Service Fees

Definition of Billable Services

These services include professional time spent outside of therapy sessions, such as:

• Report writing, record review, or preparation of treatment summaries

• Documentation, meetings, or consultations (client or third party requested)

• Phone/email/text communication lasting more than six (6) minutes

• Administrative or legal-related work (see Legal and Court-Related Matters section below)

• Other professional services requested outside of therapy

Non-Billable Communications

Brief communications are not billed, including scheduling or rescheduling appointments, brief logistical messages, or communications lasting six (6) minutes or less.

Client Awareness & Authorization

Clients are encouraged to ask questions about potential fees in advance. Whenever reasonably possible, I will discuss with you in advance anticipated billing  prior to services. 

Responsibility for Payment

The party requesting non-psychotherapy professional services is responsible for associated fees. This applies whether the request is made by you or by a third party (such as an attorney, court, insurance company, employer, or other entity), unless otherwise required by law. If a third party requests services involving your care, I may require your written authorization before proceeding.

Record Copying Fees and Records-Related Fees: 

Copies of medical or mental health records requested by the client or the client’s authorized representative will be provided in the form and format permitted by applicable law. Copying fees will not exceed $0.25 per page for paper records, plus postage if mailed. 

Requests for records made by third parties, even when accompanied by a valid authorization, are not patient requests and may be billed differently. Fees may include reasonable charges for copying, administrative time, and professional time spent reviewing, preparing, and producing records, as permitted by state and federal law and will be billed at my standard professional rate unless otherwise required by law. Records will be provided in the form and format permitted by applicable law. 

Legal and Court-Related Matters: 

Role and Scope of Services

If you anticipate involvement in a legal matter, I encourage you to discuss this with me in advance so you understand the potential impact on treatment, confidentiality, and the therapeutic relationship.

My role as a Licensed Professional Clinical Counselor (LPCC) is limited to providing clinical services within the scope of my license. These services are separate from psychotherapy, and I do not serve as a legal advocate, evaluator, or expert witness, unless we explicitly agree to this in writing. I do not provide forensic opinions unless separately contracted. 

If your legal matter requires professional evaluation or advocacy, you are encouraged to consult with your own attorney, as my role remains limited to providing clinical treatment, not legal advocacy or evaluations. 

Client Authorization & Voluntary Nature of Services

Except where required by law, court order, or valid legal mandate, legal-related services are performed only with your voluntary and informed written authorization. You may also revoke this authorization at any time.

You are encouraged to consult with your attorney before requesting my involvement. I may decline, limit, or discontinue legal involvement if outside my scope, expertise, or clinical role. When appropriate, referral to  an independent, neutral third-party evaluator may be recommended.

Fees for Legal and Court-Related Services

Legal and court-related services are billed at $214 per hour, prorated in 6-minute increments (0.1 hour) with a 6-minute minimum ($21.40 per increment). Billable time may include, but is not limited to: document review or preparation, report writing, consultation with attorneys or other parties, travel and waiting time, attendance at depositions, hearings, or court appearances, or testimony. 

Whenever reasonably possible, I will inform you in advance of anticipated time requirements and associated costs.

This tier is available to all clients. You may choose a fee within this range based on your financial circumstances. Service Fee agreement is valid for 12 months and may be renewed annually. Annual fee increases may apply at renewal.

Service Fees & Descriptions (Summary):

• Left Bottle: $214; client comfortably meets all their basic needs

• Middle Bottle: $182; client generally meets basic needs with some stress

• Right Bottle: $150; client may frequently struggle to meet their basic needs

• This tier provides ongoing care at a reduced-rate for clients experiencing financial hardship. Availability is limited based on reduced-fee slot capacity. Service Fee Agreement is valid for 12 months and may be renewed upon review. Annual fee increases may apply at renewal.

• If your financial situation changes and your current fee is no longer sustainable, we will discuss available options, which may include adjusting your fee (if available) or providing appropriate referrals to lower-cost or community-based services.

This tier provides a short-term option for clients experiencing significant financial hardship. It is intended to provide a time-limited, short-term stabilization option that is not intended for ongoing or long-term care. Client and clinician will collaboratively identify a sustainable long-term treatment option. Availability is limited based on reduced-fee slot capacity.

Tier 3 Service Fee Agreements are valid for up to 12 sessions. You may select a fee within the Tier 3 range based on your self-assessment of your  financial circumstances. 

As we near the completion of the 12-sessions, we will discuss your needs and available options, which may include transitioning to Tier 1 or Tier 2 (if available and financially sustainable), adjusting session frequency, or providing appropriate referrals to lower-cost or community-based services.

If transitioning to a higher fee tier is not feasible, appropriate referrals will be provided to support transition of care. Future participation in Tier 3 or extensions is not guaranteed and will be considered based on financial need, clinical appropriateness, and availability of reduced-fee slots. 

Temporary Fee Exception for Severe Financial Hardship:

In cases of severe financial hardship, fees may be temporarily reduced below the Tier 3 minimum as short-term support for up to 6 sessions. This exception is time-limited, and not intended for ongoing or repeated use. As the Service Fee Agreement period nears its end, we will discuss your needs and available options to support continuity of care. This exception is applied consistently based on financial hardship criteria and clinical appropriateness.

• I may stress about meeting my basic needs but still regularly achieve them

• I may have some debt but it does not prohibit attainment of basic needs

• I own or lease a car

• I am employed

• I have access to health care

• I might have access to financial savings

• I have some expendable income

• I am able to buy some new items & I thrift others

• I can take a vacation annually or every few years without financial burden

• I frequently stress about meeting basic needs & don’t always achieve them

• I have debt and it sometimes prohibits me from meeting my basic needs

• I rent lower-end properties or have unstable housing

• I do not have a car and/or have limited access to a car but I am not always able to afford gas

• I am unemployed or underemployed

• I qualify for government assistance including food stamps & health care

• I have no access to savings

• I have no or very limited expendable income

• I rarely buy new items because I am unable to afford them

• I cannot afford a vacation or have the ability to take time off without financial burden

Acceptable payment methods include: checks, and all major credit, debit, FSA, and HSA cards. Please make all checks payable to: Melissa Pérez. A $10.00 service charge will be charged for any checks returned for any reason for special handling.

Payments for Telehealth sessions are processed through the Electronic Health Record (EHR) system, a secure and HIPAA-compliant platform. Payment for a Telehealth session is expected at the time services are rendered. Payment schedules for other professional services will be agreed upon as they are requested. Please ask me if you wish to discuss a written agreement that specifies an alternative payment procedure.

Good Faith Estimate and the “No Surprises” Notice: Self-pay clients will be provided with a Good Faith Estimate and a “No Suprises” notice. The Good Faith Estimate explains how much your care will cost. Under the law, health care providers need to give clients who don’t have insurance or are not using insurance (including clients who pay out-of pocket and request insurance reimbursement) an estimate of the bill for medical items and services (including psychotherapy). You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services, including psychotherapy services. The “No Surprises” notice reviews these client rights.  

I am currently an in-network provider with Lyra Health insurance plan. You are ultimately responsible for all fees for therapy and non-psychotherapy services, regardless of whether your insurance pays for services. Session fees are paid for by the sponsoring employer, as long as you remain eligible. Your coverage may stop if there are changes to the sponsoring employee’s Lyra eligibility or employment status. Your sponsoring employer may cover a limited number of late cancellation/no-show fees, before it is your responsibility to pay. 

If you have insurance other than Lyra, I may be considered an out-of-network provider. This is primarily for individuals with Preferred Provider Organization Plan (PPO) insurance. The out-of-network fee is $214 per 50-minute session, due at the time of service. I can provide a monthly superbill upon request. You are responsible for submitting the superbill to your insurance for direct reimbursement. The rate for reimbursement would depend on your insurance plan and out-of-network benefits, and would most likely be a partial reimbursement. 

Please note that some insurance policies have a deductible that clients must meet before being eligible for reimbursement. I recommend you speak with your insurance and ask clarifying questions about your insurance plan, and the reimbursement rate and deductible for mental health care for out-of-network providers. 

Some helpful questions to ask your insurance provider before our first appointment: 

• Do I have out-of-network mental/behavioral health benefits?

• Do I have an out-of-network deductible that has to be met first before I get reimbursed? Has any amount of my deductible been covered this year? 

• How much would I get reimbursed?

• What is the usual and customary rate covered by my insurance for outpatient psychotherapy (CPT code 90834) (This is a specific code insurances use for billing)? 

• Is approval or pre-authorization required?

• Is there a limit to the amount of sessions I can have in a year?

• How do I submit claim forms for reimbursement?