Billing, insurance, and appointment policies for therapists and clients

This article outlines the key policies and procedures for client billing, insurance collection, appointment cancellations, and therapist responsibilities.

Client guidelines

Billing your clients

Before a new client is added to your calendar, we ensure that their insurance information has been collected and a credit card has been securely stored on file. We handle the collection of all patient obligations (e.g., copays, coinsurance, and deductibles). Interest-free payment plans are available, upon client request.

If your client has a question about billing, please have them contact

Credit card charges

We charge the client's credit card on file within 1-2 days after you submit the charge slip. If the client has a known copayment or coinsurance amount, we charge their card before their insurance company processes the claim as well. In some cases, a client's credit card may be charged twice for a single visit. This can happen when we initially charge the card for the known copayment or coinsurance amount. Later, if the insurance company determines that the client owes more money (for example, if the remaining balance is applied to their deductible), we will charge the credit card again to cover the additional amount


Late cancel and no-show policy

All clients sign Rula's 24-hour Cancellation and No-Show policy during registration (details here).

Once you've determined that the client is a no-show, there are two things you'll need to do to be sure you are paid:  

  • Complete a Missed Appointment note with the outreach attempts listed above
  • Mark the client a no-show from the scheduler

If a clinician enters a no-show as "no charge" due to their clinical discretion, the clinician will not be paid for the missed appointment. 

Rula's Support team will manage any disputes or exceptions. Please direct the client to contact Support at Clinicians are not involved in decision-making around no-show fees once you have entered the Missed Appointment note in the chart. We'll take care of those details to ensure you can focus on the relationship with the client.

Please complete a Missed Appointment note if a client doesn't show up.


Multiple sessions in one week

If your client requests to see you more than once a week, you can do so if you deem it medically necessary for the client's treatment. We recommend you check the client's chart to ensure they do not have a session limit before scheduling multiple weekly appointments. Please document the additional session's medical necessity in each note. Insurances only cover one psychotherapy session per day; do not bill back-to-back or multiple sessions on the same day. You can review this article on client charts for more information, Overview of client charts in the Rula provider portal.

If a client is approved for a limited number of annual sessions, we will include that as a pop-up memo on the client chart. Note that pop-up memos are exclusive to AMD client charts. When you type in a patient's name in the AMD search bar to access their client chart, any pop-up memos will appear as a golden yellow note on the chart.

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You can also see all Quick Memos in that section on the client chart.

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For more information, please review the Overview of the client chart in AdvancedMD article.


Private pay clients

You are welcome to use our EHR and billing services for private pay clients. Our private pay rate for clients is $150 for individual sessions and $165 for family/couples sessions. You will be compensated for these visits at your contracted hourly rate.

Therapist policies

Notes and charge slips

You'll need to sign your notes before you complete a charge slip. Notes and charge slips are due within 48 hours of the completed appointment. As a refresher, please write a note associated with the session, sign it, and sign the related charge slip. This allows us to get you paid on time each pay period. Submitting your note and charge slip is part of following our guidelines around pay. Please review this article for more information, Creating and signing your charge slips.


Treating clients located outside of their home state

Generally speaking, you are only allowed to bill insurance if the client is physically located in the state you are licensed. While we verify their location before ever scheduling them, it is best practice to ask where they are located at the start of every session. Suppose you have a continuity of care issue for a client who has temporarily relocated to another state (e.g., less than 30 days). In that case, therapists are expected to contact the appropriate licensing board in that state to determine if it is permissible to continue to provide services.


CPT and diagnosis codes

Please use the CPT code 90791 in your note and charge slip for all initial appointments. Please read these article for more information about CPT codes and billing:

Therapist no-show policy

Our goal is to provide world-class support and care for our clients. We collaborate with therapists who contract with Rula to ensure our clients receive life-changing treatment. To confirm this, therapists agree to the following: 

  • Please arrive on time for their appointments with clients.
  • In case of an emergency, reach out to the client directly and promptly to let them know about changes to the schedule.
  • Align with the client before making adjustments to the appointment time.
  • Provide clients with at least 24 hours notice of a cancellation or rescheduled appointment.

If we hear from a client that a therapist was late or missed their session, we will check in with them. However, after three instances of late cancellations, missed appointments, or tardiness, we will pause sending new clients to that therapist until they have demonstrated the ability to arrive on time and communicate appropriately with clients.

For more information on our no-show policy please review this article, Client outreach and no-shows.

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