Cancellation & Patient Policy Agreement

 

If a Cancellation is made with less than 24 hours notice or if an appointment is missed without proper notification, the patient will be charged a $90 cancellation fee.

Three Cancellations, No-Shows or Reschedules within 30-day period is grounds for termination of services per New York State and Insurance Policy guidelines.

Lateness will result in a shortened treatment time.

New York State Law mandates a physician’s prescription for physical therapy treatment.  Each prescription is only valid for the time period specified.  Patient must schedule and keep the appropriate frequency and duration of sessions as prescribed by their physician.  At the end of this period, it is the responsibility of the patient to obtain a new prescription in order to continue physical therapy.

A parent or guardian must accompany any child receiving therapy at all times.

If your insurance does not cover your visits, you may have to pay.  Your insurance does not pay for everything, even some care that you or your health care provider have good reason to think you need.  You have two options:

A)    You can receive care and pay privately for the session, but we will also bill to your insurance company on your behalf. If insurance does pay, you will be refunded any payments made for that date of service.

B)    You can choose to self-discharge from care and with this choice you are not responsible for any additional payments.

(Our private pay rates are $180.00 for one-hour sessions and/or an initial examination and $135.00 for follow up sessions.)

I authorize Sloane Stecker Physical Therapy to charge the credit card that I have on file for any outstanding balances including but not limited to: copayment charges, visits applied to my annual medical deductible, reimbursement made by insurance directly to the patient (Some BCBS Plans), visits not covered by my insurance plan and/or missed appointment fees.

Our aim is to open otherwise unused appointments for our patients, not to collect missed appointment fees.  This policy is to ensure that each of our patients receives the highest quality care.  Thank you for your cooperation.