Below is information for you to read about psychotherapy, as well as the implications of the Health Insurance Privacy & Portability Act (HIPPA) on psychotherapy services. Your therapist may ask you to sign a form saying that you have reviewed and understand the following. Please feel free to make copies for yourself. You will have the opportunity to ask questions before you sign any forms.

 

This page answers some questions clients often ask about any therapy practice.   It will cover the following information:

• The risks and benefits of therapy
• Consultations
• Cost of services, and other money matters
• Other important areas of the therapeutic relationship
• HIPPA regulations
• Information about using insurance
• Privacy practices

After you read this information we can discuss, in person, how these issues apply to your own situation.  Write down any questions you think of, and we can discuss them at our next meeting.

The Benefits and Risks of Therapy

As with any powerful treatment, there are some risks as well as many benefits with therapy. You should think about both the benefits and risks when making any treatment decisions. For example, in therapy, there is a risk that clients will, for a time, have uncomfortable levels of sadness, guilt, anxiety, anger, frustration, loneliness, helplessness, or other negative feelings. Clients may recall unpleasant memories. These feelings or memories may bother a client at work or in school. In addition, some people in your community may mistakenly view anyone in therapy as weak, or perhaps as seriously disturbed or even dangerous. Also, clients in therapy may have problems with people important to them. Family secrets may be told. Therapy may disrupt a marital relationship and sometimes may even lead to a divorce. Sometimes, too, a client’s problems may temporarily worsen after the beginning of treatment. Most of these risks are to be expected when people are making important changes in their lives. Finally, even with our best efforts, there is a risk that therapy may not work out well for you.

While you consider these risks, you should know also that the benefits of therapy have been shown by scientists in hundreds of well-designed research studies. People who are depressed may find their mood lifting. Others may no longer feel afraid, angry, or anxious. In therapy, people have a chance to talk things out fully until their feelings are relieved or the problems are solved. Clients’ relationships and coping skills may improve greatly. They may get more satisfaction out of social and family relationships. Their personal goals and values may become clearer. They may grow in many directions—as persons, in their close relationships, in their work or schooling, and in the ability to enjoy their lives.

We do not take on clients we do not think we can help. Therefore, we will enter a therapeutic relationship with optimism about your progress.

Consultations

If you could benefit from a treatment your therapist cannot provide, we will help you to get to the proper therapist or facility. You have a right to ask about such other treatments, their risks, and their benefits. Based on what is learned about your problems, a medical exam or use of medication may be recommended. If this is the case, the reasons will be discussed fully with you, so that you can decide what is best. If you are treated by another professional, your therapist will coordinate services with your medical doctor.

If for some reason treatment is not going well, it might be  suggested that  you see another therapist or another professional in addition to your therapist. As responsible persons and ethical therapists, we cannot continue to treat you if the treatment is not working for you. If you wish for another professional’s opinion at any time, or wish to talk with another therapist, we will help you find a qualified person and will provide him or her with the information needed.

What to Expect from Our Relationship

As  professional, we will use our best knowledge and skills to help you. This includes following the standards of our professions.  The psychologists in the practice follow the rules and ethics of the American Psychological Association, or APA, and the professional counselors adhere to the American Counseling Association. In your best interests, the APA  and ACA put limits on the relationship between a therapist and a client, and we will abide by these. Let us explain these limits, so you will not think they are personal responses to you.

First, we are licensed and trained to practice psychology and/or counseling—not law, medicine, finance, or any other profession. We are not able to give you good advice from these other professional viewpoints.

Second, state laws and the rules of the APA and ACA require us to keep what you tell us confidential (that is, private). You can trust your therapist not to tell anyone else what you talk about, except in certain limited situations. We explain what those are in the “About Confidentiality” section below. Here we want to explain that we try not to reveal who our clients are. This is part of the effort to maintain your privacy. If we meet on the street or socially, your therapist may not say hello or talk to you very much. This behavior will not be a personal reaction to you, but a way to maintain the confidentiality of our relationship.

Third, in your best interest, and following the APA’s standards, your therapist can only be your therapist. Your therapist cannot have any other role in your life. He or she cannot, now or ever, be a close friend or socialize with any of his or her  clients. She or he cannot be a therapist to someone who is already a friend, can never have a sexual or romantic relationship with any client during, or after, the course of therapy. He or she cannot have a business relationship with any clients, other than the therapy relationship.

Even though you might invite your therapist, he or she  will not attend your family gatherings, such as parties or weddings.

As your therapist, he or she  will not celebrate holidays or give you gifts; may not notice or recall your birthday; and may not receive any of your gifts eagerly.

About Confidentiality

We will treat with great care all the information you share. It is your legal right that our sessions and the records about you be kept private. That is why you will be asked to sign a “release-of-records” form before your therapist can talk about you or send records about you to anyone else. In general, your therapist will tell no one what you talk about in therapy. In fact, he she will not even reveal that you are receiving from treatment him or her.

In all but a few rare situations, your confidentiality (that is, your privacy) is protected by state law and by the rules of our professions. Here are the most common cases in which confidentiality is not protected:

1.  If you were sent to therapy by a court or an employer for evaluation or treatment, the court or employer expects a report from the therapist. If this is your situation, please talk with your therapist  before you talk about  anything you do not want the court or your employer to know. You have a right to discuss only what you are comfortable discussing.

2.  Are you suing someone or being sued? Are you being charged with a crime? If so, and you tell the court that you are seeing a therapist, the therapist may then be ordered to show the court your therapy records. Please consult your lawyer about these issues.

3.  If you make a serious threat to harm yourself or another person, the law requires a therapist to try to protect you or that other person. This usually means telling others about the threat. We cannot promise never to tell others about threats you make.

4.  If we believe a child has been or will be abused or neglected, we are legally required to report this to the authorities.

5. Psychologists are state mandated to report driving impairments.

There are two situations in which your therapist might talk about part of your case with another therapist. We ask now for your understanding and agreement in these two situations.

First, when your therapist is away from the office for a few days, a trusted fellow therapist “covers” for the practice. This therapist will be available to you in emergencies. Therefore, he or she may need to know about you. Of course, this therapist is bound by the same laws and rules as your therapist to protect your confidentiality.

Second,  sometimes therapists consult with other therapists or other professionals about their clients. This helps in giving high-quality treatment. These consultants are also required to keep your information private. Your name will never be given to them, and they will be told only as much as they need to know to understand your situation.

Except for the situations described above, the office staff and therapists will always maintain your privacy. We also ask you not to disclose the name or identity of any other client being seen in this office.

Our office staff makes every effort to keep the names and records of clients private. Our staff and we will try never to use your name on the telephone, if clients in the office can overhear it. All staff members who see your records have been trained in how to keep records confidential.

If your records need to be seen by another professional, or anyone else, your therapist will discuss it with you. If you agree to share these records, you will need to sign a release form. This form states exactly what information is to be shared, with whom, and why, and it also sets time limits. You may read this form at any time. If you have questions, please ask your therapist.

It is the office policy to destroy clients’ records 15 years after the end of our therapy. Until then, your case records will be stored in a safe place.

If your therapist must discontinue your therapy because of illness, disability, or other presently unforeseen circumstances, we ask you to agree to the transfer of your records to another therapist who will assure their confidentiality, preservation, and appropriate access.

If we do family or couple therapy (where there is more than one client), and you want to have the records of this therapy sent to anyone, all of the adults present will have to sign a release.

As part of cost control efforts, an insurance company will sometimes ask for more information on symptoms, diagnoses, and  treatment methods. It will become part of your permanent medical record. We will let you know if this should occur and what the company has asked for. Please understand that we have no control over how these records are handled at the insurance company. Our policy is to provide only as much information as the insurance company will need to pay your benefits.

You can review your own records in your therapist’s  files at any time. You may add to them or correct them, and you can have copies of them. We ask you to understand and agree that you may not examine records created by anyone else that have been sent to us.

In some very rare situations, your therapist may temporarily remove parts of your records before you see them. This would happen if we believe that the information will be harmful to you, but your therapist will discuss this with you.

About Your Appointments

The very first time your therapist meets with you, it will likely be for an hour.  Following this, we will usually meet for a 50-minute session once or twice a week, then less often.  We attempt to give you a few week’s notice of upcoming time out of the office (for vacation, conferences, etc).

An appointment is a commitment to our work. We agree to meet here and to be on time. If your therapist is ever unable to start on time, we ask your understanding. We also assure you that you will receive the full time agreed to. If you are late, we will probably be unable to meet for the full time, because it is likely that another appointment will be scheduled after yours.

A cancelled appointment delays our work. Your therapist considers your meetings to be very important and asks you to do the same. Please try not to miss sessions if you can possibly help it. When you must cancel, please give us at least a week’s notice. Your session time is reserved for you. We are rarely able to fill a cancelled session unless wew know a week in advance. If you do not show up for an appointment or do not give 24 hour’s notice, we will have to charge you for the lost time. Your insurance will not cover this charge.

We request that you do not bring children with you if they are young and need babysitting or supervision, which we cannot provide.

Fees, Payments, and Billing

Payment for services is an important part of any professional relationship. This is even more true in therapy; one treatment goal is to make relationships and the duties and obligations they involve clear. You are responsible for seeing that our services are paid for. Meeting this responsibility shows your commitment and maturity.

Telephone consultations: Telephone consultations may be suitable or even needed at times in your therapy. If so, you will be charged your regular fee, prorated over the time needed.   Insurance companies rarely pay for telephone consultations, so these charges will be billed directly to you.  If your therapist needs to have long telephone conferences with other professionals as part of your treatment, you will be billed for these at the same rate as for regular therapy services. If you are concerned about any of this, please be sure to discuss it with your therapist in advance so we can set a policy that is comfortable. Of course, there is no charge for calls about appointments or similar business.

Extended sessions: Occasionally it may be better to go on with a session, rather than stop or postpone work on a particular issue. When this extension is more than 10 minutes, your therapist will tell you, because sessions that are extended beyond 10 minutes will be charged on a prorated basis.  These sessions are typically paid for by insurance company at the prorated charge.

Reports: You will not be charged for time spent making routine reports to your insurance company. However, you will have to be billed for any extra-long or complex reports the company might require. The company will not cover this fee.

Other services: Charges for other services, such as hospital visits, consultations with other therapists, home visits, or any court-related services (such as consultations with lawyers, depositions, or attendance at courtroom proceedings) will be based on the time involved in providing the service at your regular fee schedule. Some services may require payment in advance.

We realize that our fees involve a substantial amount of money, although they are well in line with similar professionals’ charges. For you to get the best value for your money, we must work hard and well.

We will assume that our agreed-upon fee-paying relationship will continue as long as services are provided  to you. This will be assumed until you tell your therapist in person, by telephone, or by certified mail that you wish to end it. You have a responsibility to pay for any services you receive before you end the relationship.

Because payment is expected at the time of your meetings, bills are typically not sent. However, if you and your therapist  have agreed that you will be billed, we ask that the bill be paid within 5 days of when you get it.

If you think you may have trouble paying your bills on time, please discuss this with your therapist. He or she will also raise the matter with you so we can arrive at a solution. If your unpaid balance becomes too high, you will be notified by mail. If it then remains unpaid, your therapist must stop therapy with you. Fees that continue unpaid after this may be turned over to our collection service.

If there is any problem with our charges,  our billing, your insurance, or any other money-related point, please bring it to your therapist’s attention. He or she will do the same with you. Such problems can interfere greatly with our work. They must be worked out openly and quickly.

If You Have Traditional (or “Indemnity”) Health Insurance Coverage

Many health insurance plans will help you pay for therapy and other services we offer. These plans include Blue Shield and most Major Medical plans. Because health insurance is written by many different companies, we cannot tell you what your plan covers. Please read your plan’s booklet under coverage for “Outpatient Psychotherapy” or under “Treatment of Mental and Nervous Conditions.” Or call your employer’s benefits office to find out what you need to know.

If your health insurance will pay part of the fee, we will help you with your insurance claim forms. However, please keep two things in mind:

1.  We had no role in deciding what your insurance covers. Your employer decided which, if any, services will be covered and how much you (and your therapist) will be paid. You are responsible for checking your insurance coverage, deductibles, payment rates, copayments, and so forth. Your insurance contract is between you and your company; it is not between your therapist and the insurance company.

2.  You—not your insurance company or any other person or company—are responsible for paying the fees we agree upon. If you ask your therapist to bill a separated spouse, a relative, or an insurance company, and payment is not received on time, payment will be expected from you.

To seek payment from your insurance company, you must first obtain a claim form from your employer’s benefits office or call your insurance company. Complete the claim form. Then attach your therapist’s  statement to the claim form and mail it to your insurance company. Our statement already provides the information asked for on the claim form.

If You Have a Managed Care Contract

If you belong to a health maintenance organization (HMO) or have another kind of health insurance with managed care (including PPO and PSO policies), decisions about what kind of care you need and how much of it you can receive will be reviewed by the plan. The plan has rules, limits, and procedures that we should discuss. Please bring your health insurance plan’s description of services to one of our early meetings, so that we can talk about it and decide what to do.

We will provide information about you to your insurance company only with your informed and written consent. The  information will be sent by mail or by fax. Our office will try its best to maintain the privacy of your records, but we ask you not to hold us responsible for accidents or for anything that happens as a result.

Please see below for more information about Managed Care and Privacy Practices.

If You Need to Contact Your Therapist

Your therapist cannot promise to be available at all times. Phone calls cannot be taken while with clients.  You can always leave a message on the office voicemail or with the answering service, which answers 24 hours a day. Your therapist will return your call as soon as possible.

If you have an emergency or crisis, tell this to the answering service who will try to contact your therapist. If you have a behavioral or emotional crisis and cannot reach your therapist or our answering service immediately by telephone, you or your family members should seek assessment and treatment at the nearest hospital emergency room.

If Your Therapist Needs to Contact Someone about You

If there is an emergency during our work together, or your personal safety becomes a concern, your therapist is required by law and by the rules of our professions to contact someone close to you—perhaps a relative, spouse, or close friend. We are also required to contact this person, or the authorities, if we become concerned about your harming someone else. Please write down the name and information of your chosen contact person in the blanks provided:

Name: ____________________________________________________________

Address: ___________________________________________________________

Phone: ________________________ Relationship to you:____________________

Other Points

If you ever become involved in a divorce or custody dispute, we want you to understand and agree that we will not provide evaluations or expert testimony in court. You should hire a different mental health professional for any evaluations or testimony you require. This position is based on two reasons: (1) Your therapist’s statements will be seen as biased in your favor because we have a therapy relationship; and (2) the testimony might affect our therapy relationship, and we must put this relationship first.

Doing follow-up and outcome research is always educational. As professional therapists, we naturally want to know more about how therapy helps people. To understand therapy better, we must collect information about clients before, during, and after therapy. Therefore, we are asking you to help us by filling out some questionnaires about different parts of your life-relationships, changes, concerns, attitudes, and other areas. We ask your permission to take what you wrote on these questionnaires and what we have in our records and use it in research or teaching that we may do in the future. If we ever use the information from your questionnaire, it will always be included with information from many others. Also, your identity will be made completely anonymous. Your name will never be mentioned, and all personal information will be disguised and changed. After the research, teaching, or publishing project is completed all the data used will be destroyed.

If, as part of our therapy, you create and provide to us records, notes, artworks, or any other documents or materials, we will return the originals to you at your written request but will retain copies.

Statement of Principles and Complaint Procedures

It is our intention to fully abide by all the rules of the American Psychological Association (APA) or American Counseling Association (depending on the license of your therapist) and by those of our state license.

Problems can arise in our relationship, just as in any other relationship. If you are not satisfied with any area of our work, please raise your concerns with your therapist at once. Our work together will be slower and harder if your concerns are not worked out. We will make every effort to hear any complaints you have and to seek solutions to them. If you feel that we, or any other therapist, has treated you unfairly or has even broken a professional rule, please tell your therapist. You can also contact the state or local psychological or counseling association and speak to the chairperson of the ethics committee. He or she can help clarify your concerns or tell you how to file a complaint. You may also contact the state board of psychologist examiners [note that this name differs across states], the organization that licenses those of us in the independent practice of psychology.

In our practice as  therapists, we do not discriminate against clients because of any of these factors: age, sex, marital/family status, race, color, religious beliefs, ethnic origin, place of residence, veteran status, physical disability, health status, sexual orientation, or criminal record unrelated to present dangerousness. This is our personal commitment, as well as being required by federal, state, and local laws and regulations. We will always take steps to advance and support the values of equal opportunity, human dignity, and racial/ethnic/cultural diversity. If you believe you have been discriminated against, please bring this matter to our attention immediately.

 

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and
how you can get access to this information.
Please review it carefully.

Our Commitment to Your Privacy

Our practice is dedicated to maintaining the privacy of your personal health information as part of providing professional care. We also are required by law to keep your information private. These laws are complicated, but we must give you this important information. This is a shorter version of the full, legally required NPP and you may have a copy of this to read and refer to it for more information. However, we can’t cover all possible situations so please talk to your therapist about any questions or problems.

We will use the information about your health which we get from you or from others mainly to provide you with treatment, to arrange payment for our services, and for some other business activities which are called, in the law, health care operations. After you have read this NPP we will ask you to sign a Consent Form to let us use and share your information. If you do not consent and sign this form, we cannot treat you.

If we or you want to use or disclose (send, share, release) your information for any other purposes we will discuss this with you and ask you to sign an Authorization form to allow this.

Of course we will keep our health information private but there are some times when the laws require us to use or share it. For example:

1. When there is a serious threat to your health and safety or the health and safety of another individual or the public. We will only share information with a person or organization that is able to help prevent or reduce the threat.

2. Some lawsuits and legal or court proceedings.

3. If a law enforcement official requires us to do so.

4. For Workers Compensation and similar benefit programs.

There are some other situations like these which don’t happen very often. They are described in the longer version of the NPP.
Your Rights Regarding your Health Information

1. You can ask us to communicate with you about your health and related issues in a particular way or at a certain place which is more private for you. For example, you can ask us to call you at home and not at work to schedule or cancel an appointment. We will try our best to do as you ask.

2. You have the right to ask us to limit what we tell people involved in your care or the payment of your care, such as family members and friends.

3. You have the right to look at the health information we have about you such as your medical and billing records. You can even get a copy of these records but we may charge you.

4. If you believe the information in your records is incorrect or missing important information, you can ask us to amend your health information. You have to make this request in writing and send it to your therapist. You must tell us the reasons you want to make the changes.

5. You have the right to a copy of this notice. If we change this NPP we will post the new version in our waiting area and you can always get a copy of the NPP from your therapist.

6. You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint with our Privacy Officer and with the Secretary of the Department of Health and Human Services. All complaints must be in writing. Filing a complaint will not change the care we provide to you in any way.

If you have any questions regarding this notice or our health information privacy policies, please contact us at 724/772-4949.

This notice is effective September 1, 2008.

You may have other rights which are granted to you by the state laws; these may be the same or different from the rights described above. I would be happy to discuss these situations with you now or as they arise.

 

Our Agreement

I, the client (or his or her parent or guardian), understand I have the right not to sign this form. My signature below indicates that I have read and discussed this agreement; it does not indicate that I am waiving any of my rights. I understand I can choose to discuss my concerns with you, the therapist, before I start (or the client starts) formal therapy. I also understand that any of the points mentioned above can be discussed and may be open to change. If at any time during the treatment I have questions about any of the subjects discussed in this brochure, I can talk with you about them, and you will do your best to answer them.

I understand that after therapy begins I have the right to withdraw my consent to therapy at any time, for any reason. However, I will make every effort to discuss my concerns about my progress with you before ending therapy with you.

I understand that no specific promises have been made to me by this therapist about the results of treatment, the effectiveness of the procedures used by this therapist, or the number of sessions necessary for therapy to be effective.

I have read, or have had read to me, the issues and points in this brochure. I have discussed those points I did not understand, and have had my questions, if any, fully answered. I agree to act according to the points covered in this brochure. I hereby agree to enter into therapy with this therapist (or to have the client enter therapy), and to cooperate fully and to the best of my ability.

___________________________________________                             ____________________________

Signature                                                                                                                                                      Date

What You Should Know about Managed Care and Your Treatment

Your health insurance may pay part of the costs of your treatment, but the benefits cannot be paid until a managed care organization (MCO) authorizes this (says they can be paid). The MCO has been selected by your employer, not by you or us. The MCO sets some limits on us, and you need to know what these are before we go further.

Confidentiality

If you use your health insurance to help pay for psychotherapy, you must allow us to tell the MCO about your problem (give a psychiatric diagnosis). You must also permit us to tell the MCO about the treatment we are recommending, about your progress during treatment, and about how you are doing in many areas of your life (functions at work, in your family, and in activities of daily living). We are not paid separately for collecting, organizing, or submitting this information, and we cannot bill you for these services. All of this information will become part of the MCO’s records, and it will be included in your permanent medical record at the Medical Information Bureau, a national data bank. The information will be examined when you apply for life or health insurance, and it may be considered when you apply for employment, credit or loans, a security clearance, or other things in the future. You will have to indicate that you were treated for a psychological condition and release this information, or you may not get the insurance, job, loan, or clearance.

All insurance carriers claim to keep the information they receive confidential, and there are federal laws about its release. The laws and ethics that apply to us are much stricter than the rules that apply at present to MCOs. There have been reports in the media about many significant and damaging breaches of confidentiality by MCOs. If you are concerned about who might see your records now or in the future, we should discuss this issue more fully before we start treatment and before we send the MCO any information. You should evaluate your situation carefully in regard to confidentiality. For some people and some problems, the privacy of their communications to their therapist is absolutely essential to their work on their difficulties. For others, their problems are not ones that raise much concern over confidentiality.

 Treatment

The MCO will review the information we send it and then decide how much treatment we can provide to you. The MCO can refuse to pay for any of your treatment, or for any treatment by your therapist. Or it may pay only a very small part of the treatment’s cost, and it can prevent your therapist from charging you directly for treatment we agree to. Finally, it can set limits on the kinds of treatments your therapist can provide to you. These limited treatments may not be the most appropriate for you or in your best interest. The MCO will approve treatment aimed at improving the specific symptoms (behaviors, feelings) that brought you into therapy, but it may not approve any further treatment. The MCO will almost always require you to see a psychiatrist for medication evaluations (and prescriptions), whether you or your therapist  think this is appropriate.

When it does authorize our treatment, the MCO is likely to limit the number of times we can meet. Your insurance policy probably has a maximum number of appointments allowed for outpatient psychotherapy (usually per year, though there may be a lifetime limit as well), but the MCO does not have to let you use all of those. It may not agree to more sessions, even if we believe those are needed to fully relieve your problems, or if we believe that undertreating your problems may prolong your distress or lead to relapses (worsening or backsliding).

If the MCO denies payment before either of us is satisfied about your progress, we may also need to consider other treatment choices, and they may not be the ones we would prefer. Your therapist  can appeal the MCO’s decisions on payment and number of sessions, but he or she can only do so within the MCO itself. Your therapist  cannot appeal to other professionals, to your employer, or through the courts. This state does not have laws regulating MCOs —that is, laws about the skills or qualifications of their staff members, about access to medical and psychological records by employers and others, or about the appeals process.

You should know that your therapist’s contract or your employer’s contract with a particular MCO prevent us from taking legal actions against the MCO if things go badly because of its decision. Your therapist’s  contract may prevent him or her from discussing with you treatment options for which the MCO will not pay. We will discuss with you any efforts the MCO makes to get us to limit your care in any way.

The particular MCO in charge of your mental health benefits can change during the course of your treatment. If this happens, we may have to go through the whole treatment authorization process again. It is also possible that the benefits or coverage for your treatment may change during the course of our therapy, and so your part of costs for treatment may change.

Lastly, even if we send all the forms and information to the MCO on time, there may be long delays before any decisions are made. This creates stressful uncertainty and may alter our earlier assumptions about the costs and nature of your treatment.

If, after reading this and discussing it with your therapist, you are concerned with these issues, you may have the choice of paying directly to your therapist and not using your health insurance. This will create no record outside of his or her files. This possibility may depend on your therapist’s contract with the MCO.

I have read and understood the issues described above and willingly enter treatment accepting these limits. I give my therapist permission to submit information in order to secure payment for the mental health services to be provided to me.

___ Yes, I want to review and/or receive copies of any written materials you send to my MCO.

___ No, that is not necessary.

_______________________________          __________________________________      __________

Signature of client                                                     Printed name of client                                      Date

 

For more information please contact us at 724-772-4949 or email us at info@malecherringandkrause.com.