PRACTICE POLICIES

*DISCLAIMER*

These policies are made publicly available in order to support an individual's ability to make an informed decision about working with me as a clinician. Though they are available to all to review, they are not to be considered as having established a client-therapist relationship unless and until they have been sent to you, by me, through your client portal, and signed by you.

PART I: THERAPEUTIC PROCESS

 

BENEFITS/OUTCOMES: The therapeutic process seeks to meet goals established by all persons involved, usually revolving around a specific complaint(s).  Participating in therapy may include benefits such as the resolution of presenting problems as well as improved intrapersonal and interpersonal relationships.  The therapeutic process may reduce distress, enhance stress management, and increase one’s ability to cope with problems related to work, family, personal, relational, etc.  Participating in therapy can lead to greater understanding of personal and relational goals and values.  This can increase relational harmony and lead to greater happiness.  Progress will be assessed on a regular basis and feedback from clients will be elicited to ensure the most effective therapeutic services are provided.  There can be no guarantees made regarding the ultimate outcome of therapy.

EXPECTATIONS: In order for clients to reach their therapeutic goals, it is essential they complete tasks assigned between sessions.  Therapy is not a quick fix.  It takes time and effort, and therefore, may move slower than your expectations.  During the therapy process, we identify goals, review progress, and modify the treatment plan as needed.

RISKS: In working to achieve therapeutic benefits, clients must take action to achieve desired results.  Although change is inevitable, it can be uncomfortable at times.  Resolving unpleasant events and making changes in relationship patterns may arouse unexpected emotional reactions.  Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. Seeking to resolve problems can similarly lead to discomfort as well as relational changes that may not be originally intended.  We will work collaboratively toward a desirable outcome; however, it is possible that the goals of therapy may not be reached. While I cannot promise that your behavior or circumstance will change, I can promise to support you and do my very best to understand you and your repeating patterns, as well as to help you clarify what it is that you want for yourself.

STRUCTURE OF THERAPY:

  • Intake Phase – During the first session, therapeutic process, structure, policies and procedures will be discussed.  We will also explore your experiences surrounding the presenting problem(s).

  • Assessment Phase – The initial evaluation may last 2-4 sessions.  During this assessment phase, I will be getting to know you.  I will ask questions to gain an understanding of your worldview, strengths, concerns, needs, relationship dynamics, etc.  During this relationship building process, I will be gathering a lot of information to aid in the therapeutic approach best suited for your needs and goals.  If it is determined that I am not the best fit for your therapeutic needs, I will provide referrals for more appropriate treatment.

  • Goal Development/Treatment Planning – After gathering background information, we will collaboratively identify your therapeutic goals.  As you make progress toward your goals, we will revisit your treatment plan and clarify next steps for your therapeutic process. Your treatment plan is what guides our time together and the work you are doing in and out of session, so it is important that it be relevant and measurable.

  • Intervention Phase – This phase occurs anywhere from session two until graduation/discharge/termination.  Each client must actively participate in therapy sessions, utilize solutions discussed, and complete assignments between sessions.  Progress will be reviewed and goals adjusted as needed.

  • Graduation/Discharge/Termination – As you progress and get closer to completing goals, we will collaboratively discuss a transition plan for graduation/discharge/termination.

LENGTH OF THERAPY: Therapy sessions are typically weekly or biweekly for 55 minutes depending upon the nature of the presenting challenges and insurance authorizations.  It is difficult to initially predict how many sessions will be needed.  We will collaboratively discuss from session to session what the next steps are and how often therapy sessions will occur.  You have the right to ask for a Good Faith Estimate in accordance with the No Surprises Act should you want one.

APPOINTMENTS AND CANCELLATIONS: You are responsible for attending each appointment and if you must cancel or reschedule your session,48-hour advanced notice is required, otherwise you will be held financially responsible.  Should you cancel or miss an appointment with notification less than 48 hours, this may result in being charged the full fee of $165 for your missed appointment as this time had been reserved specifically for you.  If this occurs more than once, we may re-evaluate your needs, desires, and motivations for treatment at this time. For legal and ethical reasons, I reserve the right to terminate the counseling relationship if more than 3 sessions are missed without proper notification.

Phone/video sessions should be treated as regular in office sessions.  If you are 10 minutes late connecting for your appointment, are unable to talk at our scheduled time, your battery has died and you are unable to access another confidential place to talk, or any other variable that would have you not be able to attend our session you may be charged for the session as a late cancelation.  Please make the necessary arrangements you need to be available and present for your session.

Psychotherapy is a uniquely personal service; therefore, treatment may be briefly interrupted due to the demands of either of our schedules. I may periodically take time off for vacation, seminars, and/or become ill.  Attempts will be made to give adequate notice of these events.  If I am unable to contact you directly, a colleague may contact you to cancel or reschedule an appointment.

It is not uncommon for availability to change over time and when possible, adjustments to appointment times and/or frequency will be offered. Please be aware that a reduction in session frequency (ie: weekly to biweekly, biweekly to monthly) may involve a change in how your future appointments are scheduled and/or the times that are available.

FEES: The fee for each 55- minute therapy session is $165 if you are paying privately or using your Out-of-Network Insurance benefits. If you are using your In-Network Insurance benefits, you will be directed to Headway (NC) or Uplift (NC, and VA) the billing agencies used for processing insurance claims. They will verify your coverage with you and confirm your expected session expenses related to your deductible and/or co-pay.  It is strongly advised that you to contact your insurance company directly to confirm their determination and ensure your understanding of your coverage and claims process as at the end of the day, you are financially responsible if your insurance company denies the claim. Payment is due at the time of service and is processed via credit/debit card. In the event that a scheduled appointment time is missed or cancelled with less than 48 hours notice, please refer to the “Appointments and Cancellations” policy above.

I charge my hourly rate in quarter hours for phone calls over 10 minutes in length, email correspondence, reading assessments or evaluations, writing assessments or letters, and collaborating with necessary professionals (with your permission) for continuity of care. As these services are not generally covered by insurance (if you are using it) you will receive an invoice for services on the day they are provided and your credit card on file will be charged 24 hours after the invoice is sent. All costs for services outside of session will be billed on the date that services are provided.

TRIAL, COURT ORDERED APPEARANCES, LITIGATION: Rarely, but on occasion, a court will order a therapist to testify, be deposed, or appear in court for a matter relating to your treatment or case.  In order to protect your confidentiality, it is strongly suggested that I not being involved in the court.  I am called into court by you or your attorney, you will be charged a fee of $500 an hour to include travel time, court time, preparing documents, etc.

COPIES OF MEDICAL RECORDS: Should you request a copy of your medical records, the cost is $10 per page.  Payment for your medical records will be due prior to them being sent.  Please allow at least 4 weeks to prepare medical records.  A brief treatment summary can also be requested instead of requesting your complete record.

PHONE CONTACTS AND EMERGENCIES: My typical office hours are 8:00am-5:00pm on Monday, Tuesday, and Friday though availability is not guaranteed during that time. If you need to contact me please call 304-209-4608, leave a voicemail, and a return call will be made within 48 hours unless you are informed otherwise by an out-of-office reply. You can also send secure messages through your client portal with the same response time. Please be advised that I don’t provide crisis intervention services. In the case of an emergency, you can access immediate assistance by calling the National Suicide Prevention Lifeline at 1-800-273-8255 or text the Crisis Line at 741741. If either you or someone else is in danger of being harmed, dial 911.

PART II: TECHNOLOGY ASSISTED COUNSELING

Technology Assisted Counseling (TAC) incorporates email, phone and video counseling.  Prior to engaging in TAC an assessment/consultation will be done to assure that TAC is an appropriate form of counseling for your therapeutic needs. This is to inform you about what you can expect regarding your participation in TAC counseling. It is also important to note that if you are using your insurance for therapy, some policies cover TAC session differently than in-person services.

Benefits:

The benefits to TAC are:

  1. The ability to expand your choice of service provider.

  2. More convenient counseling options including location, time, no driving, etc.

  3. Reduces the overall cost and time of therapy due to not having to drive to and from and office.

  4. Ability to have real time monitoring and reduces the wait time for scheduling office appointments.

  5. Increased availability of services to homebound clients. clients with limited mobility, and clients without convenient transportation options.

Limitations:

It is important to note that there are limitations to TAC that can affect the quality of the session(s). These limitations include but are not limited to the following:

  1. I cannot see you, your body language, or your non-verbal reactions to what we are discussing in the same way I would be able to if we were in the same physical space.

  2. I may not hear all of what you are saying and may need to ask you to repeat things.

  3. Technology might fail before or during the TAC session.

  4. Although every effort is made to reduce confidentiality breaches, breaches may occur for various reasons.

  5. To reduce the effect of these limitations, I may ask you to describe how you are feeling, thinking, and/or acting in more detail than I would during a face-to-face session. You may also feel that you need to describe your feelings, thoughts, and/or actions in more detail than you would during a face-to-face session.

Logistics: When I provide phone/video-counseling sessions, I will call you at our scheduled time or send you a link for our secure and HIPAA compliant video session.  I expect that you are available at our scheduled time and are prepared, focused and engaged in the session.  I am calling/videoing you from a private location where I am the only person in the room and additional measures have been taken to assure audio confidentiality.  You also need to be in a private location where you can speak openly without being overheard or interrupted by others to protect your own confidentiality.  If you choose to be a in a place where others can hear you, I cannot be responsible for protecting your confidentiality.  Every effort MUST be made on your part to protect your own confidentiality and the use of headphones or a noise machine can help to this end.  Please know that I cannot guarantee the privacy or confidentiality of conversations held via phone, as phone conversations can be intercepted either accidentally or intentionally.  Please ensure you reduce all possibilities of interruptions for the duration of our scheduled appointment.

According to best practices and ethical guidelines I can only clinically practice in the states I am licensed in, even though we are meeting remotely.  That means that at the time of our appointment, you must be physically present in either NC, VA, DC, WV, MD, or PA. You agree to inform me if your therapy location has changed or if you have relocated your domicile to a different jurisdiction. If you are traveling temporarily outside of my jurisdiction and would like to keep your scheduled appointment, please give me at least two weeks notice so I can make an effort to reach the licensing Board in that state to seek permission to continue care.

Our primary TAC platform will be through your secure client portal, though I have multiple HIPAA compliant backup options should we need to switch service providers due to connection issues. I use DoxyMe, Sessions through Psychology Today, and Google Meet as alternatives and will provide you with the links to connect via them should the need arise.

Connection Loss:

During Phone Sessions: If we lose our phone connection during our session, I will call you back immediately.  Please also attempt to call me at 304-209-4608 if I cannot reach you after 3 minutes (as we want to avoid getting busy signals from each other in our attempts to connect). If we are unable to reach each other due to technological issues, I will attempt to call you two times.  If I cannot reach you, I will remain available to you during the entire course of our scheduled session.  Should you contact me back and there is time left in your session we will continue.  If the reason for a connection loss i.e. technology, your phone battery dying, bad reception, etc. occurs on your part, you will still be charged for the entire session.  If the loss of connection is a result of something on my end, I will call you from an alternate number.  The number may show up as restricted or blocked, please be sure to pick it up.

During Video Sessions: If we lose our connection during a video session, I will wait in our virtual meeting space for 3 minutes to allow you to return if you had a momentary disruption to your connection. After 3 minutes, I will attempt to call you two times in order to troubleshoot the reason we lost connection.  If I cannot reach you, I will remain available to you during the entire course of our scheduled session.  Should you contact me back and there is time left in your session we will continue.  If the reason for a connection loss i.e. technology, battery dying, bad reception, etc. occurs on your part, you will still be charged for the entire session.  If the loss for connection is a result of something on my end, we can either complete our session via. phone or plan an alternate time to complete the remaining minutes of our session.

As any troubleshooting we experience will occur by phone, it is advisable to conduct video sessions on a computer or other device in order to leave a phone line free to connect.

Recording of Sessions: Please note that recording, screenshots, etc of any kind of any session is not be permitted and are grounds for termination of the client-therapist relationship.

PART III: CONFIDENTIALITY

Anything said in therapy is confidential and may not be revealed to a third party without written authorization, except for the following limitations:

  • Child Abuse: Child abuse and/or neglect, which include but are not limited to domestic violence in the presence of a child, child on child sexual acting out/abuse, physical abuse, etc.  If you reveal information about child abuse or child neglect, I am required by law to report this to the appropriate authority.

  • Vulnerable Adult Abuse: Vulnerable adult abuse or neglect.  If information is revealed about vulnerable adult or elder abuse, I am required by law to report this to the appropriate authority.

  • Self-Harm: Threats, plans or attempts to harm oneself.  I am permitted to take steps to protect the client’s safety, which may include disclosure of confidential information.

  • Harm to Others: Threats regarding harm to another person.  If you threaten bodily harm or death to another person, I am required by law to report this to the appropriate authority.

  • Court Orders & Legal Issued Subpoenas: If I receive a subpoena for your records, I will contact you so you may take whatever steps you deem necessary to prevent the release of your confidential information.  I will contact you twice by phone.  If I cannot get in touch with you by phone, I will send you written correspondence.  If a court of law issues a legitimate court order, I am required by law to provide the information specifically described in the order.  Despite any attempts to contact you and keep your records confidential, I am required to comply with a court order.

  • Law Enforcement and Public Health: A public health authority that is authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability; to a health oversight agency for oversight activities authorized by law, including audits; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or action; limited information (such as name, address DOB, dates of treatment, etc.) to a law enforcement official for the purpose of identifying or locating a suspect, fugitive, material witness, or missing person; and information that your clinician believes in good faith establishes that a crime has been committed on the premises.

  • Governmental Oversight Activities: To an appropriate agency information directly relating to the receipt of health care, claim for public benefits related to mental health, or qualification for, or receipt of, public benefits or services when a your mental health is integral to the claim for benefits or services, or for specialized government functions such as fitness for military duties, eligibility for VA benefits, and national security and intelligence.

  • Upon Your Death: To a law enforcement official for the purpose of alerting of your death if the there is a suspicion that such death may have resulted from criminal conduct;  to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other duties as authorized by law.

  • Victim of a Crime: Limited information, in response to a law enforcement official's request for information about an you if you are suspected to be a victim of a crime; however, except in limited circumstances, we will attempt to get your permission to release information first.

  • Court Ordered Therapy: If therapy is court ordered, the court may request records or documentation of participation in services.  I will discuss the information and/or documentation with you in session prior to sending it to the court.

  • Written Request: Clients must sign a release of information form before any information may be sent to a third party.  A summary of visits may be given in lieu of actual “psychotherapy/process notes”, except if the third party is part of the medical team.  If therapy sessions involve more than one person, each person over the age of 18 MUST sign the release of information before information is released.

  • Fee Disputes: In the case of a credit card dispute, I reserve the right to provide the necessary documentation (i.e. your signature on the “Therapy Consent & Agreement” that covers the cancellation policy to your bank or credit card company should a dispute of a charge occur.  If there is a financial balance on account, a bill will be sent to the home address on the intake form unless otherwise noted.

  • Couples Counseling & “No Secret” Policy: When working with couples, all laws of confidentiality exist.  I request that neither partner attempt to triangulate me into keeping a “secret” that is detrimental to couple’s therapy goal.  If one partner requests that I keep a “secret” in confidence, I may choose to end the therapeutic relationship and give referrals for other therapists as our work and your goals then become counter-productive.  However, if one party requests a copy of couples or family therapy records in which they participated, an authorization from each participant (or their representatives and/or guardians) in the sessions before the records can be released.

  • Dual Relationships & Public: Our relationship is strictly professional.  In order to preserve this relationship, it is imperative that there is no relationship outside of the counseling relationship (ie: social, business, or friendship).  If we run into each other in a public setting, I will not acknowledge you as this would jeopardize confidentiality.  If you were to acknowledge me, your confidentiality could be at risk.

  • Social Media: No friend requests on our personal social media outlets (Facebook, LinkedIn, Pinterest, Instagram, Twitter, etc.) will be accepted from current or former clients.  If you choose to comment on our professional social media pages or posts, you do so at your own risk and may breach confidentiality.  I cannot be held liable if someone identifies you as a client.  Posts and information on social media are meant to be educational and should not replace therapy.  Please do not contact me through any social media site or platform.  They are not confidential, nor are they monitored, and may become part of medical record.

  • Electronic Communication: If you need to contact me outside of our sessions, please do so via phone or secure message through your client portal.

    • Clients often use text or email as a convenient way to communicate in their personal lives.  However, texting introduces unique challenges into the therapist–client relationship.  Texting is not a substitute for sessions.  Texting is not confidential.  Phones can be lost or stolen.  DO NOT communicate sensitive information over text.  The identity of the person texting is unknown as someone else may have possession of the client’s phone.

    • Do not use e-mail for emergencies.  In the case of an emergency call 911, your local emergency hotline or go to the nearest emergency room.  Additionally, e-mail is not a substitute for sessions.  If you need to be seen, please call to book an appointment or communicate through secure messaging in your client portal.  E-mail is not confidential.  Do not communicate sensitive medical or mental health information via email.  Furthermore, if you send email from a work computer, your employer has the legal right to read it.  E-mail is a part of your medical record.

  • Virtual Tele-Health Sessions: As sessions are conducted using a secure HIPAA compliant platform, there is minimal and mitigated risk of confidentiality being breached by a third party and not audio or video records of your session are retained. The clinician conducts sessions behind a closed door with a white noise machine on and uses headphones if there is anyone else on the premises to ensure privacy on their side. In order to aid you in protecting your confidentiality, you will always be asked to confirm that you have privacy, are in a secure location, and your identity will be confirmed visually at each session (more detailed initial verification at first appointment).

Occasionally I may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name or other identifying information.

PART IV: HEALTH INSURANCE

YOUR INSURANCE COMPANY: By using insurance, I am required to give a mental health disorder diagnosis that goes in your medical record.  The clinical diagnosis is based on your current symptoms even though you may have been previously diagnosed.  As it is relevant, your diagnosis will be discussed during session as it will be assessed throughout treatment to determine medical necessity.  Your insurance company will know the times and dates of services provided.  They may request further information to authorize additional services regarding treatment.

IMPORTANT: Some psychiatric diagnoses are not eligible for reimbursement (ie: marriage/couples therapy).  In the event of non-coverage or denial of payment, you will be responsible to pay for services provided.  I reserve the right to seek payment of unpaid balances by collection agency or legal recourse after reasonable notice to you, the client.

PRE-AUTHORIZATION & REDUCED CONFIDENTIALITY: When visits are authorized, usually only a few sessions are granted at a time.  When these sessions are complete, we may need to justify the need for continued service, potentially causing a delay in treatment.  If insurance is requesting information for continued services, confidentiality cannot be guaranteed.  Sometimes, additional sessions are not authorized, leading to an end of the therapeutic relationship even if therapeutic goals are not met.

POTENTIAL NEGATIVE IMPACTS OF A DIAGNOSIS: Insurance companies require clinicians to give a mental health diagnosis (i.e., “major depression” or “obsessive-compulsive disorder”) for reimbursement. 

Psychiatric diagnoses may negatively impact you in the following ways:

  1. Denial of insurance when applying for disability or life insurance;

  2. Company (mis)control of information when claims are processed;

  3. Loss of confidentiality due to the increased number of persons handling claims;

  4. Loss of employment and/or repercussions of a diagnosis in situations where you may be required to reveal a mental health disorder diagnosis on your record.  This includes but is not limited to: applying for a job, financial aid, and/or concealed weapons permits.

  5. A psychiatric diagnosis can be brought into a court case (ie: divorce court, family law, criminal, etc.).

It is important that you’re an informed consumer.  This allows you to take charge regarding your health and medical record.  At times, having a diagnosis can be helpful (ie: child needing extra services in the school system or a person being able to receive disability).

CHOOSING NOT TO USE INSURANCE: Effective January 1, 2022, a ruling went into effect called the “No Surprises Act,” which requires mental health practitioners to provide a “Good Faith Estimate” (GFE) about out-of-network care to any patient who is uninsured or who is insured but does not plan to use their insurance benefits to pay for health care items and/ or services. If this applies to you, you will get a GFE prior to starting treatment. While many people who choose not to use their insurance for therapy do so avoid a psychiatric diagnosis in their medical record, since a GFE requires a diagnosis for treatment, ICD-10 codes related to “Other Conditions That May Be a Focus of Clinical Attention” are how I have chosen to satisfy the GFE requirement as they are not psychiatric diagnoses.