The boring, but important stuff
Welcome to my practice. I am pleased to have the opportunity to serve you and hope that this information will be helpful in making an informed decision concerning my services. If you have any questions or concerns which you feel are not addressed here, please feel free to discuss them with me at any time.
FEES: My basic fee is $195.00 per 55-minute session. Sessions, which are longer or shorter, are prorated from this basic fee.
PAYMENT FOR SERVICE: Clients are expected to pay for services at the time they are provided unless other arrangements have been made. Payment may be made by electronically. Clients are responsible for payment of all fees, even if you plan to bill an insurance company for reimbursement.
CANCELLATIONS: A minimum of 24 hours notice is required for rescheduling or cancellation of any appointment. The full fee will be charged for missed sessions without such notification.
CONFIDENTIALITY: The confidentiality and privacy of our sessions are extremely important. To the degree allowed by law, information about your contact with me and/or my office will not be disclosed to any person or organization unless you give me a specific written release to do so. You are free to discuss anything that occurs in our sessions with anyone; however, I am required not to discuss such matters without your written authorization. Communication between my clients and me, or between me and those whom my clients authorize me to contact, is protected by confidentiality regulations in state laws and by my professional ethics and standards.
However, there are some situations written into law that deny me complete control over confidentiality of communication as follows:
I am legally required to report any situation of suspected child abuse or neglect to the proper authorities. I am also legally required to report suspected abuse, neglect, or exploitation of an elderly or disabled person.
In some circumstances, my records may be subject to a subpoena issued by the court. In particular, confidentiality may be waived with regard to any suit affecting the parent-child relationship.
If I believe a client may harm her/himself or another individual, I am permitted by law to break confidentiality by contacting law enforcement officials and/or medical authorities who may then take protective actions.
If I am contacted by an insurance company or an auditor, I may be required to release client information as dictated by law. The law also permits me to release the information to a collection agency in order to collect on an overdue account.
If a client discloses to me the identity of a mental health professional who engaged in sexual contact with him or her during the process of treatment, state law requires me to report that professional to the appropriate authorities. In this situation, I am not permitted to disclose the identity of the client if he or she does not wish to be identified.
This is not an exhaustive list, but these are the most common circumstances which may occur. The situations described above are out of the ordinary and have no impact on the large majority of individuals seeking professional mental health services. I share this information with you so that you can be fully informed and your questions and concerns can be addressed.
INSURANCE REIMBURSEMENT: Evaluating the resources you have available to pay for therapy is important in order for us to set realistic treatment and priorities. If you have health insurance, it may provide some coverage for mental health treatment. At your request, I will provide you with a written statement listing our meetings and the services provided. You may use this to seek reimbursement from your insurance company. It is very important that you find out exactly what mental health services your insurance policy covers. Please carefully read the section in your insurance company manual that describes mental health services. If you have questions about the coverage, call your plan administrator.
Often, mental health coverage requires authorization and pre-certification before providing reimbursement for services. Some plans require you to receive treatment from a therapist who is on their provider panels. Mental health services are often limited to short-term treatment approaches to work out specific problems. It may be necessary to seek approval for more therapy after a certain number of sessions. While a lot can be accomplished in short-term therapy, some clients feel that they need more services after insurance benefits end.
Most insurance companies require you to authorize me to provide them with a clinical diagnosis. Sometimes I have to provide additional information such as treatment plans or summaries. This information will become part of the insurance company files and most likely be stored in a computer. Insurance companies claim to keep this information confidential; however, I have no control over what they do with it once it is in their hands.
PARENTS: If I am seeing your child for therapy, most of the 55 minute session needs to be devoted to his/her treatment needs. Parents sometimes feel that they need extra time with me to discuss their concerns about their children. If you would like additional time to talk with me, please do not hesitate to request a family session to discuss your concerns. I will likely suggest such sessions periodically, as family work is often an essential part of a child’s therapy.
CONSENT FOR TREATMENT: I hereby grant my permission for any counseling or diagnostic evaluation that may be deemed necessary by my therapist. I understand that therapy is a joint effort between the therapist and client, the results of which cannot be guaranteed. Progress depends on many factors including motivation, effort, and other life circumstances. I agree that I will be responsible for payment of all professional fees. I know that I can end therapy at any time I wish and I can refuse any requests or suggestions made by my therapist. I have read, understand and agree to the office policies listed above.