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Honeybee Helps Financial Form
Honeybee strongly believes that all children should have access to the therapy they need without adding financial stress on the family. If you need assistance meeting the financial aspect of services at Honeybee, please fill out this form to learn about the options available to you.
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* Indicates required question
Child's Name
*
Your answer
Parent/Guardian's Name
*
Your answer
Phone # if we have questions
*
Your answer
Are you having difficulty paying for your child's therapy?
*
Yes
No
Other:
What are you having difficulty paying?
*
Deductible
Co-payments
Co-insurance
Treatment Fee; No Insurance
Treatment Fee; Benefits have maxed out for the year
Treatment Fee; Therapy is not a covered service
Other:
Required
There are some foundations, grants and scholarships available to help families that are uninsured, under insured, maxed out benefits, high copays/deductibles. Are you willing to apply to alternate funding sources to meet your financial obligation?
*
Yes
No
Unsure
Other:
How much could you reasonably pay for each treatment session? (If your child receives multiple sessions, please feel free to indicate a weekly or monthly amount if that is easier)
*
Your answer
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