Oregon EMDR Contact Form

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PLEASE NOTE THAT I'M NOT TAKING CLIENTS AT THIS TIME.

Thank you for your interest.

*Oregon EMDR is an in-network provider for Providence Health Plans and Pacificsource Commercial plans but NOT Pacificsource Community Solutions, the OHP product.

*Oregon EMDR does NOT offer billing for any other insurance plan in or out-of-network.

*All clients are ultimately responsible for the cost of services with Oregon EMDR and payment can be made via HSA card, zelle, cash, check, credit card or PayPal.

*Please note that many isurance plans offer an out-of-network benefit and you may be eligible for partial or full reimbursement of out-of-pocket healthcare expenses paid to Oregon EMDR. Please contact your insurer to find out about your out-of-network benefit and information about submiting a "super bill" for reimbursement of expenses.

Email *

Name *

Phone number *

I am *

Interested in Mental Heath Therapy

I am a mental health professional interested in training or consultation

Oregon EMDR Standard rates with insurance billing (Providence Health Plans and Pacificsource Commercial Plans only):

$200 per 53-55 minute session (90791, 90837, 90847)

$165 per 38-52 minute session (90834)

Oregon EMDR Standard rates without insurance billing

$165 per 45-55 minute session (90791, 90837, 90834)

Prepaid Reduced Rate without insurance billing:

Clients may prepay $1800 for 12 individual therapy sessions.

Prepay rate breaks down as follows:

$150 per 45-55 minute session (90791, 90837, 90834)

Pro Bono services are available to 1 client at a time through the Returning Veterans Project.

Oregon EMDR Professional Consultation rate: $150 per 55 minute meeting.

Oregon EMDR hours of operation: M - F 9am - 4pm. Weekly 53-55 minute sessions are available ONLY M-W.

** Please note that Oregon EMDR does not offer evening or weekend appointments.

I have read and understand Oregon EMDR's service rates and hours of operation.

Please choose the statement that best describs you.

I am covered by a Pacificsource Commercial plan and will add my date of birth and insurance ID number below.

I am covered by Providence Health Plans and will add my date of birth and insurance ID number below.

I will be paying out of pocket for 53-55 minute Weekly Therapy sessions

(n/a) I am a mental health professional seeking consultation or training

Date of birth

YYYY

Providence Health Plan or Pacificsource Commercial Plan ID number

The Federal Centers for Medicare and Medicaid, as well as, the States of Oregon and Illinois, require Oregon EMDR to comply with fairness in billing legislation which includes providing a "Good Faith Estimate" to clients seeking mental health care prior to starting treatment. Please clarify your billing preference below. *

I will pay out of pocket at the time of sessions

I will pay in advance at the prepay discounted rate

I am a mental health professional interested in training or consultation

I am covered by Providence Health Plans or Pacificsource Commercial Plan.

Please briefly describe what you're seeking and share any other information you feel is important. I'll get back to you soon. *

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