Cancellation Policy Form

  • Cancellation Policy

    Traci W. Flome will file insurance claims for payment. Insurance information will be needed before beginning services to verify benefits. A copy of your insurance card(s) will be requested.

    Medicaid is accepted. Insurance will always be billed first and Medicaid will be billed secondary unless it is the primary source of payment.

    As in all healthcare situations, the client/family is always responsible for payment when all other sources have been exhausted. Therapy services may be on hold or terminated if there is a problem regarding payment.

    If your child receives therapy at school and will be going on a field trip, conflicting school program or doctor’s appointment, we must have notification at least 24 hours in advance in order for you to not be charged for a missed appointment. If you must cancel a morning appointment due to sickness, please call the speech language pathologist the evening before or by 8:00 a.m. the day of the scheduled appointment. As part of your financial responsibility, we are advising you that Express Yourself reserves the right to charge a fee for any appointment that is not kept or not canceled by giving 24 hours advanced notice. If you fail to follow these policies, you will be billed in full for the session. Unforeseen circumstances are anticipated and will be dealt with on a case by case basis.

  • Date Format: MM slash DD slash YYYY