Client Agreement

 

Fee Schedule for Counseling Services and Client Agreement

I WILL provide the following services at your request:

  • One FREE phone consultation.
  • Consultation: In my office, in your home, or on the phone.
  • Review your current medical benefits and provide policy comparisons to assist you in choosing a policy and/or HMO best suited to your needs.
  • Claims Management:
  • Assist you in determining what medical bills you need to pay.
  • Submit complete claims forms to your insurance carrier with required documentation.
  • Maintain and provide a record of all claims activity.
  • Act as your advocate with health care providers, insurance companies and Medicare to secure payment for all legitimate claims and/or negotiate reductions in the health care provider charges.
  • Provide insurance reimbursement data for income tax purposes.
  • Provide Adult Care resource referrals.
  • Provide Medicare Part D Drug information and comparison.

Your Insurance Counselor WILL NOT:

  • Sell medical insurance policies prepare your income tax returns, or provide tax advice.
  • Guarantee reimbursement for every claim submitted.
  • Provide legal advice or act as a claims adjuster.
  • Guarantee estimates of how long it will take or how many hours of billing time will be required to prepare your claims for submittal and follow-up to closure.

Your Obligations:

 You agree to provide the documents and information necessary to prepare and file your claims in a timely   manner to avoid missing claim-filing deadlines.

  • You agree to provide prescription the information necessary to do Part D comparisons and enrollment.
  • You agree to pay in full for services rendered upon receipt of our monthly invoice – irrespective of when you receive benefit payments from your insurance carriers.

Fee Schedule: Ask Pat for current rate.

 A one time, one half hour set up charge will apply to all new client accounts. A $15.00 per month additional charge will apply to all of the client accounts in probate or conservatorship, while awaiting final payment of the client account.

Fees Apply as follows:

  • Time spent with client – office, home, or phone call to provide services listed above.
  • Time spent acting on behalf of the client. Time spent closing out and returning a client file..
  • Time spent traveling to and from an in-home appointment, when appropriate.
  • A late fee of $15.00 per month will be charged for non-payment of a client account after 60 days.
  • No new work will be done until full payment has been received.

I have read and understand what will and will not be provided by Pat Johnson. I agree to pay promptly for the services rendered at the fee schedule listed above.

Client Signature: ____________________________________________ Date:_____________

Here is a PDF version:

Fee Schedule for Counseling Services and Client Agreement for 2017 Web