Forms / Fees / Insurance

“I cannot imagine what my life would be like had God not graced me with you, my therapist. Knowing you has been life transforming!” – Janet

Save time by filling out forms before you arrive for your first appointment.

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Consent to Treatment Form
HIPAA Communication Form
Financial Form
Patient Intake Form

Fees are determined during the first therapy session or when other services (such as supervision, consultation, or community education) are scheduled. The range of fees for counseling, depending on education, credentials, experience, and availability, are between $60 – $150 for a 45-50 minute session. Scholarships are made available by The Samaritan Fund based on an adjusted fee structure. In crisis situations or for immediate response (less than 24 hours) a higher, one time, fee may be charged. Insurance may cover some of the costs. See below for answers to common questions:

Q: “Will my insurance cover the services offered by Covenant?”
A: Currently, Denesha Chambers is the only provider at Covenant that accepts Insurance. However, it is important that any potential client call his/her insurance carrier to find out if she is on the provider list for their particular insurance. Also, ask for an “authorization number,” and provide this at your first appointment along with your insurance card and co-pay. Please be advised that insurance does not cover missed appointments.

Q: What options for payment do I have if insurance will not cover the service?
A: You should always ask your insurance company if they will pay for counseling services on an “out of plan/network” basis. If they do, the payment is generally 50% of the fee. Otherwise, Covenant has a Samaritan Fund from which some scholarship assistance is available. The fee is typically similar to the co-pay for “out of plan/network” providers.

Q: Does insurance cover marriage/family counseling?
A: Not typically, however it is always best to ask your insurance carrier.

Q: How does insurance coverage for mental health services differ from medical benefits?
A: There are more similarities than differences. The insurance carrier will require a form be submitted with your information, dates of therapy, what type of session (individual, group, with or without family members present), and a diagnostic code. They will then determine if they will cover/pay for that diagnosis and either deny or provide additional authorization for sessions. This could be 1, 3, 6, or even 20 sessions. It depends on the process of that company. They may then require a treatment plan to address the symptoms of the diagnosis.

Q: CC&FRC is listed as a provider with my EAP (Employee Assistance Program) benefits, how does this work?
A: EAP companies have specific providers (counselors) under contract. Be sure to ask your EAP the name of the staff person with whom you should make an appointment. If they do not specify a person, ask the credential requirements of the counselor. That will best help us match you with the correct person.

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