The following information is offered in order to help you understand how much the services from IDCC will cost you. We base our fee on the type of service provided and on the amount of time we spend in providing these services to you. Our basic fees are as follows:
| Family size of | Annual Income (At or below 100% of FPL) | Annual Income (between 101–125% of FPL) | Annual Income (between 126–150% of FPL) | Annual Income (between 151–175% of FPL) | Annual Income (between 176–200% of FPL) | Annual Income (between 201–250% of FPL) | Annual Income (between 251–325% of FPL) | Annual Income (between 326–400% of FPL) | Annual Income (between 401–450% of FPL) | Annual Income (between 451–500% of FPL) | Above 500% |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 0–$15,650 | $15,650–$19,562.50 | $19,562.50–$23,475 | $23,475–$27,387.50 | $27,387.50–$31,300 | $31,300–$39,125 | $39,125–$50,862.50 | $50,862.50–$62,600 | $62,600–$70,425 | $70,425–$78,250 | Above $78,250 |
| 2 | 0–$21,150 | $21,150–$26,437.50 | $26,437.50–$31,725 | $31,725–$37,012.50 | $37,012.50–$42,300 | $42,300–$52,875 | $52,875–$68,737.50 | $68,737.50–$84,600 | $84,600–$95,175 | $95,175–$105,750 | Above $105,750 |
| 3 | 0–$26,650 | $26,650–$33,312.50 | $33,312.50–$39,975 | $39,975–$46,637.50 | $46,637.50–$53,300 | $53,300–$66,625 | $66,625–$86,612.50 | $86,612.50–$106,600 | $106,600–$119,925 | $119,925–$133,250 | Above $133,250 |
| 4 | 0–$32,150 | $32,150–$40,187.50 | $40,187.50–$48,225 | $48,225–$56,262.50 | $56,262.50–$64,300 | $64,300–$80,375 | $80,375–$104,487.50 | $104,487.50–$128,600 | $128,600–$144,675 | $144,675–$160,750 | Above $160,750 |
| 5 | 0–$37,650 | $37,650–$47,062.50 | $47,062.50–$56,475 | $56,475–$65,887.50 | $65,887.50–$75,300 | $75,300–$94,125 | $94,125–$122,362.50 | $122,362.50–$150,600 | $150,600–$169,425 | $169,425–$188,250 | Above $188,250 |
| 6 | 0–$43,150 | $43,150–$53,937.50 | $53,937.50–$64,725 | $64,725–$75,562.50 | $75,562.50–$86,300 | $86,300–$107,875 | $107,875–$140,237.50 | $140,237.50–$172,600 | $172,600–$194,025 | $194,025–$215,750 | Above $215,750 |
| 7 | 0–$48,650 | $48,650–$60,812.50 | $60,812.50–$72,975 | $72,975–$85,137.50 | $85,137.50–$97,300 | $97,300–$121,625 | $121,625–$158,112.50 | $158,112.50–$194,600 | $194,600–$218,975 | $218,975–$243,250 | Above $243,250 |
| 8 | 0–$54,150 | $54,150–$67,687.50 | $67,687.50–$81,225 | $81,225–$94,762.50 | $94,762.50–$108,300 | $108,300–$135,375 | $135,375–$175,987.50 | $175,987.50–$216,600 | $216,600–$243,675 | $243,675–$270,750 | Above $270,750 |
| 9 | 0–$59,650 | $59,650–$74,562.50 | $74,562.50–$89,475 | $89,475–$104,387.50 | $104,387.50–$119,300 | $119,300–$149,125 | $149,125–$193,862.50 | $193,862.50–$238,600 | $238,600–$268,425 | $268,425–$298,250 | Above $298,250 |
| For each additional | $5,500.00 | $6,875.00 | $8,250.00 | $9,625.00 | $11,000.00 | $13,750.00 | $17,875.00 | $22,000.00 | $24,750.00 | $27,500.00 | $27,500.00 |
| Type | Fee | At or Below | 5.00 | 10.00 | 15.00 | 20.00 | 25.00 | 50.00 | 100.00 | 150.00 | 200.00 |
| All | 319.40 / 100% | 0 | 2% | 3% | 5% | 6% | 8% | 16% | 31% | 47% | 63% |
Your charges may vary depending upon how much time you spend in some of the above services. Our staff will help you estimate this as soon as we determine with you what your treatment needs are.
Because our primary concern is that persons in need of our services receive them, no one will be refused service due to an inability to pay part or all of the fee. However, if you are able to pay and choose not to, we will refuse to provide services to you. If after you have reviewed the fee schedule and understand your treatment plan, the cost appears to be more than you can manage, let us know. We have several ways that we can help.
Most health insurance policies cover behavioral health and substance abuse services to some extent. IF YOU HAVE HEALTH INSURANCE, INCLUDING MEDICARE OR MEDICAID, IT IS IMPORTANT THAT YOU GIVE US THIS INFORMATION RIGHT AWAY. We will bill your insurance company directly so that they can pay us directly. Should your insurance company pay us for what you have already paid, we will credit your account or give you a refund. Your insurance company is billed our full fee. You are responsible for any deductibles, co-pays, and the balance that is not covered by your insurance company. Any deductibles and co-pays are not eligible for a sliding fee adjustment. If your balance after insurance payments reaches $500, you will be required to make a payment to lower the balance below $500 or your next appointment will not be scheduled.
If necessary, an Extended Payment Plan may be arranged. If this approach will assist you in paying your bill, please arrange to meet with our Client Accounts staff. Should your financial circumstances change, we reserve the right to renew and revise your extended payment plan at any time. If you are on an extended payment plan, you will be required to pay your pre-arranged amount at each appointment, or your next appointment will not be scheduled.
If your financial circumstances are such that paying the full fee is not possible, you may be eligible for a Sliding Fee, which will allow payment at less than the full fee. If this approach seems necessary for you, please discuss it with our Client Accounts staff. If you do not have insurance, Interborough Developmental and Consultation Center offers a sliding fee scale for services provided. The sliding fee scale applies to patients with incomes at or below 400% of the federal poverty guidelines. Please speak to the front desk to set your fee if you would you are requesting a reduced fee per day.
You will be expected to pay your fee each time you receive service. Credit cards are accepted. If, however, you are unable to remain current with your account, a different approach may be necessary. Please discuss such circumstances with our Client Accounts staff. If you do not, and payment is not made, we reserve the right to turn your account over to a collection agent. Payment for the services provided by our agency is a part of the patient-provider relationship. If you have insurance coverage or a payor program that will reimburse our agency for the services provided (like Medicare, Tricare or Medicaid), our agency will submit all claims to your insurance or payor for reimbursement.
If, however, you do not have health insurance benefits, and your insurance fails to pay for my treatment, Interborough Developmental and Consultation Center CCBHC does not accept my insurance coverage or you elect to self-pay for all services I receive (and I have instructed Interborough Developmental and Consultation Center not to submit claims to my insurance plan and I agreed to forgo my insurance coverage benefits), You will be responsible to pay the fees due to Interborough Developmental and Consultation Center for the services provided. In such event, you agree to the terms of this Self-Pay Agreement. Unless a sliding scale fee is provided, you acknowledge and agree to pay a $311.34 fee per day and understand that such fees are subject to change as the applicable rates are adjusted and that I will pay the fee charged by the agency at the time the services are provided.