|
Office Information and New Client Forms
I hope this answers
your practical questions. If you need more information, feel free to
call or email anytime.
Marti
Address:
The office
is in North Seattle, west of I-5 (on the other side of the freeway from
Northgate Mall) just south of the intersection of Northgate Way and
Meridian Ave. N.
The actual
address is: 10740 Meridian Ave. N., Suite 203, Seattle, WA
98133.
Directions and map:
From the
south: Go north on I-5 and exit at the Northgate exit. At the
bottom of the ramp, go left (north parallel to the freeway). Turn
left under the freeway at Northgate Way (west) and continue to the next
intersection at Meridian Ave. N. Turn left onto Meridian and the
office is on your left just around the corner.
From the
north: Go south on I-5. Exit at the Northgate Exit and head west.
The next intersection is Meridian Ave. N. Turn left. The
building is on the left, just around the large brick building on the
corner.
The
building sits slightly back from the street, directly across from Arby's
on Meridian. It is the smallest of the surrounding buildings and
there is a sign, "Meridian North Office Building", on the sidewalk.
The office is in Suite 203.
Office Hours:
Appointments are available Monday, Tuesday, Thursday and Friday, 8 AM to 1 PM.
About Insurance and billing:
Your work with me
will be covered to the extent your specific insurance plan allows if you
have:
- Premera,
- Uniform,
- a plan without a specific mental health provider panel
- a plan that allows coverage for "out-of-network" or
"non-participating" mental health professionals.
- auto insurance that covers psychological recovery.
Ask your health insurance company if your plan will cover work with me
specifically, or by virtue of my being a Licensed Mental Health Counselor.
It is well worth a call to your health insurance provider to find out.
At the time you come in for
a session the amount you pay me depends on your insurance plan. You
would either pay me:
- nothing, or a pre-determined co-pay, if I am
billing your insurance directly. (You will be billed for any remainder.)
- the full amount if I am giving you a receipt
for out-of-network reimbursement by your insurance plan, or
- a discounted amount if you are paying without
insurance involvement.
If I am billing your
insurance directly or giving you a receipt for reimbursement for
"out-of-network" or "non-participating provider" coverage, my fee is $130
for the first visit and $115 thereafter.
If you are not using any
insurance, my discounted fee is $110 for the first visit and $100
thereafter
If I have billed your
insurance, there may be an amount owed by you after they have paid their
amount. You will receive a bill letting you know what that amount
is. You can cover that amount by paying me at a session if we are
still meeting or sending me a check. At this point I do not take
credit card payments.
New Client Forms:
If you have made
an initial appointment, here are links to the forms you can bring to our
first session (#1 - #4). (The Privacy Policy, #5, is for your
information only.) Filling these out ahead and bringing them in will save time during the session
so that we can concentrate fully on your needs.
1.
Counselor
Disclosure of Information and Office Policies:
Please read this thoroughly, sign at the bottom and bring with you for me
to sign, along with any questions you may have.
2.
Client
Information Form: A
short form for you to fill out and bring. If I will not be billing
your insurance directly, you can leave the insurance information section
blank.
3.
Billing and Fee Information Form:
An explanation of my fees and insurance billing policies.
4.
Agreement Form:
A short list of items I would like you to be aware of before we begin.
5. Privacy
Policy: This document outlines my privacy policy
in accordance with HIPAA regulations as it applies to counseling. It
is here for you to review. There is no need to bring
it with you to our first session. You may also request a paper copy
from me in person if you wish.
I look forward to
seeing you soon.
Thank you,
Marti
|