Insurance Billing

We will gladly file your insurance claim and accept assignment of benefits for most insurance companies. Benefits are estimates only. The actual claim benefits are determined when your insurance carrier receives the claim. The insurance carrier bases their benefits on their "usual and customary" charges and those may not reflect our charges. You are financially responsible at the time of services for any patient portion, co-payments, deductible amounts or non-covered treatments, as determined by your insurance carrier. Please call the office to give us your insurance information so that we can check your out-patient mental health coverage before your first visit.

Payment

Payment is due at time of service. If we are billing your insurance, you are financially responsible at the time of service for any patient portion, co-payments, deductible amounts or non-covered treatments. We accept cash, check, Visa, MasterCard.

 

Cancellation and No-Show Policy

An important part of your treatment process requires you to attend scheduled appointments. We have allotted this time especially for you. Because we are holding this time for you (usually a 45-50 minute appointment), we expect you to attend all sessions. YOU WILL BE CHARGED FOR YOUR APPOINTMENT UNLESS one of the following requirements is met: 1) You cancelled your appointment at least 24 hours in advance or, 2) You have a serious illness or emergency, and this is an unusual occurrence. Please respect these boundaries, and call us 24 hours in advance.

New Client Forms

At Bend Counseling & Biofeedback, Inc. in Bend, Oregon, our focus is always on your mental, emotional and physical health. Please download and complete the following documents prior to your first session in order to maximize our time with you. If you are unable to complete them, plan to arrive 10 minutes before your appointment. Remember to bring your insurance card to your first visit.

New Client Forms - Randy Wild
Client Intake History Form
Financial Agreement Form - Randy Wild
Privacy Policy/Informed Consent Form
Credit Card Authorization Form

New Client Forms - Lindsay Dycus
Client Intake History Form
Financial Agreement - Lindsay Dycus
Privacy Policy/Informed Consent Form
Credit Card Authorization Form

 (Forms are PDF files. You will need Adobe Acrobat Reader to view them.)