Essex County, New York scenery, from left to right: Lincoln Pond, Elizabethtown; Lake Placid Sinfonietta; Lake Placid; World-class skaters at the Olympic Center; Heart Lake, North Elba; Ausable River, Jay (Heart Lake and Ausable River photos courtesy of Steve and Luisa Towne, all others provided by Mike Brenish)

FEE POLICY AND PROCEDURE

Essex County Mental Health Services is a public mental health clinic supported in part by State and County funds, and client receipts. We therefore charge a fee for service. As a public clinic, however, we do not refuse services based on inability to pay. We utilize options such as a sliding fee scale and a fee adjustment process to assist our clients who have difficulty paying.

At first contact with the clinic, the method of payment will be established either by the office staff in Elizabethtown or by a therapist in any of our satellite offices. Regardless of method of payment, all clients will also have a fee set for them (except for those with Medicaid). As a public clinic, the set fees are based on a client's ability to pay, and are therefore dependent on individual circumstances. Using a sliding scale, we will initially set this fee based on income and number of dependents. The fee may be adjusted upon request, and the presentation of adequate documentation. This process of fee adjustment is explained in a later section. If at any time there are questions about the fee or bills received, the staff at the Elizabethtown office will respond promptly.

We will accept four methods of payment. They are:

1) Self-pay (out-of-pocket)
2) Medicaid
3) Medicare
4) Private Insurance

Self-Pay
All clients who pay out-of-pocket are expected to pay in full at the time of service. As stated above, their fee is set at the time of initial contact with the clinic. They may make a payment in the form of cash or check. Please note that there will be a charge, set by the County Treasurer, for all checks returned for insufficient funds. We do not accept credit cards.

Medicaid
We will accept Medicaid as full payment for service.

Medicare
We will accept Medicare as full payment for service, once a client's deductible is met.

Private Insurance
We are a participating provider with some health insurance companies, and will bill those health insurance companies for the payment amount agreed upon by contract or accommodation. A client who wishes to use this private insurance to pay for services will be asked to provide his/her insurance cards so that the clinic may make a copy for its records. The clinic will submit bills to his insurance company. The client is expected to pay his/her co-pay, which is set by his/her insurance company. A client may pay a fee lower than this co-pay under the following condition: As mentioned above, a client with private insurance has his/her fee set upon initial contact with the clinic, like everyone else. If the client's fee is set lower than his co-payment, the clinic will accept the lower set fee in lieu of the co-pay amount. Again, payments are accepted in the form of cash or check.

At the time of initial contact with the clinic, clients with private insurance shall be informed of the following: If the client's insurance company does not agree to pay for his/her clinic services, the client will be liable for the fee that is set. The client will be told of the insurance company's refusal to pay as soon as possible.

On occasion a client's private insurance company does not accept the credentials of the treating therapist. An option may be to transfer to another therapist who will be covered by the insurance company. Or, the client may opt to stay with the therapist and pay a set fee. Decisions in these situations are made on a case-by-case basis, and should be reviewed with the Assistant Director.

Billing
It is the clinic's expectation that clients will pay their fee at the time of service. However, if a bill is generated, it is the expectation that the client will pay this bill upon receipt. Clients will be billed on a monthly basis.

Past Due Balance
A past due balance is a balance owed to the clinic for at least 30 days but less than one year. In an effort to resolve a past due balance, monthly billings are made for up to one year. The handling of a past due balance is explained in a separate chapter titled, "Procedure For Resolution of Past Due Balances."

Bad Debt
A bad debt is a past due balance that is at least one year old, and in which there has been no activity despite repeated attempts to resolve it. The clinic must take steps to resolve the matter for the purpose of bookkeeping. The procedures are as follows:

The resolution of bad debt under fifty dollars is handled internally. An audit memorandum is written by the account clerk/typist and given to the fiscal service administrator. The Fee Committee then convenes to review the memo. The Fee Committee consists of the clinic director, the fiscal services administrator, and the account clerk/typist. The committee determines if an adjustment is to be made. If approved, the bad debt is adjusted to zero.

The resolution of bad debts over fifty dollars is handled differently. A list of these bad debts is generated by the account clerk/typist and given to the clinic director. The clinic director then submits this list to the Community Services Board for review and approval for resolution. It is then submitted to the Board of Supervisors. Once the Board of Supervisors approves the resolution, the clinic is then able to adjust the bad debts to zero.

Inability to Pay
As previously stated, this is a public clinic, and we will not refuse services to anyone based on an inability to pay. That inability, however, must be based on documentation of income and expenses.

Fee Adjustment Procedures
If a client feels the set fee is not reflective of his financial ability to pay, he needs to demonstrate that with documentation. At any later point in time while he is receiving services, he may opt for a fee adjustment. It is expected that the issue of fee adjustment will be discussed between the client and his therapist, so that the therapist is aware the client is feeling the need to apply for the fee adjustment.

Upon request, the front office staff will provide the client with a fee adjustment form. The client can ask for the explanation of the form at that time or at any time by calling or stopping by the clinic. In filling out the form, the client will need to itemize his gross income as well as his relevant expenses. The form must be turned in with copies of supporting documentation, or it will not be considered complete.

After the form and supporting documentation are turned in, the Fee Committee will convene to review the papers, usually within a week's time. Based on this new information presented with documentation, the Fee Committee decides whether a new, lower fee may be set. A fee adjustment could be set as low as zero. If a new fee is set, it will be retroactive to the date the client brought in the completed application, resulting in a credit adjustment to the client if he had any session after that date. The Committee's decision is shared with the therapist as well as the client, who receives a letter regarding the decision. Documentation of the decision is filed with the client's chart. Depending on individual circumstances, a new set fee may or may not have a time limit. The new set fee may also be readjusted at a later date upon receipt of information that the client' s financial status has changed.

It is important to note that the client who applied for a fee adjustment is expected to pay for any services provided to him at the older set fee until such time he receives notice of a new fee set by the Fee Committee. For this reason the client and therapist may opt to delay services, if possible, until this news is received, to avoid further financial debt to the clinic. It should also be noted that receipt of this fee adjustment does not relieve the client of any past debt owed to the clinic. In addition, unless the new set fee is zero, it is expected that the client will pay the new set fee at time of service, so as not to accumulate any more debt to the clinic.

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