Fee Scheduling & Billing Policies

Copayments, Coinsurance, & Deductibles Policy

Your insurance plan likely requires you to cover a portion of the cost of your visit in the form copayments, coinsurance, and/or deductibles. If we are unable to determine an exact figure for your out-of-pocket responsibility at the time of visit, we will charge you approx. 90% of what we believe you owe, and collect the remainder once we bill your insurance and have an exact amount.

    1. Example: If you owe 30% coinsurance, we estimate what you owe us based on our fee arrangement with your insurance company. For a counseling visit, the insurance fee might be $110, of which we would expect $33 coinsurance (30%). We charge you $30 at the time of visit, and adjust later for the remaining $3 once we receive a response your insurance plan.

Treatment Services

The grid below shows our services and the typical frequency to be expected in treatment. Treatment services will vary based on your individual course of treatment.

Title of the document
CPT Counseling Service Fee Schedule* Details
90791 Assessment $289.20 Required once to start treatment
90792 Initial psychiatric assessment $322.69
90832 Individual Therapy, 30 min $124.50
90834 Individual Therapy, 45 min $165.25 1:1 with your counselor
90837 Individual Therapy, 60 min $243.97
90853 Group Therapy, 30-60 min $55.00
90846 Family Therapy, without patient, 50 min $158.56
90847 Family Therapy, withpatient, 50 min $164.14
99404 Preventative Counselling $160.00
CPT Medical Service Fee Schedule* Details
90833 Individual Therapy, with exam, 30 min $150.00
90836 Individual Therapy, with exam, 45 min $195.00
90838 Individual Therapy, with exam, 60 min $260.00
99202 New Patient Medical Exam, 20 min $118.35
90837 Individual Therapy, 60 min $243.97
99203 New Patient Medical Exam, 30 min $182.00
99204 New Patient Medical Exam, 45 min $271.89
99205 New Patient Medical Exam, 60 min $358.98
99212 Existing Patient Medical Exam, 10 min $91.01
99213 Existing Patient Medical Exam, 15 min $147.95
99214 Existing Patient Medical Exam, 25 min $209.92
99215 Existing Patient Medical Exam, 40 min $293.10

Authorization to Pay Benefits to Kemet

In consideration of Kemet Health rendering treatment to me without immediate compensation, I irrevocably authorize and assign my right to payment of Kemet’s bill for treatment rendered to me out of the proceeds of any judgment or settlement in my case, and furthermore, from any insurance company providing coverage to me for such expenses. I understand, authorize, and agree that no payment due me under my contract for insurance shall be made to me for any other medical expenses until Kemet Health’s bill for my treatment is paid in full.

Self Pay Rates

Kemet Health also offers a discounted bundled services pricing option to patients without insurance. Ask us about this if you are interested in paying out of pocket.

Secondary Government Payers

Kemet does not accept Medicare or Medicaid insurance plans at this time. As a result, while these plans would normally pay patient balances, you will be held accountable for these costs. You agree to pay the amount that Medicare/Medicaid normally “covers”. This is often a co-pay or deductible from your insurance. If you have questions contact our front desk.

In signing below, I understand and agree to the above fee schedule & billing policies.

    I will be given a copy of this authorization for my records and the original will be included in the healthcare record.

    Please let parent, guardian, or your personal representative sign below:

    By submitting your signature, the parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.