Client Balance Consent

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General Information

Policy Title: Patient Balance and Service Provision Policy

Policy Statement:

Dr. John G. Kuna Psy.D. & Associates is committed to providing exceptional mental health services. To maintain operational efficacy and resource allocation, it is imperative that financial obligations are met by our patients. This policy outlines the Practice’s stance on outstanding patient balances and the scheduling of future appointments or services.

Policy Purpose

To establish a consistent and clear policy regarding the management of outstanding patient balances at Dr. John G. Kuna Psy.D. & Associates to ensure financial sustainability and the continued provision of high-quality mental health services.

This policy is intended to balance the financial health of Dr. John G. Kuna Psy.D. & Associates with the commitment to providing outstanding care to our patients. We believe in transparent communication and are dedicated to working collaboratively with our patients to manage their accounts effectively.


1. Balance Threshold: A patient with an outstanding balance exceeding $100 will be unable to schedule additional appointments or receive further services at Dr. John G. Kuna Psy.D. & Associates until the balance is sufficiently addressed. This includes ongoing therapy services or additional types of services (i.e. testing, assessment, etc.).

2. Notification: In addition to monthly statements and statements reminders, patients will be notified of their balance after each appointment via their preferred method of communication (email, text, or mail). If a patient's balance exceeds the $100 threshold, they will receive a notification detailing the balance and the implications for future service provision.

3. Payment Plans and Assistance: Patients experiencing financial hardship are encouraged to communicate with our billing department to discuss payment plan options or to explore potential financial assistance programs that may be available.

4. Rescheduling of Appointments: Patients with a balance over $100 must settle their outstanding balance or make acceptable payment arrangements before any further appointments can be scheduled or services rendered.

5. Emergency Services: This policy does not apply to emergency mental health services. Patients experiencing a mental health crisis will be provided necessary care regardless of their account balance.

6. Account Review and Appeals: Patients have the right to request a detailed review of their account and to appeal or dispute charges they believe to be incorrect. The billing department will provide the necessary support to ensure transparency and accuracy.

7. Exceptions: Clients who are using a payment plan and paying on a regular basis as agreed, even if their balance is over the threshold, will be eligible to continue receiving services.

8. Payment Plans: Exceptions to this policy may be made on a case by case basis.

9. Approvals: Any client subject to this policy that may have a schedule change due to an overdue balance must be approved by clinical leadership before communication with the client.


The Billing Department and Clinical Leadership is responsible for the implementation, enforcement, and periodic review of this policy. Dissemination of Policy:

This policy will be communicated to all patients upon their initiation of services at Dr. John G. Kuna Psy.D. & Associates and will be accessible through our website and from our providers. Review and Revision:

This policy is subject to annual review or as needed to adapt to regulatory changes, operational needs, or financial considerations. Any amendments to this policy will be communicated promptly to all patients and staff.

Devised: 1/2024
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Consent by Legal Guardian (if under 14 years old)
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