Home » For New & Prospective Clients » Billing & Insurance Info

Billing & Insurance Info

Thank you for embarking on this journey with us. On this page, we outline general information about our current billing policies, including the insurances we accept.

Card-On-File Info

Cancellation Fees

Our Growing List of Insurance Providers

The following is the list of insurances with which we participate. This will be updated from time to time as needed.
If you do not see your insurance listed please email our billing team: billing@orchardmentalhealth.com.

Contact Our Billing Department

*At this time, testing services are only in-network with Carefirst/BCBS.
Medicaid is only accepted for medication management services.
Please contact us for more details, including self-pay rates.

Card-On-File

We now require clients to keep a credit card on file. Because of this, clients will no longer receive statements from us.

However, once your claim has been processed, you will continue to receive your Explanation of Benefits (EOB) from your insurance carrier, detailing the charges and payments made on your behalf.

Access Your Patient Portal

At check-in you will:

Submit the credit card of your choice, including your Flexible Spending Account (FSA) or Health Savings Account (HSA) card

After your insurance has paid their portion, we will:

Notify you via email of the balance owed

Charge the balance owed to your card on file

Email a receipt for the charge

Credit Card Authorization Form

CREDIT CARD AUTHORIZATION FORM

Quince Orchard Psychotherapy, dba/ Orchard Mental Health Group requires you to provide your credit/debit card information on file with us so we can automatically charge any co-pays, co-insurance, deductible amounts, and professional service charges such as late cancellation or missed appointment charges.

We store financial information and other protected health information in an encrypted, HIPAA compliant site. Your card(s) is/are processed for copays, co-insurance, and deductible amounts at the time of service and/or after the claim has been filed to and processed by your insurance carrier, and the insurance portion of the claim has posted to your account, or if valid insurance information was not provided at the time of service.

ACKNOWLEDGEMENTS & AGREEMENT

I, the client, understand that...

Once the insurance paid their portion for my care, I will receive an explanation of benefits (EOB) from them. The insurance EOB will state any balance to be paid by me.
Orchard Mental Health Group may charge my credit card on file for the balance due when they receive a copy of the EOB.
This authorization relates to all balances not covered by my insurance company for services provided by Orchard Mental Health Group. This could be amounts resulting from balances related to co-payment, deductible, co-insurance, non-covered services, or denials for no coverage/eligibility but is not limited to these scenarios.
If balance accrues and no payment is received, OMHG reserves the right to seek payment by any means, including using the credit/debit information OMHG has on file or retaining a collection agency. OMHG may be willing to work out a payment plan that includes a reasonable period for resolving the balance.
If my balance remains unpaid, OMHG reserves the right to suspend services until the balance is paid in part or in full.

Professional Service Fees
No-Show Fees & Late (<48 business hrs) Cancellation Fees	Medication Management Appointments	Initial Appointment: $150.00 Follow-Up Appointment: $100.00
	Therapy/Counseling Appointments	$125.00
	Testing/Evaluation Appointments	$400.00
Form Fees	Including, but not limited to Disability Forms, Miscellaneous Forms, etc.	$125.00/hr, prorated in 15-min increments
Other Professional Services Not Covered by Insurance	Including, but not limited to Professional Consultation (e.g. peer consultations, legal), Meeting Attendance (e.g. IEP meetings), Court Appearances	$150.00/hr

Client's First Name(Required)

Client's Last Name(Required)

Payer's Name - If different from client

First Last

Name as it Appears on the Credit Card

Same as the client's/payer's name

Name as it Appears on the Credit Card(Required)

Credit Card Billing Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Type of Card(Required)

Other Credit Card Type(Required)

Credit Card Number(Required)

Expiration date(Required)

CVV(Required)

Contact Email(Required)

This field is required for online form submission.

Contact Phone Number(Required)

Today's Date(Required)



Your payment information always stays secure.

Your credit card information will always be fully protected by our off-site, card-processing partner Elavon, and not on our computers, as required by industry standards (Payment Card Industry Data Security Standard — PCI-DSS).

Late Arrivals, Cancellations, No-Shows & Dismissal

Late Arrivals: If you are more than 7 minutes late for a scheduled appointment, you may be asked to reschedule your appointment and a fee will incur on your account. We will try our best to accommodate late-comers as best as possible, but cannot compromise on the quality and timely care provided to our other clients.

Cancellations: If you are unable to keep a scheduled appointment, you must call or email at least forty-eight (48) business hours in advance or we may consider you a “no-show” and a fee will incur on your account. Please note that the 48-hour notice period excludes Fridays after business hours, as well as weekends.*

No-Shows: If you miss your appointment without prior notice, you will be charged a fee on your account. Fees associated with missing appointments cannot be billed to insurance.

Here are the fees based on the type of appointment:

New Therapy Appointments: $125.00
Follow-Up Therapy Appointments: $125.00
New Medication Management Appointments: $150.00
Follow-Up Medication Management Appointments: $100.00
Testing Appointments: $400.00

Please call 240-624-2983 or email appointments@orchardmentalhealth.com if you need to cancel or reschedule an appointment.

*=For example, if a client leaves a message after 5pm Eastern time on a Friday, canceling their appointment for the upcoming Monday, the client will incur a fee.

Cancel or Reschedule an Appointment

In crisis or need immediate help?
Call 988 or go to your nearest ER.

Contact Us

M-F, 9am-5pm Eastern Time
Phone: 240- 750-6467
Fax: 240-912-7835
contact@orchardmentalhealth.com

9707 Key West Avenue, Suite #100 Rockville, MD 20850

10 North Jefferson Street, Suite #202 Frederick, MD 21701

Privacy & Cookie Policies

Billing & Insurance Info

Our Growing List of Insurance Providers

Card-On-File

At check-in you will:

After your insurance has paid their portion, we will:

Credit Card Authorization Form

Credit Card Authorization Form

CREDIT CARD AUTHORIZATION FORM

ACKNOWLEDGEMENTS & AGREEMENT

Your payment information always stays secure.

Late Arrivals, Cancellations, No-Shows & Dismissal

Here are the fees based on the type of appointment:

Services

Find a Provider

Appointments

Patient Resources

Accepted Insurance*

Partner Resources

Orchard Mental Health Group

Contact Us

We’re all about convenience! If you are a current client with us, you can now schedule, cancel, and reschedule appointments through your OmniMD Patient Portal.

You may also fill out this form if you wish to cancel and reschedule your existing appointment.

Cancel/Reschedule an Appointment

Reschedule an Appointment

We’re all about convenience! As a current client with us, you can now schedule, cancel, and reschedule appointments through your OmniMD Patient Portal.

You may also fill out this form if you are a current client, and wish to schedule your next appointment.

For Current Clients: Schedule an Appointment

Welcome back! Before we get started, we may need to confirm that we have your info on file...

Thank you for starting this journey with OMHG.

Welcome back!

Referral Form