Dr. Mary Ann Thirakul accepts most major insurance plans. Please be sure to bring your insurance card to the intake appointment. The patient is responsible to pay a co-pay/deductible (if it is determined there is a co-pay/deductible) and that it is payable each time he/she comes for evaluation/treatment services.
The self-pay amount that is payable each time he/she comes for evaluation/treatment services when he/she does not have insurance/managed care is:
Therapy/Counseling- Self-Pay – $165 per session
Psychological Testing – Self-Pay – depends on the type and hours for testing (Estimated cost from $450-1500), may be more if it takes longer to complete
Appointment Policy:
Each patient is responsible for keeping appointments with Dr. Mary Ann Thirakul. The appointment times are times reserved for each patient. If it becomes necessary to break an appointment, it is expected that a patient contact this office 24 hours in advance of a scheduled appointment. If a patient misses his or her scheduled appointment or fails to provide 24 hours advance notice, there will be a charge of $50.00. This charge will not and cannot be billed to the insurance company. The patient is personally responsible for this charge and will be responsible for all collection costs. If a patient shows up late to an appointment, then the appointment may be subject to a cancellation.
Medical Records:
Medical records can be obtained by signing a Release of Information Form. Any records that are from current/active patients may be faxed/email for free to the patients or other parties will a signed Release of Information Form. Any records that are requested from patients to be copies, may be copies for up to 10 pages. If the records exceed 10 pages, then a fee of .25 per page will be charged not to exceed $50. In addition, a fee of $30 for patient records which need to be retrieved from storage will be charged.
HIPPA laws are considered and abided by regarding the release of records. AZ Psychologist Board of Examiners Rules R4-26-106.C.: “A psychologist may deny a request to provide access to or a copy of a client’s or patient’s record if the psychologist determines: 1. Access by the clients or patient is reasonably likely to endanger the life or physical safety of the client or patient; 2. The record makes reference to a person other than a health professional and access by the client or patient or the client's or patient’s health care decision maker is reasonably likely to cause substantial harm to that other person; 3. Access by the client’s or patient’s health care decision maker is reasonably likely to cause substantial harm to the client or patient or another person; 4. Access by the client or patient or the client’s or patient's health care decision maker will reveal information obtained under a promise of confidentiality with someone other than a health professional and access is reasonably likely to reveal the source of the information; or 5. Access by the client or patient or the client's or patient’s health care decision maker may result in misuse or misrepresentation of the information and potentially harm the client or patient.”
COURT/LEGAL RELATED MATTERS
Please note that Dr. Mary Ann B. Thirakul does NOT appear in court. She does not get involved in any custody disputes and will not testify or prepare any documents related to custody or other legal matters for parents. Dr. Mary Ann B. Thirakul does not provide child custody psychological or family evaluations for the purpose of litigation, does not accept court referrals, does not supervise visitations, does not serve as a court advisor, nor provide child advocate services.
Copies of evaluations or progress notes will NOT be released without a judge’s order if it is determined that it is appropriate to deny a request based on the rules above (AZ R4-26-106.C), and/or HIPPA laws. However, Dr. Mary Ann B. Thirakul may provide a written report and/or case summary with the appropriate signed consents if so ordered by the court. A report fee will be filed at the rate of $250.00 per hour. The attorney issuing the subpoena will be responsible for payment of service in advance and any monies not used will be returned within 15 business days after the final judgment in the case.
If Dr. Mary Ann B. Thirakul is subpoenaed and court-ordered to appear in court, the attorney issuing the subpoena will contact the office at least 4 weeks in advance of the court date. Any legal fees and/or court fees are NOT billed under the medical insurance and will be charged $250.00 per hour (e.g., consultation with attorneys/court, written documents/reports to court, telephonic appearances with court, court testimony, etc.).