Welcome!
Contact Information
Location
Spectrum of Practice
Fee Information
 


I generally provide all of my new clients with a copy of this document at the first session.  After reading and discussing these policies, I ask each client to sign a copy of the document and I provide each client a copy of this agreement.

                                   Outpatient Services Contract

Welcome to my practice.  This document contains important information about my professional services and business policies.  Please read it carefully and jot down any questions to you might have so that we can discuss them at our next meeting.  Once you sign this, it will constitute a binding agreement between us.

Psychological Services

Psychotherapy is not easily described in general statements.  It varies depending on the personality of both the therapist and the patient and the particular problems that the patient brings.  There are a number of different approaches that can be utilized to address the problems you hope to address.  It is not like visiting a medical doctor in that it requires a very active effort on your part.  In order to be most successful, you will have to work both during our sessions and at home.  

Psychotherapy has both benefits and risks.  Risks sometimes include experiencing uncomfortable levels of feelings like sadness, guilt, anxiety, anger and frustration, loneliness and helplessness.  Psychotherapy often requires recalling unpleasant aspects of your history.  Psychotherapy has also been shown to have benefits for people who undertake it.  It often leads to a significant reduction of feelings of distress, and better relationships and resolutions of specific problems.  But there are no guarantees about what will happen.   By the end of the evaluation, I will be able to offer you some initial impressions of what our work will include and an initial treatment plan, if you decide to continue.  You should evaluate this information along with your own assessment about whether you feel comfortable working with me.  Therapy involves a large commitment of time, money, and energy, so you should be very careful about the therapist you select.  If you have questions about my procedures, we should discuss them whenever they arise.  If your doubts persist, I will be happy to help you to secure an appropriate consultation with another mental health professional.

Meetings

My normal practice is to conduct an evaluation that will last from two to four sessions.  During this time, we can both decide whether I am the best person to provide the services that you need in order to meet your treatment objectives.  If psychotherapy is initiated, I will usually schedule one 50-minute session (one appointment hour of 50 minutes duration) per week at a mutually agreed time, although sometimes sessions will be longer or more frequent.  Once this appointment hour is scheduled you will be expected to pay for it unless you provide 24 hours advance notice of cancellation or unless we both agree that you were unable to attend due to circumstances that were beyond your control.  If this is the case, I will try to find another time to reschedule your appointment.

Professional Fees

My hourly fee is $175.  In addition to weekly appointments, it is my practice to charge this amount on a prorated basis for other professional services you may require such as report writing, telephone conversations that last more than 5 minutes, attendance at meetings or consultations with other professionals which you have authorized, preparation of records or treatment summaries or the time required to perform any other service which you may request of me.  In unusual circumstances, you may become involved in litigation that may require my participation.  You will be expected to pay for the professional time required even if I am compelled to testify by another party.  Because of the complexity and difficulty of legal involvement, I charge $250 per hour for preparation for and attendance at any legal proceedings with a minimum charge of four hours.

Billing and Payments

You will be expected to pay for each session at the time it is held, unless we agree otherwise or you have insurance coverage that requires another arrangement.  For patients with insurance coverage, most typically you will be expected to pay the co-pay or amount not covered by insurance (this can range from $10 to $175 per session).  If you have no insurance and have a significant financial hardship, I will be willing to discuss some discount of my fees.  Unless we make some specific arrangement, you are responsible for payment of $175 at the time of each session.  My lowest discount is to $140 per session.  If you are unable to afford my fees I will provide you with names of other providers that you might be able to see.   Payments can be made by cash, check, or credit card (MasterCard or Visa).

Insurance Reimbursement

In order for us to set realistic treatment goals and priorities, it is important to evaluate what resources are available to pay for your treatment.  If you have a health benefits policy, it will usually provide some coverage for mental health treatment.  I will provide you with whatever assistance I can in facilitating you receipt of the benefits to which you are entitled including filling out forms as appropriate.  However, you, and not your insurance company, are responsible for full payment of the fee that we have agreed to.  Therefore, it is very important that you find out exactly what mental health services your insurance policy covers.   You should carefully read the section in your insurance coverage booklet that describes mental health services.  If you have questions, you should call your plan and inquire.  Of course, I will provide you with whatever information I can based on my experience and will be happy to try to assist you in deciphering the information you receive from your carrier.

Insurance benefits have become increasingly complex and it has made it difficult to understand how much mental health coverage is available.  Managed health care plans and HMOs and PPOs often require you seeing a particular provider and require advance authorization before they will provide reimbursement.  I participate in no such plans.  These plans are often oriented to a short-term treatment approach designed to resolve specific problems that interfere with one’s usual level of functioning.  Many of these plans also require or encourage the use of medications.  In my experience, while quite a lot can be accomplished in short-term therapy, many clients feel that more services are necessary after insurance benefits expire.  If you choose to continue receiving services from me after the benefits have ended, you will be expected to provide the full fee at the time of service.  

You should also be aware that most insurance agreements require you to authorize me to provide a clinical diagnosis, and sometimes additional clinical information such as a treatment plan or summary, or in rare cases, a copy of the entire record.  This information will become part of the insurance company files, and, in all probability, some of it will be computerized.  All insurance companies claim to keep such information confidential, but once it is in their hands, I have no control over what they do with it.  In some cases they may share the information with a national medical information data bank.  If you request it, I will provide you with a copy of any report that I submit.   Once we have all of the information about your insurance coverage, we will discuss what we can expect to accomplish with the benefits that are available and what will happen if the insurance benefits run out before you feel ready to end our sessions.  It is important to remember that you always have the right to pay for my services yourself and avoid the complexities that are described above.

Contacting Me

I am often not immediately available by telephone.  While I am usually in my office Monday through Thursday from 8 AM to 5 PM, I usually will not answer the phone when I am with a client.  My phone is always answered by a confidential voice mail system to which only I have access.  I monitor this frequently during the workweek and occasionally check it on the weekends.  I try and return all calls during the week within several hours of receiving the message.  I am generally not available for crisis counseling or emergencies and do not have my practice structured to deal with patients in crisis.  I do not carry a pager and often will be unavailable for emergencies.  If you cannot reach me, and you feel that you cannot wait for me to return your call, you should call your family doctor or the emergency room at the local hospital where arrangements can be made for you to meet with a psychologist or psychiatrist on call.  You may also call 911 to arrange for emergency services.  If I am unavailable for an extended time, I will provide you with the name of a trusted colleague whom you can contact if necessary.

Professional Records

Both law and the standards of my profession require that I keep appropriate treatment records.  You are entitled to receive a copy of the records or I can provide you with a summary of the records.  Because these are professional records, they can be misinterpreted and/or upsetting.  If you wish to see your records, I recommend that you review them in my presence so that we can discuss what they contain.  Clients will be charged an appropriate fee for any preparation time that is required to comply with an information request.

Minors

If you are under 18 years of age, please be aware that the law provides your parents with certain rights to your treatment records.  While I generally request that parents honor certain limits of confidentiality, and the law provides some exceptions to a parent’s right to know, many situations can develop where your parents or guardians will receive information about your treatment.  If I plan to discuss anything with your parents or guardians I will discuss this with you and generally have our discussion with you present with your parents.

Confidentiality

In general, law protects the confidentiality of all communications between a client and a psychologist, and I can only release information about our work to others with your written permission.  However, there are a number of exceptions.   In virtually every judicial proceeding you have the right to prevent me from providing any information about your treatment.  However, in rare circumstances a judge can require my testimony if he/she determines that resolutions of the issues before him/her demands it.   There are some situations in which I am legally required to take actions to protect others from harm, even though that requires revealing some information about a client’s treatment.   If I believe that a child or an elderly or disabled person is being abused, I must file a report with the appropriate state agency.  If I believe that a client is threatening serious bodily harm to another, I am required to take protective actions, which may include notifying the potential victim, notifying the police, or seeking appropriate hospitalization.  If a client threatens to harm him/herself, I may be required to intervene.  These situations have rarely arisen in my practice.  Should such a situation occur, I will make every effort to fully discuss it with you before taking any action.

While this written summary of exceptions to confidentiality should prove helpful in informing you about potential limits, it is important that we discuss any questions or concerns that you may have at our next meeting.  As you might suspect, the laws governing these issues are complex.  While I am happy to discuss these issues with you, should you need specific advice, formal legal consultation may be desirable.  I will provide you with relevant portions or summaries of the applicable state laws governing these issues.

Your signature below indicates that you have read the information in this document and agree to abide by its terms during our professional relationship.  You acknowledge your responsibility for all fees and charges for treatment provided.


Signed:___________________________________________


Date:________________________

 
Top