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For Clients
For Clinicians
- We Are Hiring
- CEU Training
Schedule Online Now
Contact

Home
About
Our Team
Counseling Resources
For Clients
For Clinicians
- We Are Hiring
- CEU Training
Schedule Online Now
Contact

×

Home
About
Our Team
Counseling Resources
For Clients
For Clinicians
- We Are Hiring
- CEU Training
Schedule Online Now
Contact

Call or Text

(480) 781-2631

Investment and Fees for Our Services

It is important to consider how you plan to pay for counseling services. We accept most insurance plans, including select Medicaid/AHCCCS and Medicare plans. We also offer affordable self pay rates. We do accept some Employee Assistance Program plans (EAP). Our goal is to provide quality, affordable, accessible counseling for everyone who wants it. If you believe you qualify for discounted services, please see the sliding scale form below and submit for review. If you are using insurance, it is your responsibility to know your benefits including your deductible amount. Please refer to the Insurance Verification form below to use as a guide prior to calling your insurance to determine how much your counseling sessions will cost. We are happy to provide a Good Faith Estimate to assist in planning your services.

Self Pay Counseling

We understand that navigating insurance can be complex, and sometimes clients prefer the flexibility and privacy of self-pay options. Our self-pay counseling services are designed to offer accessible, high-quality care without the constraints of insurance networks. Link to Sliding Scale Form.

Why Choose Self-Pay?

Confidentiality: No third-party reporting—your sessions remain private.

Flexibility: Choose the frequency and duration of sessions that best suit your needs.

No Diagnosis Required: Focus on growth and healing without a formal diagnosis.

Immediate Access: No waiting for insurance approvals or referrals.

Sliding Scale Fee Application Form

"*" indicates required fields

Personal Information

Full Name*

Date of Birth

Day

Month

Year

Phone Number*

Email Address*

Occupation

Number of dependents (children or adults you support)

Financial Information

1. What is your total monthly household income (before taxes)?

Less than $1,500

$1,500 – $2,499

$2,500 – $3,499

$3,500 – $4,499

$4,500 – $5,999

$6,000 and above

2. What sources of income apply to your household? (Check all that apply)

Employment

Social Security

Disability benefits

Unemployment benefits

Child support/alimony

Other

Other Sources of Income

3. Do you have any significant monthly expenses? (e.g., rent, loans, childcare) Please list them and estimated monthly amounts:

Rent/Mortgage: $

Please enter a number greater than or equal to 0.

Utilities: $

Please enter a number greater than or equal to 0.

Loan payments: $

Please enter a number greater than or equal to 0.

Childcare/Education: $

Please enter a number greater than or equal to 0.

Other: $

Please enter a number greater than or equal to 0.

4. Do you currently have health insurance that covers mental health services?

Yes

No

Unsure

Additional Considerations

5. Have there been recent changes in your financial situation?

Yes

No

If yes, please explain briefly:

6. Is there anything else you’d like us to consider when reviewing your request for a reduced fee?

This information helps us offer equitable access to care. All data is kept confidential and is used solely for determining sliding scale eligibility.

Name

This field is for validation purposes and should be left unchanged.

Sliding Scale Fee Application Form

Insurance Pay Counseling

We accept a wide range of insurance plans to make mental health care more accessible and affordable. Our team is committed to helping you navigate your benefits so you can focus on what matters most—your well-being.

🧾 What We Accept

Most major insurance providers

Select Medicaid/AHCCCS and Medicare plans

Employee Assistance Programs (EAP), where applicable

If you're unsure about your coverage, we recommend using our Insurance Verification Form to guide your conversation with your provider. We're also happy to provide a Good Faith Estimate to help you plan your care.

Insurance Verification Form

"*" indicates required fields

Insurance Disclaimer: A quote of benefits and/or authorization does not guarantee payment or eligibility. Understanding your insurance plan and what services are covered is your responsibility and can be complicated. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member's contract at time of service. If you plan to use your health insurance to help cover a portion of the cost of counseling, please call the phone number on the back of your card to discover how much counseling sessions at Ahwatukee Psychology will cost you. Please complete this form as soon as possible before your first appointment. Use this worksheet as a guide to get a better understanding of your plan's benefits so there are no surprises regarding your portion of the financial responsibility.

Name*

Email*

Phone*

Do I have mental health/behavioral health benefits?

Yes

No

Please call your insurance company and ask the following questions:*

Is the mental health/behavioral health benefit different than my primary health insurance?

For mental health, is Ahwatukee Psychology (NPI 1326608290) listed as an in-network provider?

Do I have a copay plan or a deductible plan for mental health benefits?

If copay, how much is my copay per session for CPT code 90837 (counseling session)?

If deductible, how much is my deductible and amount met? (the amount you pay out of pocket before benefit)

I understand and agree that I have voluntarily elected to use my insurance for therapy sessions and that it is my responsibility to know my insurance benefits. I understand that I will be responsible for any and all deductible amounts, coinsurance amounts and/or copayments based on the insurance Explanation of Benefits (EOB) reported to Ahwatukee Psychology and that the amount will be collected from the payment card on file automatically upon insurance processing.

I consent to sharing information provided here.

I consent to sharing information provided here.

Email

This field is for validation purposes and should be left unchanged.

Insurance Verification Form

Insurances Partners

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11011 S. 48th St., Suite 106
Phoenix, AZ 85044

(480) 781-2631

scheduling@ahwatukeepsychology.comEmail Us

7 days a week 7:00 AM - 9:00 PM

Ahwatukee Psychology NPI: 1326608290
AZDHS License: CSLG-11488

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