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Finance Information and Forms

The Human Service Center provides citizens of Oneida, Forest and Vilas counties with mental health, chemical dependency and developmental disability services regardless of the patients’ ability to pay.  This page provides an overview of the most commonly asked questions, but if you have any questions please contact our Billing Department at (715) 369-2215 x3945.

Who is Responsible for the Cost of Services?

The client is responsible for the cost of services rendered by The Human Service Center. The “client” can include the client, the client's spouse, or the client's parents.

Ability to Pay Considerations

Clients unable to pay the full cost of services or an amount not covered by insurance can apply for a suspended or reduced payments by completing a Financial Information form.  The application form is available upon request at our front desk or from the WI Department of Health Services.  You can also complete a digital version of the application                           .  Upon receipt of a competed form, our Billing Department will calculate the monthly liability amount based on your family size and income per the current Wisconsin Department of Health Maximum Monthly Payment Schedule. Some families, because of their financial status, may be found to have no liability and will not receive a billing statement at all. Others will be billed up to the monthly liability amount determined by the Wisconsin Department of Health Services based on income and family size.

Clients enrolled in Medicaid are automatically deemed to have no Ability to Pay.  Verification of earned and unearned income are required for all other applications and require submission of proof of income.  This most common types of income and the required documentation are listed below:


INCOME TYPE                                                                                             DOCUMENTATION REQUIRED

Employed, Paid by the hour or salaried                                                  2 months of pay stubs. If receive overtime, tips or

                                                                                                                     commissions, also include the prior year’s W-2

Self-employed                                                                                             2 most recent tax returns

                                                                                                                     (Form 1040/1065/1120 with all schedules)

Disability                                                                                                     Award letter OR the portion of 2 most recent

Pension                                                                                                        bank statement showing direct deposit of

Social Security                                                                                             payments.


VA pension, disability, or other benefits


Approval for reduced or suspended payments does not impact or reduce the outstanding balance on an account.  For example, a client deemed to have no Ability to Pay receives services totaling $1,000 on 1/1/2015.  The client annually submits an updated Financial Information form and is found to have no Ability to Pay through 12/31/2020.  On 1/1/2021 the client started a new job with a significantly higher income and is deemed to have an ability to pay.  Payments received by the client are applied against the Outstanding balance of $1,000 until the balance is paid in full or until the debt is forgiven, generally 10 years following the date of service. 


Failure to submit a complete financial application update when due will terminate existing Ability to Pay agreements and cause the entire balance to become due.

Collection Policy

It is the policy of The Human Service Center to appropriately pursue the collection of all monies due to the facility from third party sources, the client, or other responsible parties. Accounts that are 180 days past due will be referred to the Wisconsin Department of Revenue State Debt Collection program and may be subject to wage garnishment, bank account levy and tax refund intercept.  Collection procedures comply with the Department of Health & Social Services Uniform Fee System and State and Federal collection laws.



Your insurance plays an important part in paying for the costs of services. We will make every attempt to collect from your insurance company. The Human Service Center does receive reimbursement from some insurance companies.


*Please be aware that some insurance companies limit their coverage to services provided by certain professionals. Others may not pay for outpatient services, and some pay only a portion of the cost and have a deductible, a maximum payment, or a percentage payment feature. Check your insurance policy or discuss your coverage with your place of employment or insurance agent.



The Human Service Center is approved for Medicare reimbursement subject to all Medicare regulations such as co-insurance, deductible, and maximum benefits.


Medical Assistance

Medical Assistance covers most outpatient services. Clients will be required to pay their co-payment at the time of their appointment.


Missed Appointments & Cancellations

Clients are expected to adhere to treatment recommendations including attending recommended outpatient appointments. A missed appointment or late cancellation is defined as missing an appointment without canceling at least 24 hours or one (1) business day before the scheduled appointment time.


Clients who do not keep their appointments may be subject to penalties including no show/late cancellation charges, suspension and/or discontinuation of services.


Fee Calculation

The Human Service Center provides various types of assessments, evaluations, therapy and counseling, both individual and group. The fees for these services vary with the type of service and with the amount of service provided.


In calculating fees, please note that the therapist includes some preparation and recording time for each individual or group counseling session. In assessments and evaluations, we include time spent by the professional staff reading and understanding previous evaluations, scoring tests which have been administered, and report preparation.




If you have questions about your bill or feel you cannot pay the full amount of your bill, please call The Human Service Center at 715-369-2215 x3945.

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