This notice is effective on and after January 10, 2024.
Be Seen Therapy: Informed Consent, Client Rights, and Policies for Mental Health Services
1. Client Rights and Responsibilities – Counseling and Therapy Services: As a client in therapy, you have certain rights and responsibilities that are important for you to understand. There are also legal limitations to those rights of which you should be aware. As your therapist, we have corresponding responsibilities to you. These rights and responsibilities are described in the following sections.
2. Benefits and Risks; No Guarantees: Our approach to therapy is tailored to your needs and, at the same time, makes use of interventions such as support, insight, and behavioral suggestions, which research has generally found to be effective. Therapy has both benefits and risks. Risks may include experiencing uncomfortable feelings, like sadness, guilt, anxiety, anger, frustration, loneliness and helplessness, because the process of therapy often requires discussing the unpleasant aspects of your life. However, therapy has been shown to have benefits for individuals and families who undertake it. Therapy often leads to a significant reduction in feelings of distress, increased satisfaction in interpersonal relationships, greater personal awareness and insight, increased skills for managing stress, and resolutions to specific problems. Therapy requires a very active effort on your part. In order to be most successful, you will have to work on things we discuss outside of sessions. Your participation can be expected to improve the results you achieve; however, therapy cannot be guaranteed to result in emotional or functional improvement for everyone.
3. Limits of Practice and Scope of Services: Our practice is currently a telehealth-based practice, and we do not provide services at a level of intensity sufficient to treat unmanageable mental or emotional states, intense interpersonal conflicts, or other crisis situations. If we become aware that you have problems or issues for which our training does not provide adequate preparation or for which our practice does not offer the intensity of services that would be required, we will refer you to another facility or provider that we believe has the resources, training and experience to provide you with the services you require. You agree to accept our referral based upon our determination that this action may be necessary to protect us both. Marriage and Family Therapists and Professional Counselors have an ethical responsibility to respect their clients’ personal values, including religious and cultural values, and our personal beliefs or values will not be a reason for us to refer you elsewhere. However, if you strongly feel that a clinician who shares your values would be a better fit (for example, religious or cultural), we will try to recommend such a person to the best of our knowledge.
5. Treatment Planning: The first consultation will involve a comprehensive evaluation of your needs. By the end of the evaluation, we will be able to offer you some initial impressions of what our work might include. At that point, we will discuss your treatment goals and create an initial treatment plan. You will sign the treatment plan. You should evaluate this information and make your own decision about whether you feel comfortable working with us. If you have questions about our procedures, we should discuss them whenever they arise.
6. Appointments, Missed Appointments, and Cancellations: Appointments will ordinarily be 50 minutes in duration, once per week at a time we agree on, although some sessions may be more or less frequent as needed. The time scheduled for your appointment is assigned to you and you alone. If you need to cancel or reschedule a session, we ask that you provide us with 48 hours notice. If you miss a session without canceling, or cancel with less than 48-hour notice, our policy is to collect the full amount of your fee. It is important to note that insurance companies do not provide reimbursement for canceled sessions; thus, you will be responsible for the portion of the fee as described above. In addition, you are responsible for coming to your session on time. If you are late, your appointment will still need to end on time. For purposes of determining the amount of the cancellation fee for in-network clients, for missed appointments not canceled within 48 hours, the cancellation fee is calculated by adding the full session fee that the Practice would have been reimbursed by your insurance company, including your copay. For example, if your insurance company reimburses the Practice $115 for a 50-minute therapy hour and your co-pay is $25, your cancellation fee will be $115 for all missed sessions not canceled within 48 hours.
7. Professional Fees: The standard fee for services is $175 for a licensed therapist and $150 for an associate therapist. Insurance rates may vary, please inquire with your insurance rates. You are responsible for paying at the time of your session. You may pay via credit card on SimplePractice.
8. Insurance: In order for us to set realistic treatment goals and priorities, it is important to evaluate the resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. With your permission, we will assist you in filing claims and obtaining information about your coverage, but you are responsible for knowing your coverage and for letting us know if/when your coverage changes. Health care plans often require advance authorization, without which they may refuse to provide reimbursement for mental health services. These plans are often limited to short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions.
HEALTH INSURANCE AND PRIVACY: You should also be aware that most insurance companies require you to authorize us to provide them with a clinical diagnosis. Diagnoses are terms that describe the nature of your problems and help providers suggest generally accepted treatments. Mental health diagnoses come from the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM) and/or the International Classification of Diseases (ICD). Sometimes we are required to provide additional clinical information such as treatment plans or summaries, or (in rare cases) copies of the entire record. This information will become part of the insurance company files and may be stored electronically. Although HIPAA and other laws and regulations apply to health records, we have no control over what insurers do with personal health information once it is in their hands. Although employers generally do not have access to this information, it may affect your ability to enroll in life or health insurance plans in the future. Insurers may also share the information with a national medical information databank. We will provide you with a copy of any report we submit, if you request it.
9. Professional Records: We are required to keep appropriate records of the services that we provide. Your records are maintained in a secure manner. We keep records noting that you were here, your reasons for seeking therapy, the goals and progress we set for treatment, your diagnosis, topics we discussed, your medical, social, and treatment history, records we receive from other providers, copies of records we send to others, and your billing records. Except in unusual circumstances that involve any danger to yourself, you have the right to a copy of your file. Because these are professional records, they may be unclear for untrained readers to understand or interpret. For this reason, we recommend that you initially review them with us, or have them forwarded to another mental health professional to discuss the contents. If we refuse your request for access to your records, you have a right to have our decision reviewed by another mental health professional, which we will discuss with you upon your request. You also have the right to request that a copy of your file be made available to any other health care provider at your written request.
10. Contact Information and Emergency Procedures: Do not use email, text messaging, voice mail, or faxes for emergencies. In case of emergency, 1) contact your local crisis line or mental health agency, 2) go to your local hospital Emergency Room, or 3) call 911 and ask to speak to an emergency worker. If you feel that you are in danger from a family member or domestic partner, you should contact law enforcement or the local domestic violence agency.
11. Other Rights: If you are unhappy with what is happening in therapy, we encourage you to talk with us so that we can respond to your concerns. Your concerns will be taken seriously and handled with care and respect. You may also request that we refer you to another therapist and are free to end therapy at any time. You have the right to considerate, safe and respectful care, without discrimination as to race, ethnicity, color, gender, sexual orientation, age, religion, national origin, or source of payment. You have the right to ask questions about any aspects of therapy and about our specific training and experience.
12. INFORMED CONSENT TO THERAPY: Having read this Counseling Policy in its entirety, you agree to all the terms laid out. You may keep this policy for future reference. If you have any questions or concerns at any time, you may contact us by e-mail at email@example.com.