🔹 Insurance Clients If I am using insurance to pay for therapy: I understand that I am responsible for verifying my own benefits with my insurance provider before beginning services, including: deductibles, copayments or coinsurance, out-of-pocket maximums & session limits. Cascone Counseling LLC will submit claims to my insurer through Alma (a third-party billing platform). I understand that any estimated coverage is not a guarantee of payment. I agree to pay: any deductible, copay, or coinsurance not covered by my plan. The full session fee if the claim is denied or not reimbursed for any reason. I acknowledge that I am financially responsible for any balances not paid by my insurance. 🔹 Private Pay Clients If I am not using insurance to pay for therapy: I agree to pay the full session fee of $150 for each therapy session, unless a sliding scale fee has been formally agreed upon in writing. I understand that payment is due at the time of service. I may request a superbill for potential out-of-network insurance reimbursement. However: Cascone Counseling LLC makes no guarantee of reimbursement. It is solely my responsibility to contact my insurance company to verify out-of-network benefits and submit claims. I remain responsible for the full session fee, regardless of any reimbursement outcome. 🔹 General Payment Terms I agree to keep a valid credit card or payment method on file and authorize Cascone Counseling LLC to charge it for sessions rendered and any outstanding balances. A receipt or invoice will be provided. I understand that late payments or unpaid balances may result in suspension of services until the balance is resolved. 🔹 Consent & Agreement I authorize Cascone Counseling LLC to charge my credit card on file. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form. By signing below, I confirm that I have read, understand, and agree to the financial policies stated above. I accept full financial responsibility for services provided by Cascone Counseling LLC.

At Cascone Counseling LLC, your appointment time is reserved exclusively for you. To provide the highest quality of care and respect everyone’s time, the following cancellation and no-show policies are in effect for all clients. 🔹 Cancellation Notice Requirement Clients must provide at least 24 hours' notice to cancel or reschedule an appointment. Notice must be given by phone, secure messaging, or email (based on how you typically communicate). This allows your therapist to offer the session time to another client in need. 🔹 Late Cancellations & No-Shows If you cancel within 24 hours of your appointment or fail to attend your session without notice: You will be charged the full session fee of $150. This fee cannot be billed to insurance and is your sole responsibility. Repeated no-shows or late cancellations may result in discontinuation of services. 🔹 Exceptions We understand that emergencies and sudden illness can arise. In such cases, Cascone Counseling LLC may consider a waiver of the missed session fee. However, any waiver is made at the sole discretion of the therapist on a case-by-case basis. Please note that waivers are not guaranteed, even in the event of unforeseen or emergency circumstances. 🔹 Consent & Agreement By signing below, you acknowledge and agree to the terms of this No-Show & Cancellation policy.

By completing this form, I understand that the information I provide will be reviewed to determine if I qualify for a reduced therapy fee. I understand that sliding scale rates are not guaranteed and are determined at the sole discretion of Cascone Counseling LLC. I also agree to notify my therapist if my financial situation changes.