New Client Forms for Amanda, Laura, Jessica & Sara (Heart of

Ivy Pay is an independent billing system that was created specifically for therapists. It is HIPAA compliant and secure. It allows space for clients to have a registered payment method, without the clinician having to be responsible for safely storing and protecting client credit card information.  

 You can pay using a credit card, debit card, FSA or HSA 

It’s easy! After your first session with your therapist, your therapist will put basic information about you into Ivy Pay and send a request via text to enroll in Ivy Pay. This request will come through as a text message to your provided mobile phone number. You will need to click on the link in the text. You will then be redirected to a website where you will be asked to put in your information, along with your form of payment. You should be able to click on this link at any time to access your account. 

You will billed after your session with your therapist. You will receive a text message from Ivy Pay indicating that you have been charged. You can click the link to view the charge, to view past charges, and/or to change payment type. Clients who cancel less than 24 hours in advance, will be charged a session fee. 

If the credit card was declined, your therapist will send a request through Ivy Pay asking you to put a new card on file. You can also click on the link sent to you by IvyPay to change payment method. 

Yes. If you chose to do this, please let your clinician know ahead of time. This way your therapist can ensure that the information needed by the insurance company is included in your information. 

 We are required by law to provide the following Good Faith Estimate. This estimate is based on a year of treatment (52 weeks), at our regular rates. Your total may be less based on a negotiated rate with your clinician.

Common service codes provided by Heart of Therapy, LLC & Insight Guidance:
90834: 45 minute counseling/psychotherapy session

Common service codes used by Heart of Therapy, LLC & Insight Guidance:
F43.20: Adjustment Disorder, Unspecified
Z91.49: Other Personal History of Psychological Trauma
Z62.820: Parent-Child Relational Problems
Z63.0: Relationship Distress with Spouse or Intimate Partner
Z72.89: Phase of Life Problem
Z62: Problems Related to Upbringing

Where services will be rendered:
350 S Main Street, Suite 213, Doylestown PA 18901
Online through agreed upon virtual format

Length of time in treatment:
Your clinician recognizes that every client comes into treatment with different needs and life circumstances. Each client’s journey to healing is unique. The length of time in treatment is determined by many different factors, including: Your schedule and life circumstances,
Therapist availability, Ongoing life challenges, The nature of your specific challenges and how you address them

You and your therapist will continually assess the appropriate frequency and duration of therapy, and will work together to determine when you have met your goals and are ready for discharge.

The current full fee rates for psychotherapy services are:
45 minutes (Individual Psychotherapy): $175/session   GFE: $9100  $150/session   GFE: $7800
45 minutes (Couples/Family Psychotherapy): $200/session   GFE: $10,400
45 minutes (Individual Psychotherapy + texting between sessions): $225/session   GFE: $11,700

Disclaimer
The Good Faith Estimate shows the cost of services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during the course of treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) services that are more than $400 above the estimated cost of services.

The Good Faith Estimate is not a contract and therefore does not require you to obtain the items or services provided by Heart of Therapy, LLC or Insight Guidance. At the foundation of a good therapeutic relationship between client and therapist is the client’s right to self determination and autonomy. Therefore you (as the client) have the right to terminate services at any time.

If you are billed for more than this Good Faith Estimate, you have a right to dispute the bill.
You may contact your clinician to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or as if there is financial assistance available.

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will pay the price of the Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider, you must pay the higher amount.

To learn more and to get a form to start the process, or to learn more about the Good Faith Estimate or No Surprise Act, go to www.cms.gov/nosurprises or call 1-800-985-3059