FEE SCHEDULE* Effective as of 5/01/2023

*Please note that the requesting party must either have authority to request the below documentation or a valid signed THRIVE FAMILY SERVICES Authorization for Release of Protected Health Information. 

 

Billing Fees

- Billing Summary/Statement (One Complimentary Report per Fiscal Year): $30.00

- Rebilling Fee, due to Client's failure to keep updated insurance coverage such as renewal, change in coverage: $25.00 per claim + 

- Client responsible for Self-Pay Rate for uncovered Sessions

- Inactive/Expired Insurance Coverage: Self-Pay Rate - See Thrive Staff

- Payment Plans: Subject to 15% Interest Rate

Clinical Documentation & Legal Affairs

**All fees must be paid prior to the release of any documentation**

- Appointment Confirmation Letter: (One Complimentary Letter per Fiscal Year) then $25.00

- Receipt summary for amount paid for sessions, that is not collected at the time of session (one complimentary per fiscal year): $30.00

- Clinical Summary Letter (Letter stating and summarizing context and scope of treatment): $50.00 and up

- Notarized Affidavit (Notarized statement evidencing the context and scope of treatment): $95.00 and up

- Clinical Records Request: $25.00 Admin Fee  + .50¢  per page

- Subpoena for Clinical Records: $25.00 Admin Fee  + .50¢  per page

- Emotional Support Animal (ESA) letter: $150.00- ***Please understand that a minimum of 6 sessions, no more than 1 per week, must take place before an ESA letter can be written.

- Accommodations/Disability form or letter: $75.00+ ***Please understand that a minimum of 6 sessions, no more than 1 per week, must take place before an Accommodations or Disability form or letter can be written or completed.

- Clinician Court Appearance (Maximum Time: 5 hours, including travel up to 50-mile radius): $1500 fee to Thrive plus the counselors fee of $2500+. The fee must be paid prior to the court date. 

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****Expedited Fee - 72 hours or less Turnaround: $75.00 and up + Document Fee****

 

Cancellations Fees

No-Show Fee (Failure to notify clinician of cancellation): $50.00/Session

Late Cancellation Fee (within/less than 24 hours of your scheduled appointment time): $50.00/Session

**The Thrive Cancellation Policy states that participants must cancel their (or their child's) scheduled appointment(s) with their clinician or Thrive office staff, 24 hours BEFORE their scheduled time. If an appointment isn't canceled prior to this deadline, absent exigent circumstances, client will be charged a cancellation fee, at the counselor's discretion. Late Cancellation and/or No-Show Fees must be paid BEFORE rescheduling. Further, Thrive Clinicians reserve the right to remove clients from their schedule for repeat violations of this policy. If this happens, the participant must contact the office to be placed with a new provider upon availability. Thrive Family Services reserves the right to ethically release a client from services upon two (2) violations for the above stated policy.