Fee Schedule

*Professional services are private/self-pay

*Charges for professional services are based on time spent and the nature of the service provided. Your clinician will discuss fees with you.

Payment

Patients are responsible for payment for all services provided by ICAN Telehealth. Self-pay amounts are due at the time of visit. 

Fees for consultation with attorneys, teachers, and other agencies will be discussed before the service is provided. Any telephone consultation fees should be paid prior to the service being rendered.

Please have personal identification with you at your first visit.

Other

Requests for form completion: $100.00

Fees for consultation with attorneys, teachers, and other agencies will be discussed before the service is provided. Any telephone consultation fees should be paid prior to the service being rendered.

Often, patients may request letters or completion of other reports to better inform schools, employers, or insurance reviewers about their treatment. No records are ever released without your permission. ICAN Telehealth has an administrative fee of $100.00 for each request for form completion. Some requests may incur additional professional fees. ICAN Telehealth does not schedule appointments to solely assess for an emotional support animal (ESA) or to write an ESA support letter. An ESA can only be recommended as an essential part of a treatment plan designed to address a disability associated with a diagnosed psychiatric condition, and is always based on the provider’s clinical judgment.

Payment can be made by cash, check, or major credit card and is expected at the time of service unless prior arrangements have been made.

Missed Appointment

$50.00

It is our goal at ICAN Telehealth to provide efficient, accessible, high quality, and timely mental health care. In order for us to assure convenience and accessibility to all of our patients, it is important that patients arrive timely for all scheduled appointments or to cancel the appointment 24 hours in advance. This policy allows us to make better use of our available appointment times for those patients in need of psychiatric care.

A “missed appointment” is an occurrence where someone does not show up for an appointment and does not cancel the appointment in advance of the scheduled date and time. If you do not show up for your appointment and do not cancel the appointment 24 hours in advance, we will record this in the record as a “missed appointment” and result in a fee for a missed appointment. This fee will be charged to the patient and you will not be able to reschedule with a provider until your fee is paid. Excessive missed appointments may result in dismissal from care. 

Refill Requests

30-day maximum prescribed with 1 missed appointment: $25.00

It is imperative for you to keep track of the number of refills written, so you may schedule your follow-up appointments in a timely manner.

Record-keeping for prescription refills that are not associated with office visits can affect the efficiency of care. Some refill requests are directly from patients. Others come from a pharmacy or mail-in service. There is an administrative charge of $25.00 for any request for prescription refills that fall outside of scheduled office visits. This charge applies regardless of the source of the request.