Policies

Document A: Psychologist-Client Service Agreement

Insurance Coverage
Dr. Tolisano is an in-network provider for Anthem Blue Cross/Blue Shield, Cigna, United Healthcare, Aetna, Medicare (Part B), and Beacon Health Options. As an out-of-network provider for other insurance companies, he provides documentation to self-pay clients to assist with their efforts to obtain reimbursement.

Please check your insurance coverage using the following questions:

• Do I have mental health insurance benefits?
• What is my deductible per year and has it been met?
• How many sessions per year are covered?
• What is the amount of coverage per session?
• Is approval for sessions required from my primary care physician?
• What information am I comfortable with disclosing (e.g., diagnosis)?

Fees
Full payment at an agreed upon rate is required at the time of service in the form of cash or personal check unless preapproval is granted for alternate arrangements.

Cancellation
Failure to provide notification within 24 hours of missing your appointment may result in charges up to the full session fee. Please be advised that insurance companies will not cover missed appointments.

Confidentiality
In accordance with state law and professional ethics, with the exception of grave disability or imminent risk to self/others, protected health information is not disclosed without a signed authorization.