Office Policies and Procedures
The purpose of these services, their potential risks and benefits, and all office policies and procedures described below will be discussed and will be subject to agreement. All services rendered will be based in established scientific practices and standards of care in the community, following all established ethical and legal requirements. At times, patients/clients may feel discomfort or distress before, during, and/or after psychological services, and are welcomed and encouraged to discuss these feelings with the provider. All services rendered are on a voluntary basis unless otherwise court-ordered. Patients, clients, or their authorized representatives may refuse services, and are free to withdraw from treatment at anytime. The outcome of services rendered cannot be guaranteed.
PROFESSIONAL FEES: My regular fee for a 45-50 minute psychotherapy, evaluation, or consultation session is $195. A reduced fee is possible based on your financial situation and availability of openings in my practice.
Unless other arrangements are made, payment is expected at the time services are rendered. Unless otherwise agreed upon in advance, professional services rendered will be charged to you, not to your insurance company. Additional fees, billed at the regular rate of $195, will be charged for late cancellations, no-shows, professional time outside of the therapy hour, and other services not billable to insurance. Due to the additional time and expense involved, any services provided that involve interaction with the legal or social service system will be billed directly to you at $400 per hour. Credit card payments are not accepted. A receipt will be provided upon request.
USING YOUR INSURANCE: I am currently an in-network provider for Blue Shield, Blue Cross, United Healthcare, United Behavioral Health, U.S. Behavioral Health, Aetna, MHN, Principal, Magellan, Tri-Care, and others. I am no longer accepting new patients covered by College Health IPA (CHIPA).
It is your responsibility to know your insurance benefits and limitations, and to address issues with your insurance company in a timely manner (e.g., claim denials). You are responsible for payment of the regular fee for all services unless/until your insurance company pays for claims submitted. If I am contracted with your insurance company, I agree to accept reimbursement at the contracted rate. All co-payments, deductibles, late cancellation/no-show charges, and payment for services not covered by insurance, including but not limited to sessions after yearly limits are reached, are your responsibility. In instances where extraordinary professional time is required to complete insurance forms or other professional reports (e.g., progress and diagnostic reports), you will incur additional charges equaling the regular fee for services, pro-rated, billed directly to you, not to your insurance company. This includes reports requested by your insurance company to determine continued eligibility for coverage. Services delivered by telephone and other electronic communication are not reimbursable by insurance and will be billed directly to you. You will be notified in advance if such fees are likely to be incurred.
It is my policy to inform you as fully as possible of known and/or possible issues concerning insurance coverage. Coverage is based on what is termed “medical necessity”, determinations about which are ultimately made by the insurance company. As such, your insurance company may deny coverage may at any time regardless of diagnosis or condition if their medical necessity criteria are not met. Insurance companies require that you authorize release of at least some information obtained over the course of your evaluation/treatment, including but not limited to diagnosis and progress, in order to process and pay claims. Information submitted may affect future insurability. If you chose not to use your insurance, my policy is that you sign a waiver stating that you are choosing not to use your insurance and indicating that you will not submit any claims for services rendered during the period of time you chose not to use your insurance. If you later decide to use your insurance, you must give me no less than 30 days notice, after which claims for services occurring after the 30-day notice period will be submitted.
CONFIDENTIALITY: The services I provide constitute confidential and privileged communication. Information regarding these services is kept in a secure location. Information stored or transmitted electronically is password-protected and secure to the extent that current technology permits. The privacy of email communication cannot be guaranteed. Information about treatment may only be released with patient/responsible adult written authorization except as required for determination of insurance claims as noted above, and unless otherwise mandated by law, namely, suspected child or elder, or abuse, dangerousness to others or self, certain legal proceedings, and conditions of the Patriot Act. The confidentiality of information released to another person or agency (for example, to another therapist or to an insurance company) cannot be guaranteed; I cannot be held liable if the other person or agency re-releases the information without your authorization. You will receive a copy of my Healthcare Insurance Portability and Accountability Act (HIPAA) Notice of Privacy Practices. This document may be reviewed here.
Treatment of Minors: Under California law, patients under age 18 are permitted certain privacy privileges at the provider’s discretion. It is my policy that parents/guardians of such patients must agree to a minor’s treatment privacy as a condition of receiving services. The exception to this privacy is in situations in which he or she is considered by the provider to be in danger of hurting themselves or others.
Consultation With Other Healthcare Practitioners: My standard of practice to ensure the best possible care includes engaging in consultation with other healthcare practitioners. If your case is discussed, it is done so in a way that protects your confidentiality, for example, by not disclosing your name or other information that would make you readily identifiable if you have not given specific authorization to do so. I may ask to record sessions to facilitate consultation with other professionals. I will do so only with your written permission, which you can revoke at any time.
EMERGENCY PROCEDURES: I am not in this office everyday and therefore cannot respond immediately to crisis situations. If you think you are having a true mental or physical health emergency, you need to call 911 and/or go to the emergency room of the nearest hospital. If you need to contact me between sessions, call (310) 702-7961 and follow the recorded instructions. If you do not receive a return call within 24 hours, assume mechanical failure of the voice mail system and call again. Do not use email to contact me for an emergency. SCHEDULING & CANCELLATION: Services are available by appointment only. You must telephone to reschedule or cancel at least 24 hours in advance of your scheduled appointment time. The full fee ($195) will be charged for missed sessions without such notification. Fees for late cancellations or no-shows will be billed directly to you, not to your insurance company. The fee will equal the regular fee for services unless otherwise arranged in advance. Cancellation by email or text messaging will not be accepted.
COMPLAINTS AND CONCERNS: You are encouraged to discuss concerns about any aspect of our work together with me at any time.
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