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Rate and Insurance Information

Fees and Insurance Information

The fees for a 50-minute session are $140 for an individual and $150 for a couple or a family. For a 75-minute session the corresponding fees are $165 and $185. If longer sessions occur, the fee will be prorated. Fees for additional time or services, including travel time, will be billed at $140 per hour. Such additional services may include, but are not limited to, consultation with other professionals, preparation of reports or correspondence, any necessary court appearances, school meetings, phone calls lasting over 10 minutes. Upon our first meeting we can come to an agreement whether we will schedule weekly or bi-weekly sessions. It is important to be consistent so that the goals are reached. It is important to be consistent so that the goals are reached.

I accept CareFirst BlueCross BlueShield and Aetna insurances. For other insurance companies I offer a statement of services that can be submitted to insurance companies for participants of out-of-network plans. Under both, Virginia and Maryland legislation, there is mental health parity and all medical insurances must provide coverage for individual and group mental health treatment. I suggest verification with the insurance company prior to your visit to check the co-pay, deductibles and what their particular policy covers. I can also offer a sliding fee scale, depending on the circumstance.

Forms

Please print, sign, and bring all the documents listed below to our first meeting.

Intake Assessment Form

Please answer the questions provided in the Intake Assessment form and email it to me 24 hours before our scheduled meeting. The information you provide will allow us to use our first session more effectively.
Download form (Word file) (PDF file)

Client Registration

Client and insurance information, billing agreement and provides general confidentiality information (HIPPA) and emergency contact.
Download form (Word file) (PDF file)

The Nature of Confidentiality

Describes the scope of confidentiality according to the law and ethical practice.
Download document (PDF file)

Office:

8720 Georgia Avenue, Suite 205
Silver Spring, MD 20910

Phone: (301) 495-6393
Fax: (301) 495-6394
Email: christina@christinaguidorizzi.com

 
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