No show/cancellation policy: 

Consistency is an important part of your or your child's therapy. We hold appointment times for you and your family that we cannot offer to other families if an appointment is canceled at the last minute. No show to appointments, or cancellation less than 24 hours in advance, will be charged a $100.00 fee. As a courtesy we will waive the fee for the first occurrence only.

Because we understand that sometimes people make mistakes or circumstances are beyond your control, our general guideline is to waive the fee for the first no-show/cancellation and for unforeseen or emergency circumstances such as sudden illness and dangerous road conditions. Frequent occurrences will result in the loss of the appointment schedule. Medicaid clients cannot be charged; however, frequent instances will result in the loss of the appointment schedule.

If 30 days have passed without a kept session or communication about continuing services, the practice and therapist reserve the right to officially close a client's file and end services. To continue services after that point, clients will need to renew paperwork, pay any outstanding balances, and then schedule an updated intake session.

Please be advised if you are using insurance coverage, this is a contract between you and your insurance company, not Family Roots Therapy.

If you are using insurance, we will need to know about ALL insurance plans that list you as a member. You are also responsible for keeping your insurance information updated and notifying us of any changes in coverage. 

IF YOU HAVE MORE THAN ONE ACTIVE PLAN FOR COVERAGE, insurance determines which is your primary and secondary plan and those claims must be submitted accordingly, in a specific order. This has a significant impact on coverage, payment, and client responsibility. Medicaid is always secondary and is unable to be used as a primary insurance if a commercial plan is active.

Of the panels we are in-network with, we have already done a preliminary verification of your insurance to let you know if coverage is active and if mental health services are available. However, it is the processing of claims by insurance that ultimately determines what they will cover and what the client will owe. We encourage each client to check directly with their insurance about their plan's coverage to reduce any unexpected costs. Clients are responsible for checking with their insurance carriers to know and understand the coverage of their plans. 

Possessing insurance is not a guarantee of payment. Insurance does not always cover all the costs involved in treatment. The client is ultimately responsible for any costs incurred that are not covered by your insurance.

Please choose the "self pay" option if you are paying cash for services. If you require a superbill to be reimbursed by your insurance company, please let us know by contacting info@familyrootstherapy or 503-746-3373 and we will provide instructions for how to download your superbills/receipts from the client portal.

Credit Card on file: 

We require that all clients save a credit card on file. You will be prompted to enter credit card information when filling out paperwork. Your credit card information is stored securely in our client portal. We cannot even see the credit card information once you enter it. 

By accepting this policy, you are consenting to charge any unpaid balances and cancellation fees as described in our policies to the card on file. 

Most clients prefer to have us bill the co-pay or session rate each week as a courtesy rather than log in to pay an invoice each week. If you prefer to pay each invoice on your own rather than be billed automatically, please let us know (info@familyrootstherapy.com) and we will not automatically bill your card each week. 

Please note that we do not allow clients to carry a balance (unless you have arranged for a payment plan) and your payment will be due each week at the time of session. Please note that if you choose not to be billed automatically, you may still be charged for overdue balances and cancellation fees. We will make attempts to reach out to you to arrange payment prior to making these charges. 

We do not accept cash or checks as forms of payment at this time.

Because we are mindful of our clients' privacy, Family Roots offers secure messaging through our client portal. If you wish to communicate electronically about your treatment or your child's treatment, the client portal is the most secure method. 

Your therapist may use e-mail to communicate about scheduling needs but will not send sensitive or personal information via unencrypted e-mail. You may choose to use unencrypted e-mail to communicate with your therapist if you prefer, as we recognize that some clients prefer e-mail communication. (Certain employees at Family Roots Therapy have encrypted email capability through PauBox and are able to send sensitive information securely through email. Please contact info@familyrootstherapy.com for more details)

Please do not use text messages (SMS) to communicate with your therapist, as our phone system does not allow for texting on each therapists' individual extension. 

Family Roots uses Google Meet for Telehealth video sessions, which is a HIPAA secure video platform. You will receive links to join these sessions via e-mail. 

Therapists at Family Roots will not use any form of social media to communicate with clients and will not engage with clients on social media in any way, even if a client initiates contact. 

By signing below, I acknowledge that I have been informed of the risks of electronic communication and accept these risks should I choose to use unencrypted forms of communication.

For virtual (telehealth) sessions, Family Roots therapy requires the use of your camera during your sessions. Virtual sessions are required to be held in the state of Oregon as the licensure board does not allow for therapists to see clients who are located outside the state.

Family Roots Therapy providers who feel comfortable offering in-person sessions will follow all CDC and state guidelines for preventing the spread of illness. This includes physical distancing, wearing a mask, hand washing, and sanitizing. Guidelines will be shared with clients and providers will ask clients to adhere to all guidelines as well. 

Clients who cannot or will not adhere to guidelines for physical distancing and mask-wearing will be offered telehealth sessions rather than in-office sessions. 

Please do not attend an in-person session if you or someone in your household: 

-Has symptoms of COVID-19 (fever, chills, cough, shortness of breath, fatigue, headache, sudden loss of taste or smell)

-Has a fever of 100.4 degrees fahrenheit or higher

-Is undergoing evaluation for COVID-19 (such as a pending viral test)

-Received a diagnosis of COVID-19 (SARS-CoV-2) infection within the last ten days

-Has had close contact to someone with COVID-19 (SARS-CoV-2) infection within the last 14 days

If you are experiencing any signs of illness, please let your provider know as soon as possible and a telehealth session will be offered instead.

Effective August 1, 2025 

PLEASE NOTE: Possessing insurance is not a guarantee of payment. Insurance does not always cover all the costs involved in treatment. The client is ultimately responsible for any costs incurred that are not covered by your plan.

Mental Health Assessment (CPT code 90791) $250 (required for the first session for diagnosis and assessment prior to treatment and for annual updates) 

*53 minute individual session (CPT code 90837) $225  

45 minute individual session (CPT code 90834) $185  

30 minute individual session (CPT code 90832) $150 

Family Therapy w/ client present (CPT code 90847 - billed for 26+ minutes) $225  

Family Therapy without client present (CPT code 90846 - billed for 26+ minutes) $225

Case Management - billed in 15 minute increments at $35 per 15 minutes for contact with external resources or providers

Neurofeedback - $105 per 45 minute session

*Our standard session is 53 minutes; shorter sessions may be billed as clinically appropriate or if there are extenuating circumstances that require a shorter session. 

Insurance
Family Roots Therapy is contracted In-Network with various insurance companies and may be able to bill your insurance for part or all of your fees. Clients using insurance out of network must pay the full prices listed above and are NOT eligible for sliding-scale. 

If we are in network with your insurance company, you are responsible for paying the patient responsibility according to your explanation of benefits (EOB) from your insurance, including co-pays, co-insurance or paying toward your deductible. You are ultimately responsible for knowing these details of your insurance coverage and for providing us with up to date insurance information. You must notify our office of any insurance changes or terminations. Please check with your insurance company directly to understand what services are covered. The explanation of benefits (EOB) that you receive from your insurance company will determine your patient responsibility. EOBs are typically processed and sent about 3-4 weeks after your session is billed.

A time of service rate applies to clients who are paying our full rate out of pocket as it eliminates the administrative cost of submitting claims on your behalf. The rate is $50 less than the quoted rates above for therapy sessions and assessment. This applies to all therapy services but does not apply to case management, parent coaching, or neurofeedback, as these are services that are not typically covered by insurance and are always paid at the time of service. 

Time of Service Cash Rates
Mental Health Assessment: $200 

53 minute individual session (CPT code 90837) $175 

45 minute individual session (CPT code 90834) $135 

30 minute individual session (CPT code 90832)  $100

Family Therapy w/ client present (CPT code 90847 - billed for 26+ minutes) $175 (CPT code 90847 - billed for 26+ minutes) 

Family Therapy without client present (CPT code 90846 - billed for 26+ minutes) $175 

Case Management - billed in 15 minute increments at $35 per 15 minutes for contact with external resources or providers *not covered by most insurances

Neurofeedback - $105 per 45 minute session

Parent Coaching - $175/session  *This cannot be billed to insurance

Sliding scale rates are available based on client need and therapist availability. See our sliding scale policy for details.

Sliding Scale Policy

We are able to offer a limited number of sliding scale spots for clients who have financial need. Sliding scale spots are reserved for those with limited financial resources and those without insurance coverage and are dependant on clinician availability as well. If you wish to see a specific clinician with a particular specialty and are unable to pay their sliding scale fees, please reach out to our intake coordinator and we may be able to accommodate on a case by case basis depending on your needs and clinicians' availability. 

Student interns are able to offer sliding scale ranging from $0-60
Associates are able to offer sliding scale ranging from $80-130
Licensed clinicians are able to offer sliding scale from $90-150

Below are general household income based guidelines for offering sliding scale for 2025. These are intended to be guidelines only, as we recognize families can have unique financial circumstances, so please reach out to us if you have special circumstances to take into consideration.  

(based on US HHS Poverty Guidelines for 2025 - use chart in link for other family sizes: https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines) 

Household Size: 1 (single individual)
$0-5:  0-$15,650 (poverty guideline) 
$20-30:  $15651-$17,215 (up to 110% of poverty guideline) 
$30-40:  $17216-$19,5623 (up to 125% of poverty guideline) 
$40-50:  $19,564-$23,475 (up to 150% of poverty guideline) 
$50-60:  $23,476-$27,388 (up to 175% of poverty guideline) 
$70-125:  $27,389-31,360 (up to 200% of poverty guideline) 

Household Size: 4 (family of four)
$0-5: 0-$32,150 (poverty guideline) 
$20: $32,151-$35,365 (up to 110% of poverty guideline) 
$30-40: $35,366-$40,188 (up to 125% of poverty guideline) 
$40-50: $40,189-$48,225 (up to 150% of poverty guideline) 
$50-60: $48,226-56,263 (up to 175% of poverty guideline) 
$70-125: $56,264-$64,300 (up to 200% of poverty guideline) 

Sliding Scale is offered based on rates outlined above to those not using insurance to pay for services. Sliding scale is offered as space allows. 

Clients who request a sliding scale spot will be directed to sign a reduced fee agreement, agreeing to a reduced fee for a specific number of sessions and agreeing not to bill insurance for any of the reduced fee sessions.

Teens who are independent of parent finances and do not have their own source of income may be eligible for up to 8 sessions of $0 payment. Please contact our administrative team at info@familyrootstherapy.com or 503-746-3373 to discuss sliding scale needs. 

Court Appearance or Preparation 
For therapists to testify in court, write letters or provide other documents on your behalf, we will charge our full individual rate of $225/hour. Because attending court requires us to cancel multiple sessions, you will be billed for a minimum of four hours of time for court appearances. The time billed will include time spent in preparation, travel time, and time spent testifying. Please note that we cannot make recommendations about custody or parenting time, and please consider that it can be extremely detrimental to a child's therapy process to have their sensitive personal information be used as part of a court case. 

Record Processing Fee
Additional fees may apply for requests for records to be sent by mail. Not to exceed $.50 per printed page plus postage. 

No show/Late Cancellation Policy
To maintain consistency in your treatment, we hold a regular appointment slot for you or your child. No show to appointments, or cancellation less than 24 hours in advance, will be charged a $100.00 fee. As a courtesy we will waive the fee for the first occurrence only.

Payment of Fees
Payment of fees you are responsible for is due upon the date of service.  Your counselor may choose to reschedule your appointment if you are unable to pay for the service. If you have a balance on your account, you will receive a statement. All accounts are due and payable within 14-days of notification. If you have questions regarding the payment of fees, please discuss them with our office manager or your counselor. Please discuss any concerns you may have regarding payment BEFORE it becomes delinquent.

If a client fails to be responsible for the account, and it is necessary to place a delinquent account into the hands of a collection agency/attorney, the client agrees to pay all court costs affixed by the court.

Your counselor accepts credit cards (Visa/MC, American Express, Health Accounts). These payments can be made on our client portal. 

Unpaid balances will be automatically charged to the card on file the day after your session if a copay or session fee was not paid at the time of service as outlined in our credit card agreement.

We are unable to accept checks and cash at this time. 

Our services are rendered at the following cost when not using health insurance:

Mental Health Assessment: $200 

53 minute individual session (CPT code 90837) $175 

45 minute individual session (CPT code 90834) $135 

30 minute individual session (CPT code 90832)  $100

Family Therapy w/ client present (CPT code 90847 - billed for 26+ minutes) $175 (CPT code 90847 - billed for 26+ minutes) 

Family Therapy without client present (CPT code 90846 - billed for 26+ minutes) $175 

Case Management: billed in 15 minute increments at $35 per 15 minutes for contact with external resources or providers *not covered by most insurances

Neurofeedback: $105 per 45 minute session

Parent Coaching: $175/session 


If you are seen once per week, your estimated costs will be: 
$700/month (53 minute sessions with 4 weeks of service) and $8400/year (53 minute sessions with 52 weeks of service)

If you are seen twice per week, your estimated costs will be:
$1400/month (53 minute sessions with 4 weeks of service) and $16,800/year (53 minute sessions with 52 weeks of service) 

We offer a limited amount of sliding scale spots, so if the full rate is too great of a barrier, please reach out to our office staff to see what other options may be available.

Disclaimer:
This Good Faith Estimate shows the costs of items and 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 treatment. You could be charged more if complications or special circumstances occur. If this happens, and your bill is $400 or more for any provider or facility than your Good Faith Estimate for that provider or facility, federal law allows you to dispute the bill.

The Good Faith Estimate is not a contract and does not require the uninsured (or self-pay) individual to obtain the items or services from any of the providers or facilities identified in the Good Faith Estimate.

Please sign below to agree to the terms and acknowledge receipt of this Good Faith Estimate

The following forms and policies are available via our website (familyrootstherapy.com), in our waiting rooms or by requesting a copy from our front office info@familyrootstherapy.com:

Client Bill of Rights
Notice of HIPAA Privacy Practices
Declaration for Mental Health Treatment
Opportunity to Register to Vote
Grievance and Appeals Process

By signing below, you confirm that you have been given the access to read and understand these policies.