Magnolia Shore Therapy | SimplePractice

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Billing & Payment

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Private-Pay Practice Notice Magnolia Shore Therapy is a private-pay practice and does not accept insurance or participate in EAP programs. Payment is due at the time of each session. I am able to provide superbills upon request, which clients may submit to their insurance company for possible out-of-network reimbursement. What is a Superbill? A superbill is a detailed receipt that includes provider and service information your insurance company may require to consider reimbursement for out-of-network mental health services. Submitting a superbill does not guarantee reimbursement, and coverage varies by plan. Important Steps Before Using Insurance Reimbursement Clients are responsible for confirming their out-of-network benefits. Before beginning services, I strongly encourage you to contact your insurance provider and ask: Do I have out-of-network mental health benefits? Are LMFT / LMFTA services eligible for reimbursement under my plan? Will the amount apply toward my deductible, or will I receive partial or full reimbursement? Is there a limit on the number of sessions or dollar amount reimbursed? What documentation is required to submit a superbill? Tips for Checking Benefits Quickly To get this information efficiently: Call the member services number on the back of your insurance card Ask specifically about out-of-network outpatient mental health therapy Request confirmation by email or reference number when possible. I understand that Magnolia Shore Therapy is a private-pay practice and that I am responsible for payment regardless of insurance reimbursement.

Are you open to a Superbill? Yes, No, N/A

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Client Preferences

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Office Hours M-TH 10am-7pm, F 10am-2pm Check all that apply

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Is there anything that the practitioner needs to know?

Examples may include current stressors, scheduling needs, past therapy experiences, or questions about fit. Please avoid sharing detailed or sensitive information here. If you are experiencing a mental health emergency, please contact 911 or local emergency services. Magnolia Shore Therapy is not a crisis service.

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For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.