Please read this information before scheduling your appointment. You can schedule an appointment by clicking the button below that said “Schedule Appointment Now”
SERVICIOS
At this moment, I only provide individual counseling services and psychotherapy to adults in Spanish or English.
COSTO
$150 Individual Session
Your payment per session will be collected at the beginning of each session. You can pay by cash, check, debit and credit cards. I also accepted (FSA) Flex Spending Account and (HSA) Health Saving Account.
I have limited spots for client reduced fee appointments when finances is an issue. My reduced rates varies between $100-145 per session, for clients that can’t afford my full fee. Please inquiry first to see if I have any spot available at a reduced fee.
INSURANCES
At this moment I only accept the following medical insurances:
Blue Cross Blue Shield
Anthem
Molina
Humana
It’s your responsibility to provide me with your insurance information at least 3 business days in advance of your first appointment to verify your insurance benefits. You can send me a photo front/back of your insurance, your full name, address, date of birth, if you are not the primary on this insurance I would need the information from the primary beneficiary as well. You can send me this information by text message at 414-305-8285 or to my email at info@monicaroman.com
I check your medical insurance benefits as courtesy, and let you know about if there is any fee you have to paid at the time of each session(deductible, copay, coinsurance). Note: I tried to be as accurate as possible when I verify your benefits; your fees may change depending on your eligibility and benefits during the date of your sessions. I won’t know your exact fee until I send the claim to your insurance and get your explanation of benefits back from your insurance company. Ultimately, you are responsible for knowing your insurance coverage and we encourage you to call the number on the back of your insurance card and ask your member representative about your ‘mental health, outpatient, office visit’ benefits.
If you didn’t provide me with your medical information in advance, I am not in-network with your insurance , or you don’t have insurance anymore, you are responsible to pay my full fee $150.00. Also note, that insurances don’t paid for late cancellations or no-show fee, this would be your responsibility if it happen.
POLIZA DE CANCELACION
I reserved your appointment time only for you. I ask you to be mindful, and if you need to cancel your appointment please give me a minimum of 24 hours notice to prevent late cancellation fees. Missed appointments (No-Shows) will be $100.00 per each no-show session. $50.00 for late cancellations of less than 24 hours notice and $75 for cancellations made 2 hrs or less from your appointment. This late cancellation or missed appointment charge would be charge the same date of your appointment on the credit card that you have on file.
3 late cancellations or no-show sessions would cause termination
FORMAS
La mayoria de mis clientes llenan estas formas en el sistema en line seguro que tengo. Pero tambien puedes imprimir estas formas y traerlas llenas a tu primera cita. Si decides traer estas formas llenadas en vez de llenarlas en mi sistema en linea por favor dejame saber. Para mandarte la activacion del portal en linea necesito que me mandes a mi correo info@monicaroman.com o por un mensaje de texto al 414-305-8285 la siguiente informacion: Nombre, correo y numero de telefono.
La forma de abajo es una forma que se tendra que llenar si decides que alguien mas entre a tu cita, que le de o hable con alguien de tus records.
Release Form
The forms below, I am required by law to provide you with the Notices of Private Practices, you don’t need to fill out anything there just for your information.
English Notice of Private Practices
Notification de Practicas de la Privacidad
MI OFICINA
