Financial Policy & Good Faith Estimate

Payment Responsibility

You are financially responsible for all services you schedule and receive through Welch Psychiatric Group, unless otherwise agreed in writing.

Payment is due at the time of service unless another written arrangement has been approved by the Practice.

Welch Psychiatric Group may require a valid credit card, debit card, HSA/FSA card, or other approved payment method to be kept on file for appointment fees, late cancellation fees, missed appointment fees, balances, and other approved charges.

Current and Anticipated Fees

Fees are subject to change. The following fees reflect current or anticipated pricing and should be confirmed before scheduling.

Private Pay and Insurance

Welch Psychiatric Group is anticipated to begin future psychiatric services as a private-pay practice while insurance credentialing is pursued.

Life coaching services are private-pay and are not billed through insurance.

Insurance participation may be added over time. Until Welch Psychiatric Group is credentialed and contracted with a specific insurance plan, patients are responsible for the full cost of services.

If Welch Psychiatric Group becomes contracted with insurance plans in the future, benefits, copays, deductibles, coverage limits, and prior authorization requirements may vary by plan.

Superbills and Out-of-Network Reimbursement

If Welch Psychiatric Group is out-of-network with your insurance plan, you may request a superbill for eligible psychiatric services when appropriate.

A superbill is a document you may submit to your insurance company for possible out-of-network reimbursement.

Reimbursement is not guaranteed. Your insurance company determines whether services are reimbursable, how much may be reimbursed, whether diagnoses or procedure codes are covered, and whether deductibles or plan limitations apply.

Life coaching services are not medical services and are generally not eligible for insurance reimbursement.

Insurance Verification Responsibility

Patients are responsible for understanding their own insurance benefits, including whether Welch Psychiatric Group is in-network or out-of-network, deductible status, reimbursement requirements, covered services, prior authorization requirements, and any exclusions.

Any information provided by Welch Psychiatric Group regarding insurance is not a guarantee of coverage or payment.

Cancellation Policy

Appointments must be canceled or rescheduled at least 48 hours before the scheduled appointment time.

Appointments canceled after this window may be considered late cancellations and may be subject to a late cancellation fee of $50.

Late cancellation fees are not typically reimbursed by insurance.

No-Show Policy

A no-show occurs when a patient or client does not attend a scheduled appointment and does not cancel within the required cancellation window.

Missed appointments significantly limit availability for other individuals seeking services and reserve time that cannot typically be filled on short notice.

The following no-show fees may apply:

• Initial Psychiatric Evaluation: $200
• Medication Management Follow-Up: $100
• Life Coaching Sessions: 50% of the scheduled session fee

No-show fees are charged to the card on file and are not billable to insurance.

Repeated no-shows or late cancellations may result in discharge from care, inability to schedule future appointments, requirement for prepayment prior to scheduling, or referral to another provider when appropriate.

Late Arrival Policy

Please arrive on time for all appointments. Late arrival may shorten the appointment or require rescheduling.

If you are more than 10 minutes late, the appointment may be considered missed and may be subject to the no-show policy.

Technology Issues and Telehealth Appointments

Patients are responsible for ensuring they have appropriate technology, internet connection, privacy, and a safe location for telehealth appointments.

If a telehealth appointment cannot be completed due to technology failure, the Practice may attempt to reconnect, call the patient, reschedule, or determine another appropriate next step.

Repeated technology-related missed appointments may be treated as missed appointments if the patient is unable to participate in the scheduled service.

Refunds

Refunds are not guaranteed and are reviewed on a case-by-case basis.

Fees for completed services are generally non-refundable.

Any approved refund may be returned to the original payment method when possible.

Outstanding Balances

Outstanding balances must be resolved before future appointments may be scheduled, unless another written arrangement has been approved by the Practice.

Unpaid balances may result in paused services, canceled appointments, or discharge from care when consistent with applicable law and ethical obligations.

Accounts with unpaid balances may be referred to collections when legally permitted.

Forms, Letters, and Administrative Fees

Requests for forms, letters, school documentation, work documentation, disability paperwork, accommodations, emotional support animal letters, records review, or other administrative tasks are not guaranteed.

Such requests may require an established clinical relationship, appropriate evaluation, clinical justification, additional appointment time, record review, and additional fees.

Welch Psychiatric Group reserves the right to decline documentation requests that are outside the scope of care, not clinically appropriate, or not supported by available information.

Good Faith Estimate Notice

Under the No Surprises Act, individuals who are uninsured or who choose not to use insurance may have the right to receive a Good Faith Estimate of expected charges for scheduled healthcare services.

A Good Faith Estimate provides an estimate of expected charges for items and services that are reasonably expected for your care.

The estimate is not a contract and does not require you to obtain services from Welch Psychiatric Group.

The estimate may not include unexpected costs that arise during treatment, additional services requested later, emergency care, outside providers, pharmacy costs, laboratory costs, or services not scheduled at the time the estimate is provided.

Your Right to Dispute a Bill

If you receive a bill that is substantially higher than your Good Faith Estimate, you may have the right to dispute the bill under applicable federal law.

You may contact Welch Psychiatric Group to discuss billing concerns before initiating a formal dispute.

Additional information about Good Faith Estimate rights and the patient-provider dispute resolution process is available through the Centers for Medicare & Medicaid Services.

Future Psychiatric Services Disclaimer

Psychiatric services are anticipated to begin July 2026, subject to licensure, credentialing, regulatory requirements, scheduling availability, and practice readiness.

Scheduling a future psychiatric appointment, joining a waitlist, or submitting forms does not guarantee availability, acceptance as a patient, insurance coverage, or establishment of a provider-patient relationship.

Agreement to Financial Responsibility

By scheduling services with Welch Psychiatric Group, you acknowledge that you understand and agree to the applicable financial policies, including payment responsibility, cancellation policy, no-show policy, insurance limitations, and Good Faith Estimate information.

Additional signed financial agreements may be required before services begin.

Contact Information

Welch Psychiatric Group, LLC
Website: www.welchpsychiatricgroup.com
Email: admin@welchpsychiatricgroup.com
Phone: 720-619-6082