Practice Policies
Below are some important policies about my practice that potential, new, and current clients should be aware of in order to make informed decisions about treatment.
Insurance, Scheduling and Cancellation Policy
Information about insurance and attendance policies are as follows:
- I am "out-of-network" for all insurance plans. Being an "out-of-network" provider means that my clients pay me a fee, and I supply them with a bill which may be presented by the client to their insurance company for application for reimbursement to the client directly. Every plan has different out-of-network benefits, and it is the responsibility of my clients to contact their insurance provider for more information on out-of-network deductibles, eligible expenses and conditions, reimbursement rates and co-insurance.
- I have Opted-Out of Medicare. This means that I can serve Medicare beneficiaries, but they cannot submit for reimbursement by Medicare, nor will I bill Medicare for services rendered.
- To use out-of-network insurance benefits for reimbursement, the insurance companies usually require a diagnosis of a "qualifying condition." If you qualify for a diagnosis, I will discuss this with you, and it will be your choice as to if you wish for me to document this for insurance purposes. If you opt for no diagnosis, insurance will likely not pay for services, and you will be responsible for the full cost of your treatment and will not be reimbursed by your insurance company. There is also no guarantee that your insurance company will reimburse you for out-of-network services, and it is clients' responsibility to confirm and pre-authorize with their insurance provider.
- It is not uncommon for insurance companies to question if "couple therapy" is an eligible service. I bill couple therapy under the code for "Family Therapy" (CPT Code 90847), as couple therapy is one form of family therapy. If you plan to ask insurance for reimbursement for couple therapy service expenses, you should contact them ahead of time to inquire about if they reimburse for this service in this way. It is my clients' responsibility for honestly, ethically, and legally submitting to their insurance companies for reimbursement.
Scheduling & Cancellations
I operate a limited clinical practice, with scheduling by the hour, on the hour as follows:
In order to provide fair and consistent access and effective services to current and wait listed clients, this practice operates through scheduled routine appointment slots, and does not routinely schedule ad hoc sessions except for same-week rescheduling where available. These slot frequencies are either weekly or biweekly for most clients, or monthly for long-term (6+ months) and stable clients in maintenance therapy at the clinician’s discretion. In order to occupy and maintain a slot, clients must commit to one of these frequencies and agree to adhere to the following payment and retainer policy for missed appointments. This policy is to encourage attendance for reserved recurring appointment times, and out of fairness for those waiting for our services, as we only take on a limited number of clients at any given time, usually keep a standing wait list, and do not admit clients from the wait list to fill in empty schedules except when current clients conclude services needing the recurring appointment times, and routine slots come available. This scheduling and fee practice promotes effectiveness in your therapy, ensures you have an appointment time and frequency that is predictable to you, and is fair to those on our list waiting for a slot to open. Please note, insurance will not reimburse for any unattended sessions.
All clients are required to give 48 hours notification by email or voice mail for cancellations, or are otherwise considered “late cancellations.” For late cancellations, clients are responsible for payment of full session fee at the clinician’s discretion.
For cancellations with more than 48 hours notice, these are considered standard “cancellations.” For cancellations, there remains a retainer policy to maintain designated appointment slots and be seen in this practice. For weekly frequency, if a client cancels or misses more than 25% of appointments in a month (more than 1 appointment in any given month), they are still responsible for payment of 50% of the session fee for additional cancellations at the clinician’s discretion. For bi-weekly frequency, this policy remains in effect if a client has more than 25% cancellations every two months (1 appointment for every two-month window). Monthly frequency, if cancelled, are subject to 50% session fee at the clinician’s discretion. If the cancelled appointments can be rescheduled for another opening during that week, and that time is available in the clinician’s calendar, there is no penalty for changing the appointment and will not be counted as cancelled.
Fee is never charged if the clinician is unable to attend sessions (i.e. injury or illness, or practitioner time off). Clients are never held responsible to pay for a cancelled appointment when the clinician/practitioner is unavailable to meet for any reason.
- Mondays-Fridays 8am-12pm
In order to provide fair and consistent access and effective services to current and wait listed clients, this practice operates through scheduled routine appointment slots, and does not routinely schedule ad hoc sessions except for same-week rescheduling where available. These slot frequencies are either weekly or biweekly for most clients, or monthly for long-term (6+ months) and stable clients in maintenance therapy at the clinician’s discretion. In order to occupy and maintain a slot, clients must commit to one of these frequencies and agree to adhere to the following payment and retainer policy for missed appointments. This policy is to encourage attendance for reserved recurring appointment times, and out of fairness for those waiting for our services, as we only take on a limited number of clients at any given time, usually keep a standing wait list, and do not admit clients from the wait list to fill in empty schedules except when current clients conclude services needing the recurring appointment times, and routine slots come available. This scheduling and fee practice promotes effectiveness in your therapy, ensures you have an appointment time and frequency that is predictable to you, and is fair to those on our list waiting for a slot to open. Please note, insurance will not reimburse for any unattended sessions.
All clients are required to give 48 hours notification by email or voice mail for cancellations, or are otherwise considered “late cancellations.” For late cancellations, clients are responsible for payment of full session fee at the clinician’s discretion.
For cancellations with more than 48 hours notice, these are considered standard “cancellations.” For cancellations, there remains a retainer policy to maintain designated appointment slots and be seen in this practice. For weekly frequency, if a client cancels or misses more than 25% of appointments in a month (more than 1 appointment in any given month), they are still responsible for payment of 50% of the session fee for additional cancellations at the clinician’s discretion. For bi-weekly frequency, this policy remains in effect if a client has more than 25% cancellations every two months (1 appointment for every two-month window). Monthly frequency, if cancelled, are subject to 50% session fee at the clinician’s discretion. If the cancelled appointments can be rescheduled for another opening during that week, and that time is available in the clinician’s calendar, there is no penalty for changing the appointment and will not be counted as cancelled.
Fee is never charged if the clinician is unable to attend sessions (i.e. injury or illness, or practitioner time off). Clients are never held responsible to pay for a cancelled appointment when the clinician/practitioner is unavailable to meet for any reason.
"No Secrets" Policy for Couples and Families
It is common for one or more parties to enter couples and family therapy withholding a secret they believe will hurt the other and are afraid to share. If during the course of treatment an individual client communicates to me that they have a secret (e.g. a current or past affair, infidelity, or breach of marital contract), I will not share your secrets with your partner without your consent, but I insist you share them in order to continue with me as your couples or family therapist. Some secrets need to be shared immediately (such as affairs and concealed addictions), and others can wait with the intention of sharing later (such as the history of a trauma). If sharing a secret could trigger a safety problem, then this is a case-by-case matter we will need to discuss, including if the relationship can be safe enough to be appropriate for treatment in couples therapy.
Why this policy?
In essence, improving your relationship requires increasing trust and intimacy, and secrets inherently block trust and intimacy by leaving the secret keeper disconnected from and anxious about at some level about their partner, usually because they are left alone with the fear of the consequences of sharing. If you have a secret, I would ask you, what kind of relationship... what kind of intimacy... do you want to have? One where you live apart from your partner/family with a secret in fear, unable to build and keep trust with the person you want connection and acceptance with? My view of couples and family therapy is to cultivate your intimacy, trust, and openness to each other and reduce fear and undo aloneness. Keeping secrets for one or more partners can make it impossible for me hold the trust of both partners.
What about disclosure?
Tensions and pain can erupt when secrets are revealed and disclosed. I encourage initial disclosures (e.g. that there is a secret, and essentially what kind of secret) to be made in private, at-home, and not in session. For secrets such as affairs or pornography use, where there are many details that can trigger explosive emotions, I recommend that details be discussed in session. For affairs where sex was involved, I recommend against discussing ANY sexual details except that sexual contact happened, if STD protection was used, and any follow up with medical care as needed. Knowing the details of acts are ultimately not necessary for recovery, and can be harmful to the betrayed person.
Why this policy?
In essence, improving your relationship requires increasing trust and intimacy, and secrets inherently block trust and intimacy by leaving the secret keeper disconnected from and anxious about at some level about their partner, usually because they are left alone with the fear of the consequences of sharing. If you have a secret, I would ask you, what kind of relationship... what kind of intimacy... do you want to have? One where you live apart from your partner/family with a secret in fear, unable to build and keep trust with the person you want connection and acceptance with? My view of couples and family therapy is to cultivate your intimacy, trust, and openness to each other and reduce fear and undo aloneness. Keeping secrets for one or more partners can make it impossible for me hold the trust of both partners.
What about disclosure?
Tensions and pain can erupt when secrets are revealed and disclosed. I encourage initial disclosures (e.g. that there is a secret, and essentially what kind of secret) to be made in private, at-home, and not in session. For secrets such as affairs or pornography use, where there are many details that can trigger explosive emotions, I recommend that details be discussed in session. For affairs where sex was involved, I recommend against discussing ANY sexual details except that sexual contact happened, if STD protection was used, and any follow up with medical care as needed. Knowing the details of acts are ultimately not necessary for recovery, and can be harmful to the betrayed person.
Confidentiality
As Licensed Clinical Social Workers, we are bound by the National Association of Social Workers Code of Ethics to dutifully keep all information you tell us as a client confidential unless you authorize, in writing, our release of your information to specified parties for specified reasons. There are exceptions to this, where we have a duty to report as specified by North Carolina law:
- Cases where a client poses an imminent threat to their own safety
- Cases where a client poses an imminent threat to the safety of others
- Cases where a minor client or client's minor child is suspected of being neglected and/or abused by a parent, guardian, custodian, or caretaker
- Cases where a disabled or elder adult client or ward of a client is suspected of being abused, neglected, and/or exploited by their caretaker.
Crisis Care
This practice is not a crisis services provider. This means that clients experiencing a psychiatric, mental health, or behavioral emergency need to contact one of the following:
- 911
- Nearest emergency department
- Local Managed Care Organization (e.g. Alliance Behavioral Health Care, Cardinal Innovations)
If you have more questions or concerns about my practice policies, fees, insurance participation, or attendance policy, please call 919-267-1661 or email [email protected]
