of all documentation for at least a year (in case the forms go astray)

Note: Some plans require claims to be submitted within a certain number of days, so check your documents about how quickly you need to file for reimbursement.


Where can I get more information about insurance for your services?

The American Speech-Language-Hearing Association, my national professional group, has helpful information online about how to learn if you're covered, what to do if a claim is denied, and tips on lobbying your employer for speech therapy coverage: http://www.asha.org/public/coverage/

Are your services tax deductible?

Yes, if you qualify. The cost of necessary speech therapy is a medical deduction subject to a percentage of your "adjusted gross income" reduction for all medical expenses.  

Please check with your tax professional or read IRS Publication 502, "Medical and Dental Expenses" :
http://www.irs.gov/pub/irs-pdf/p502.pdf