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New Client Forms

Treatment Contract Form

New Client Information Form

Client Consent Form

Billing Practices Consent Form

Release of Information Form

Once you have been referred to a Hull Institute clinician, please complete the Insurance Form which comes to us via email. The Treatment Contract, Client Information and Client Consent forms should be printed out, completed and brought to the first session. If you are able to bring in printed information about your insurance coverage, that would be helpful as well. We request payment at the time of service, via cash, check or credit card. If you have any questions, we will answer them at your first session.

Insurance Form– Please complete this form online and submit.

What you should know:

Navigating through your insurance coverage is getting trickier and trickier these days. Things are not always as they appear, and information can be difficult to understand.


Is The Hull Institute in network for your particular insurance plan? Inquire about The Hull Institute and the provider. Most insurance companies have a variety of plans/products and we are in some and not others.

What is your co-pay/co-insurance per session? We request a minimum payment of $20.00 co-pay if you are not sure of your exact co-pay amount.
If you have a high deductible plan, have you met your annual deductible? (If not, you are responsible for the full fee payable at each session until you reach your full deductible amount). This will be discussed with you during your initial call to us.

If The Hull Institute is out of network, what is your out of network coverage- out of network deductible and percentage you must pay?

Helpful definitions:

Annual deductible: The amount you owe to providers annually before your insurance kicks in. This amount starts over each year, usually in January. Most insurance plans have an annual deductible.

Out of Network Deductible: A separate amount you must pay to an out of network provider until insurance kicks in. Many insurance companies no longer offer out of network coverage. If they do, they pay only a percentage of the full fee, an amount they determine is “reasonable and customary”. You, however, are responsible for paying whatever insurance doesn’t pay for our full fee, not an adjusted amount. This is customary practice in all medical facilities.

Co-pay: The amount you owe per session once your deductible has been met. For therapy, some insurance companies use the co-pay you pay for your PCP, some use what you pay to see a specialist. Co-pays will be collected at the time of service. Again, look at old EOB’s, check your account on line or call your insurance company to determine your co-pay.

Co-insurance: The amount you owe per session based on a percentage of what the insurance company pays, not a flat amount. You pay this like you pay a co-pay, except the amount can vary. Please be prepared to pay $20 at each visit until you get your EOB that shows the exact amount you owe. You should receive an EOB within 30-45 days after your session. Should you have a credit, you can apply it to future visits or we can reimburse you.

High deductible plans: These plans require patients to pay the full amount for all medical care until they hit their deductible, which is often $2000.00 and above. Insurance won’t pay on any claims until you have paid out the full deductible. We always submit claims to your insurance company so they keep track of what charges you incur. You should be paying us with your HSA card. As a current client, any past EOB will show you what they pay/what you will owe.

Pre-Authorizations: Not many insurance companies require pre-authorizations for mental health services anymore. Yet some still do. If your insurance company requires this, we request you share with us staying on top of this. Please discuss this with your therapist. We will submit forms and treatment plans, and request you help us keep track of how many sessions you have before another authorization is needed.

*** We will help in any way we can. This is a cumbersome process for all of us and we will do our best to work with you and your insurance company to be sure our services are covered. AND, if we find out after the session that we are not in network for your particular plan, you will be responsible for the full fee.***

Thank you for choosing The Hull Institute and we look forward to working with you.