Fee Policy & Financial Agreement

Pennock Center for Counseling is a not-for-profit organization and relies on client fees for a major portion of its operating costs. You are ultimately responsible for all services you or members of your household receive from the Center.


All Fees are collected and due at the time of service.


Sliding Scale Fee:

  • Will be determined by center staff based on client documentation.

Insurance:

  • You are asked to provide a copy of your insurance card (front and back) at the time of the initial appointment. Verification of insurance benefits is not a guarantee of payment. The contract for your insurance is between you and your insurance carrier. You are responsible for all deductibles and co-pays. You are also responsible for all payments should your insurance not pay for services rendered.
  • You will be required to sign a Release of Information for insurance purposes and and Authorization of Benefits so that payment can be made directly to Pennock Center for Counseling.

Fee/Billing Policies:

  • If you are choosing to pay out of pocket and not utilize your health insurance, we ask you to sign a statement indicating this choice.

Cancellation/No Show Policies:

  • All appointments must be cancelled 24-hours in advance of your scheduled appointment. After hour cancellation messages can be left on the Center’s voice mail.
  • You will be charged a $10.00 no show fee for appointments not attended (unless cancellation notice is given). This fee will be due at your next appointment.

Delinquent Accounts:

  • You will be billed for any delinquent payments. Failure to pay may result in termination of services. The decision to terminate services will be based on both clinical and financial information.