Benna Z. Sherman, Ph.D., Licensed Psychologist
479 Jumpers Hole Road, Suite 304B, Severna Park, MD 21146
Phone: 410-544-9564 Fax: 410-647-9174 email: bzsherman@comcast.net
Practice Policies and Fee Agreement for Professional Services
Office hours are 9 a.m. to 4 p.m., Monday through Friday. Voice mail is available 24 hours a day. Phone calls and email are generally for administrative matters, such as scheduling appointments. Therapeutic matters are to be reserved for therapy sessions. There is no charge for brief (≤ 10 minutes), administrative phone calls.
Fees-- initial sessions are $250 for 50-60 minutes; individual therapy is $150 per 45-50 minutes; couples/family therapy is $175 per 45-50 minutes. Longer sessions can be arranged, for which the fees are pro-rated. Full fees are to be paid at time of service. For your convenience, you may pay by cash, check, or credit card. Current patients will always be given substantial notice of any intended fee increase.
Full charge is made for any sessions missed or canceled with less than 24 hours (business day) notice.
This means, for example, that a 2:30 Tuesday appointment must be cancelled by 2:30 on Monday. Monday appointments must be cancelled by Friday, since weekends are not business hours. Similarly, appointments following holidays must be cancelled by the preceding business day.
Cancellations must be made in person or by phone/voicemail. Email is not adequate unless it is well in advance AND you have received a confirmation email from me.
Voice mail-- (410)544-9564-- is available at all times and automatically records the date and time of incoming calls.
In the event of inclement weather, there will be an outgoing message on the voicemail by approximately 7 a.m. to tell you if the office is closed. Please call to confirm the status of your appointment. Regardless of whether the office is open, there is no penalty if you cannot make it to your appointment because of the weather.
I maintain no relationships with insurance companies and do not either bill them or accept payment from them. If you request it, at the end of each month an itemized invoice (“Superbill”) will be provided to you that you can submit to your insurance company for reimbursement. If treatment plans are required and you wish to submit one, we will complete it together during your session time and you can submit it. It is your responsibility to keep track of when an authorization expires and when a summary is due.
The person accepting financial responsibility for professional services will be responsible for any costs involved in the event that a court, your attorney, or other legal entity with whose orders I must comply requires my services or my records. The financially responsible party will be expected to pay for all of my professional time, including preparation and transportation costs, even if my participation is compelled by another party. I charge $300 per hour for preparation and/or attendance at any legal proceeding. Payment will be required in advance.
If letters or reports are requested or required for any reason, the financially responsible party will be billed for the time involved, at the usual hourly rate, with a minimum half-hour charge.
If a minimum negotiated payment is not made for two months on overdue balances, your overdue balance will be applied in full to a credit card (below). Alternately, the account may be turned over for collection or to Small Claims Court, and the person accepting financial responsibility for professional services will be responsible for any expenses incurred to collect overdue balances.
Regardless of how you intend to pay for sessions, please provide a current credit card number. It will only be used at your request or if you default on payment of your account.
__________________________ ________ ____________________
Card # Expires Name on card
____________
3 digit verification code on back of card, on signature strip
I have read and I understand the conditions of this agreement and agree to abide by these conditions.
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signature date
(3/11)
