New Clients Questionnaire. All should be completed and emailed to me directly.
My fee is $150/per 60 minute counseling session and I can reduce my fee if needed. I expect payment at each visit, by check or credit card. I use IvyPay to store your card info safely as per HIPAA requirements for self-pay clients, and STRIPE for insurance clients in the Kareo HIPAA-compliant software used by my billing company, CareMed Partners.
Please bring your insurance card at our first visit. At this time I can accept:
- Great West
- Kaiser Permanente
- Medicare (not Medicaid-I cannot collect a fee from you even if you are willing to do so)
- Beacon (formerly Value Options)
Not seeing your insurance listed? I can also give you a detailed receipt for my full fee that you can submit to your insurance for reimbursement. Usually this works if you have “out of network” benefits. Your card should indicate this or you or my biller can check for us.
Insurance does not pay for extended case management I perform on your behalf, including letters, consultations with your other providers or my appearance at court. You will be charged for my time for these and crisis phone calls over ten minutes, and for missed appointments and those cancelled too late for me to fill—usually 24 hours’ notice. Exceptions are made for illness, bad weather, and rare work obligations.
HIPAA–Health Information Portability And Accountability Act
FYI:This Act instructs all health care providers to do our utmost to protect your health information from improper disclosure. Even prior to HIPAA, Psychotherapists have always practiced the principle of confidentiality, including safeguards such as keeping patient files locked away, keeping therapy notes apart from routine record keeping, using fake names when discussing your case with colleagues, and refusing to share information about you without your written consent (except in certain situations or emergencies). You may revoke your consent in writing. You may review your file with your therapist.
We will need to use our limited session time to complete these if not done ahead of time. Once you and I have decided to meet for an appointment, you may access my Client Portal to review forms and schedule appointments. You will need an access code that I will email.
- New Clients and Insurance: Please complete and submit this form – Insurance Information Form – or print and email, firstname.lastname@example.org, to my billing service, at least 48 business hours before your appointment, in order to avoid paying full out of pocket fee.
- Client Authorization to Release Confidential Information