1221 Bower Parkway, Columbia, SC 29212
Phone: 803-233-6956 | Website: journeyinwardsc.com
I authorize Journey Inward Therapy to bill my insurance carrier directly for mental health services and release necessary medical information for claim processing. I understand that insurance benefits are not guaranteed and I remain financially responsible for non-covered services.
I acknowledge that I am responsible for knowing my mental health benefits, copays, deductibles, and preauthorization requirements. I understand that any denied or unpaid claims become my responsibility.
Our standard fee for a 45-60 minute session is $110 unless adjusted by your insurance contract. Copays and deductibles are due at the time of service. Any balance due after insurance adjustments will be billed to you.
I understand and agree to the payment terms outlined above.
I understand that 24-hour notice is required for cancellations and that I will be charged $85 for appointments missed without proper notice.
I authorize Journey Inward Therapy to keep my credit card information on file and charge it for outstanding balances or late cancellation fees.
I authorize direct payment of mental health benefits to Journey Inward Therapy for services provided by its therapists.
Only required if the client is a minor or has a legal guardian
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