Privacy Policy

WEB SITE TERMS AND CONDITIONS OF USE

1. TERMS
By accessing this web site, you are agreeing to be bound by these web site Terms and Conditions of Use, all applicable laws and regulations, and agree that you are responsible for compliance with any applicable local laws. If you do not agree with any of these terms, you are prohibited from using or accessing this site. The materials contained in this web site are protected by applicable copyright and trade mark law.

2. USE LICENSE
a) Permission is granted to temporarily download one copy of the materials (information or software) on Affiliated Family Counselors’s web site for personal, non-commercial transitory viewing only. This is the grant of a license, not a transfer of title, and under this license you may not:
• modify or copy the materials;
• use the materials for any commercial purpose, or for any public display (commercial or non-commercial);
• attempt to decompile or reverse engineer any software contained on Affiliated Family Counselors’s web site;
• remove any copyright or other proprietary notations from the materials; or
• transfer the materials to another person or “mirror” the materials on any other server.
b) This license shall automatically terminate if you violate any of these restrictions and may be terminated by Affiliated Family Counselors at any time. Upon terminating your viewing of these materials or upon the termination of this license, you must destroy any downloaded materials in your possession whether in electronic or printed format.

3. DISCLAIMER
The materials on Affiliated Family Counselors’s web site are provided “as is”. Affiliated Family Counselors makes no warranties, expressed or implied, and hereby disclaims and negates all other warranties, including without limitation, implied warranties or conditions of merchantability, fitness for a particular purpose, or non-infringement of intellectual property or other violation of rights. Further, Affiliated Family Counselors does not warrant or make any representations concerning the accuracy, likely results, or reliability of the use of the materials on its Internet web site or otherwise relating to such materials or on any sites linked to this site.

4. LIMITATIONS
In no event shall Affiliated Family Counselors or its suppliers be liable for any damages (including, without limitation, damages for loss of data or profit, or due to business interruption,) arising out of the use or inability to use the materials on Affiliated Family Counselors’s Internet site, even if Affiliated Family Counselors or a Affiliated Family Counselors authorized representative has been notified orally or in writing of the possibility of such damage. Because some jurisdictions do not allow limitations on implied warranties, or limitations of liability for consequential or incidental damages, these limitations may not apply to you.

5. REVISIONS AND ERRATA
The materials appearing on Affiliated Family Counselors’s web site could include technical, typographical, or photographic errors. Affiliated Family Counselors does not warrant that any of the materials on its web site are accurate, complete, or current. Affiliated Family Counselors may make changes to the materials contained on its web site at any time without notice. Affiliated Family Counselors does not, however, make any commitment to update the materials.

6. LINKS
Affiliated Family Counselors has not reviewed all of the sites linked to its Internet web site and is not responsible for the contents of any such linked site. The inclusion of any link does not imply endorsement by Affiliated Family Counselors of the site. Use of any such linked web site is at the user’s own risk.

7. SITE TERMS OF USE MODIFICATIONS
Affiliated Family Counselors may revise these terms of use for its web site at any time without notice. By using this web site you are agreeing to be bound by the then current version of these Terms and Conditions of Use.

8. GOVERNING LAW
Any claim relating to Affiliated Family Counselors’s web site shall be governed by the laws of the State of Kansas without regard to its conflict of law provisions.

General Terms and Conditions applicable to Use of this Web Site

PRIVACY POLICY
Your privacy is very important to us. Accordingly, we have developed this Policy in order for you to understand how we collect, use, communicate and disclose and make use of personal information. The following outlines our privacy policy.

Before or at the time of collecting personal information, we will identify the purposes for which information is being collected.

We will collect and use of personal information solely with the objective of fulfilling those purposes specified by us and for other compatible purposes, unless we obtain the consent of the individual concerned or as required by law.

We will only retain personal information as long as necessary for the fulfillment of those purposes.

We will collect personal information by lawful and fair means and, where appropriate, with the knowledge or consent of the individual concerned.

Personal data should be relevant to the purposes for which it is to be used, and, to the extent necessary for those purposes, should be accurate, complete, and up-to-date.

We will protect personal information by reasonable security safeguards against loss or theft, as well as unauthorized access, disclosure, copying, use or modification.

We will make readily available to customers information about our policies and practices relating to the management of personal information.

We are committed to conducting our business in accordance with these principles in order to ensure that the confidentiality of personal information is protected and maintained.

Make a Payment

Terms and Conditions:
The therapists and staff at Affiliated Family Counselors are committed to providing the best possible care. It is important to our professional relationship that you understand our fee and payment policies. Please review the following information carefully and sign as indicated. If you have any questions about our fees, our policies or your responsibilities, please let us know. All patients must complete the Patient Information Form prior to seeing our counselors. You are responsible for notifying our office of any patient information changes (i.e. address, name change, insurance change, etc.) Any charges incurred due to the failure to report changes of information are the full responsibility of the patient or responsible party. There is an Appointment Hold Fee of $50.00 to $100.00 depending on the type of appointment scheduled. This fee is used to hold the appointment and will be put toward the co-pay or deductible if you show up for the appointment. If you fail to show up for the first appointment or do not call 24 hours in advance to cancel, the Appointment Hold Fee will be kept by the agency. FMLA/Social Security paperwork is $35.00. Records is $25.00 plus 0.56 per page for retrieval and copies. Affiliated Family Counselors will file patient insurance claims upon receipt of complete insurance information including a photocopy of the insured’s card. We will bill secondary insurance, but if they do not pay then you will be responsible. We can bill a third insurance party if the correct information is provided. AFC will not become involved in disputes between patients and their insurance providers, however we will supply factual information as necessary. You are responsible for the timely payment of your account. This includes, but is not limited to: deductibles, co-payments, non-covered charges, and “usual and customary” charges. You will be notified by your insurance company of all payments made to AFC on your behalf and any non-covered charges or remaining balance on your claim. Please call our billing office to make payment arrangements upon receipt of a patient account statement indicating an unpaid account balance. AFC will do our best to assist in obtaining reimbursement for flexible spending accounts, however AFC will not become involved in account disputes. At your request, you will receive a receipt for services. In addition, AFC will provide you with a copy of applied account payments, once monthly, per patient request. Any additional reporting will be subject to administrative fees. If a referral is required for your insurance, it is your responsibility to obtain the referral prior to any appointments. Failure to obtain a referral may result in reduction of benefits and any non-covered charges will become the responsibility of the patient. Copayments and/or coinsurance are due in full PRIOR to being seen by a therapist.

I understand if I have an unpaid balance to Affiliated Family Counselors (AFC) and do not make satisfactory payment arrangements, my account may be placed with an external collection agency. I will be responsible for reimbursement of any fees from the collection agency, including all costs and expenses incurred collecting my account, and possibly including reasonable attorney’s fees if so incurred during collection efforts.

In order for, Affiliated Family Counselors or their designated external collection agency to service my account, and where not prohibited by applicable law, I agree that AFC and the designated external collection agency are authorized to (i) contact me by telephone at the telephone number(s) I am providing, including wireless telephone numbers, which could result in charges to me, (ii) contact me by sending text messages (message and data rates may apply) or emails, using any email address I provide and (iii) methods of contact may include using pre-recorded/artificial voice message and/or use of an automatic dialing device, as applicable.

Payment in full is due at the time of service unless prior arrangements have been made through the business office. We accept cash, checks, Visa & MasterCard. Any overdue balances may be considered for further collection action.

The charge for a returned check is $35.00, payable by cash or money order. This will be applied to your account in addition to the insufficient fund amount. You may be placed on a “Cash Only” basis following any returned check.

If the patient is a minor, the parent/guardian is responsible for full payment and will receive all billing statements.

Clients under the age of 18, who are not emancipated, and their parents, should be aware that the law may allow parents to examine their child’s treatment records. Because privacy is often crucial to successful progress, particularly with teenagers, we may request that the parents give up access to their child’s records. If they agree, we will provide the parents with a summary of the child’s treatment when it is completed unless the child is in danger or is a danger to someone else. In this case, we will notify the parents of the situation immediately.

A signed release to treat may be required for unaccompanied minors.

If you become involved in legal proceedings that require a therapist’s participation, you will be expected to pay for all professional time, including preparation and transportation costs, even if the therapist is called to testify by another party. Due to the difficulty of legal involvement, AFC therapists have a separate rate for preparation for and attendance at any legal proceeding.

In the event you would like AFC to share your patient record with another provider or physician, a Release of Records Consent must be completed. No patient information will be shared without a signed release on file.

You must read and accept our Service Payment Policy. By clicking on the “Accept” button you will continue to our secure payment portal.

SELF-PAY & PRIVATE HEALTH INSURANCE

Schedule an Appointment

Terms and Conditions:
Appointment Cancellation Policy: There may be an Appointment Hold Fee of $50.00 to $100.00 depending on the type of appointment scheduled. This fee is used to hold the appointment and will be put toward the co-pay or deductible if you show up for the appointment. If you fail to show up –no-show– for the first appointment or do not call 24 hours in advance to cancel, the Appointment Hold Fee will be kept by the agency. A “no-show” is someone who misses an appointment without canceling it within a 24 hour working day in advance. No-shows inconvenience those individuals who need access to medical care in a timely manner. If it is necessary to cancel your scheduled appointment, we require that you call one working day in advance. Appointments are in high demand, and your early cancellation will give another person the possibility to have access to timely care. To cancel an appointment, please call our office at (316) 636-2888. Again, if an appointment is not cancelled at least 24 hours in advance, you will be charged the Appointment Hold Fee; this will not be covered by your insurance company (see Appointment Cancellation Policy Terms & Conditions). Appointment Cancellation Policy Terms & Conditions: These Terms and Conditions, as may be amended from time to time, apply to all our services directly or indirectly made available online, through any mobile device, by email, or by telephone. By accessing, browsing, and using our (mobile) website or any of our applications through whatever platform (hereafter collectively referred to as the “Platform”) and/or by completing an appointment reservation, you acknowledge and agree to have read, understood, and agreed to the Terms and Conditions set out below. These pages, the content, and infrastructure of these pages and the online appointment reservation service (including the facilitation of payment service) provided by us on these pages and through the website are owned, operated, and provided by Affiliated Family Counselors and are provided for your personal, non-commercial (B2C) use only, subject to the Terms and Conditions set out below. By making an appointment reservation with Affiliated Family Counselors, you accept and agree to the relevant cancellation and no-show policy as outlined herein. All appointments require an Appointment Hold Fee or Deposit (hereafter called “Deposit.”). All appointments have a 24-hour cancellation period. In order to receive a refund of your Deposit, all appointments must be cancelled 24 hours prior to your appointment. No-show or cancellations without 24-hour notice will be charged the Deposit. No exceptions.

By clicking on the “Accept” button YOU ACKNOWLEDGE AND AGREE TO HAVE READ AND ACCEPTED OUR CANCELLATION POLICY AND UNDERSTAND YOU MAY BE CHARGED FOR ANY MISSED APPOINTMENTS OR CANCELLATIONS WITHOUT 24-HOUR NOTICE.

You will be redirected to our secure patient information portal.

MEDICAID PATIENTS

Schedule an Appointment

Terms and Conditions:
Appointment Cancellation Policy: A “no-show” is someone who misses an appointment without canceling it within a 24 hour working day in advance. No-shows inconvenience those individuals who need access to medical care in a timely manner. If it is necessary to cancel your scheduled appointment, we require that you call one working day in advance. Appointments are in high demand, and your early cancellation will give another person the possibility to have access to timely care. To cancel an appointment, please call our office at (316) 636-2888. Appointment Cancellation Policy Terms & Conditions: These Terms and Conditions, as may be amended from time to time, apply to all our services directly or indirectly made available online, through any mobile device, by email, or by telephone. By accessing, browsing, and using our (mobile) website or any of our applications through whatever platform (hereafter collectively referred to as the “Platform”) and/or by completing an appointment reservation, you acknowledge and agree to have read, understood, and agreed to the Terms and Conditions set out below. These pages, the content, and infrastructure of these pages and the online appointment reservation service (including the facilitation of payment service) provided by us on these pages and through the website are owned, operated, and provided by Affiliated Family Counselors and are provided for your personal, non-commercial (B2C) use only, subject to the Terms and Conditions set out below. By making an appointment reservation with Affiliated Family Counselors, you accept and agree to the relevant cancellation and no-show policy as outlined herein. All appointments have a 24-hour cancellation period. By clicking on the “I Accept” button YOU ACKNOWLEDGE AND AGREE TO HAVE READ AND ACCEPTED OUR CANCELLATION POLICY.

By clicking on the “Accept” button YOU ACKNOWLEDGE AND AGREE TO HAVE READ AND ACCEPTED OUR CANCELLATION POLICY AND UNDERSTAND YOU MAY BE CHARGED FOR ANY MISSED APPOINTMENTS OR CANCELLATIONS WITHOUT 24-HOUR NOTICE.

You will be redirected to our secure patient information portal.