If you are an established client, with a Theranest client portal account, you will receive an e-mail appointment reminder in advance of each session. If you do not have a client portal, please ask your clinician to send you an invitation. Cancellations made without a minimum of 48-hours notice or “no-shows” will be charged the full clinician rate from the required retainer.
These fees are not reimbursable through insurance. You will not be able to schedule another appointment until that fee is paid. There will be no charge for cancellations made at least 48 hours in advance. If you are running late, call and plan to attend anyway and use the remaining time already reserved for you.
Patient Setup Fee
There is a one-time paperwork setup fee of $35.00 per client.
After Hours Communication Fee
A $20 per hour fee is added to the clinician's rate for nonurgent communication with the client or a third-party outside of the normal business hours of 8 a.m. - 5 p.m. Monday - Friday. This includes consultations conducted via telephone, email, written correspondence, or in-person and will be billed at a minimum of 15 minutes. Unless it is an emergency, the emergency rates will not apply.
Adoptions or Home Studies
For adoption and home study cases, the rate is $125 per hour. Adoption/Home Study cases will require an $800 retainer to be paid at the time of the first session.
Court Related Services
For depositions, court appearances, and delays, including consultations, research, preparation, documentation, and travel time, the fee is $300 per hour. Advance payment for subpoenas is required 72 hours prior to the hearings or depositions.
Insufficient Funds Fee
For checks or credit cards drawn on insufficient funds, there will be a service charge of $35.00. If a check is submitted with insufficient funds, only cash or money orders will be accepted for future appointments.
Litigation
Any cases involving litigation must be made known to the clinician at the first point of contact with this office. Any cases involving litigation are required to have a non-refundable retainer of $500. If two parties are involved, then each party must pay the $500 non-refundable retainer.
Urgent or Crisis Appointments
If you need to make an urgent/crisis appointment with less than 48 hours' notice, the fees are increased.. Any urgent or crisis communication with clients or other parties involved will be billed a minimum of 15 minutes at the same urgent / crisis appointment rate.
A retainer will be held for each client in the amount of their clinician's service fee to be used for appointments missed or not canceled with at least 48 hours’ notice. The fee for any session is due 48 hours in advance unless other arrangements have been made in writing. This includes telephonic communication, telephonic sessions, email communication, text messaging, and video sessions.
Credit card information must be left on file or entered when setting up their Theranest client account and will be kept on file for future appointments, phone calls, and/or email communications unrelated to rescheduling.
All information shared during our sessions is confidential and remains privileged information. Your information will not be released without written consent. However, there are specific legal and ethical exceptions where required by law to break confidentiality without your permission:
Please provide your insurance card information to determine whether we are in network with your insurance. It is the responsibility of the client to inform this provider of any changes in their insurance policy. No billing is made to insurance companies that are of out of network with, but a Superbill can be provided upon request. If this practice is not in network with your insurance provider, please request a Superbill that you can mail to your insurance provider so they can directly reimburse the insured.
As licensed professionals, we are legally and ethically obligated to report to the appropriate authorities (such as Child Protective Services or Adult Protective Services) if there is reasonable cause to suspect:
Our primary goal is to support you, but safety must be prioritized as required by law.
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. PLEDGE REGARDING HEALTH INFORMATION:
It is understood that health information about you and your health care is personal. The highest commitment is taken to protecting health information about you. A record of the care and services you receive will be created to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which usage and disclose of health information about you in conducted. We also describe your rights to the health information kept about you, and describe certain obligations regarding the use and disclosure of your health information.
We are required by law to:
• Make sure that protected health information (“PHI”) that identifies you is kept private.
• Give you this notice of our legal duties and privacy practices with respect to health information. • Follow the terms of the notice that is currently in effect.
•We can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, in the office, and on the website.
Private Health Information
1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and we may say “no” if we believe it would affect your health care.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
3. The Right to Choose How PHI is sent to You. You have the right to ask for contact in a specific way (for example, home or office phone) or to send mail to a different address, and our office will agree to all reasonable requests.
4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that on file about you. You will be provided with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and there may be a reasonable charge, cost-based fee for doing so.
5. The Right to Get a List of the Disclosures that Have Made. You have the right to request a list of instances where your PHI was disclosed for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. A respond to your request for an accounting of disclosures within 60 days of receiving your request. The list provided will give you will include disclosures made in the last six years unless you request a shorter time. This list is provided to you at no charge, but if you make more than one request in the same year, there will be a charge of a reasonable cost based fee for each additional request.
6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request corrections be made to the existing information or add the missing information. We do retain the right to “no” to your request, but it will be explained to in writing within 60 days of receiving your request.
7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.
8. If you believe your privacy rights have been violated, you may file a complaint. To do this, you may submit your request in writing to my office. You may also send a written complaint to the U.S. Department of Health and Human Services or visit their website at www.hhs.gov.
