(The Message Tenth Anniversary Readers Edition, pg. 2232)
If you're a new client, please complete the following forms and bring them to your first therapy session.
(Currently under revision.)
Usually billed as a 45-50 minute session.
"It is my professional opinion that it is best to not use insurance for mental health services (sometimes aka behavioral health services) because doing so requires me as the provider to provide a medical diagnosis from the DSM-V. These diagnosis' become a part of your health history and at this time of changing health care in America, we are uncertain as to how insurance premiums will be affected by any diagnosis in the future. Therefore, a reduced fee-for-service of $80 is available if insurance coverage will not be your preference and/or as a courtesy for all appointments scheduled during typical normal business hours of 9:00 AM - 5:00 PM. Please feel welcome to discuss these issues with me prior to beginning our work together."
Services may be covered in full or in part by your health insurance or employee benefit plan. If I am an in-network provider for your insurace plan, your financial responsibility might be a copay plus any uncovered deductibles as determined by your insurance company. If I am not an in-network provider on your insurance, I will give you an insurance form for you to submit to your insurance company for your own reimbursement. Please check your coverage carefully by asking the following questions:
Do I have out-patient mental health insurance benefits?
What is my deductible and has it been met?
How many sessions per year does my health insurance cover?
What is the coverage amount per therapy session for an out-of- network provider?
Is approval required from my primary care physician?
Cash, check and Visa and/or MasterCard credit cards may be accepted for payment. I prefer to collect the fee prior to beginning our session.
Your appointment is reserved especially for you. If you do not show up for your scheduled counseling / therapy appointment, and you have not notified me at least 24 hours in advance, you will be required to pay the full cost of the session prior to your next scheduled appointment.
The law protects the relationship between a client and a therapist, and information cannot be disclosed without written permission.
Suspected child abuse or dependent adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately.
If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.
If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.