We are pleased that you will be working with us.
Here is some important information for you. Please let us know if you have any questions about any content in this Informed Consent.
Important Fee Information
- We are out-of-network providers. Regardless of your insurance status, you are ultimately responsible for the balance on your account for any professional services rendered. (This is especially true because we can never be sure, until insurance reimbursements are received, exactly what the amount of any reimbursements will be.)
- If we are working with your insurance company, we may be required to fulfill their requirements of providing certain information to them to justify the necessity for reimbursement.
- Specific details about your fee information, including your copay, have been discussed and agreed upon with you and our billing department representative. If you have any questions, please don’t hesitate to contact us.
- Please be aware that there will be a full session charge for any sessions canceled 24 hours or less before the appointment time, or broken without notice (“no show”).
- Please notify us immediately if there are any changes in your health status, insurance or credit card information.
- Please notify us about any new or changed details that may be pertinent to your treatment.
- Telephone and video sessions can be scheduled seven days per week.
- We offer in-person sessions, but due to the ongoing pandemic, availability is determined at the discretion of the therapist and the Center for Coping administration. The procedure for in-person sessions will be explained to you by your professional, or by the Center for Coping staff, at the time of scheduling. It is necessary for everyone’s safety that all health and safety protocols be followed specifically, and that masks are worn at all times.
What you discuss during your sessions is kept strictly confidential. Under HIPAA regulations, no contents of treatment sessions, whether verbal or written, may be shared with another party without your written consent or the written consent of your legal guardian. The following is a list of exceptions:
- Duty to Warn and Protect- If you disclose a plan or threat to harm yourself, the therapist must attempt to notify your family and notify legal authorities. In addition, if you disclose a plan to threaten or harm another person, the therapist is required to warn the possible victim and notify legal authorities.
- Abuse of Children and Vulnerable Adults- If you disclose, or it is suspected, that there is abuse or harmful neglect of children or vulnerable adults (i.e. the elderly, disabled/incompetent), the therapist must report this information to the appropriate state agency and/or legal authorities.
- Insurance Providers- As mentioned above, insurance companies and other third-party payers may require information from your counselor in order to reimburse for treatment services. Among the types of information required may be: service provided, dates/times of service, diagnoses, treatment plan, description of issues, progress of treatment, summaries, etc.
Thank you for trusting us with your treatment!
To confirm that you have read and understand the above “Informed Consent” details, please CLICK HERE, fill out the requested information and, in the “Message or Questions” box, please type your complete name. This will serve as a digital signature. Thank you!