Registration Forms

The Financial Form

The Insurance Form

Our Insurance and Financial Policy

It is our belief that healthcare professionals and their patients (not insurance companies) should make treatment decisions. That is why our practice has chosen not to participate with any insurance plans. It is our policy to never compromise the level of quality care that we are committed to providing.

 

Out-of-Network Insurance Benefits

We are a fully licensed and qualified out-of-network provider. This means that we do not participate directly with your health plan. As a courtesy, we will submit claims to your carrier on your behalf for reimbursement to you. Most Traditional, PPO, and POS plans have optional “out-of-network” benefits that provide coverage for the types of psychological therapy services that we provide. Unless you have an HMO, you will likely be covered for a significant portion of our service fees. Please contact your insurance company for a more detailed explanation of your benefits, or ask us to pre-certify for you.

** PLEASE UPLOAD A COPY OF THE FRONT AND BACK OF THE INSURANCE CARD**
Front of Insurance Card
Upload supported file (Max 15MB)
Back of Insurance Card
Upload supported file (Max 15MB)
** IF YOU DO NOT HAVE ACCESS TO UPLOAD CARD, PLEASE PROVIDE THIS INFO
(IF YOU UPLOAD YOUR CARD, JUST PUT IN N/A IN THESE BOXES**

PATIENT INFORMATION (MANDATORY)

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INSURED SUBSCRIBER INFORMATION (MANDATORY)

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PLEASE MAKE SURE YOU DOUBLE CHECK YOUR INFORMATION. YOU CAN'T GO BACK ONCE YOU CLICK SUBMIT!

© Hellenic Therapy Center

maria@hellenictherapy.com

567 Park Ave, Suite 203

Scotch Plains, NJ 07076

Hours of Operations:

Monday - Friday 8am-9pm

Saturday 8am-2pm

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