1752 Capital St. Suite 100. Elgin. IL. 60124

(847) 695-3680

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Fee Information

Cancellations

If you must cancel an appointment, please notify your therapist no later than 24 hours prior to your scheduled appointment. If the appointment is canceled with less than 24-hour notice, you will be charged a $25.00 fee. If you fail to keep an appointment without notifying the agency (except due to emergency situations) you will automatically be charged a $25.00 fee. If you fail to keep two appointments, services may be terminated.

Insurance

Depending on your health insurance coverage, our agency may file a claim with your insurance carrier. You may be responsible for your “per session” payment regardless of what your insurance pays. You must make regular fee payments, per your fee agreement, regardless of what payments you expect from your insurance company. We will bill your insurance carrier at the full rate for the services you receive. Most insurance policies pay a percentage of our agency fee. If the amount paid by you, plus the amount received from your insurance company totals more than the full cost of service, a direct payment refund will be made to you. Family Service Association seeks only to collect the full cost of providing services.

Missed Appointment

Standard missed session or late cancellation fee

$ 25 / fee

Insurance Co-Pay

Select your required co-payment amount

Service Co-Pay

Sliding scale fee for session services

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