Therapy Hour: The Therapy "Hour" is actually 45 minutes. Scheduled appointments begin on the hour (i.e.2:00 pm). If you are late for an appointed hour, the missed time is forfeited. If I am late, the time will be made up or the fee will be adjusted.
Cancellation Policy: Unless 48 hours notice is given for cancellation, you will be charged for the scheduled appointment at my standard fee of $125.00. Insurance companies cannot be billed for missed appointments.
Fee/Payment Policy: The fee will be established prior to the 1st Consultation. Payment is expected at the beginning of the scheduled appointment. My standard fee is $125.00 per 45 minute session. Phone calls will be charged in quarter hour increments at $35.00 per 15 minutes. Insurance companies cannot be charged for phone calls.
Insurance and Case Management: I will cooperate so that your insurance company pays you unless other arrangements have been made. If your mental health insurance benefit is managed by a managed care company, we will discuss payment procedures as they are determined by your plan. Please be aware that all managed care plans involve direct clinical management by the company. This makes it necessary for us to work together with your company to determine the nature of your treatment and, therefore, does have some impact on confidentiality.
Release of Information to Health Insurance Plan: “I acknowledge the release of information for claims, certifications/case management/quality improvement and other purposes related to the benefits of my Health Insurance Plan."
Termination Policy: An appointment for discussing termination of therapy is expected. This can be done during regularly scheduled time with at least two weeks notice.
Confidentiality: The information disclosed by Client is confidential and will not be released to any third party without written authorization from Client, except where required or permitted by law. Exceptions to confidentiality, include, but are not limited to, reporting child, elder and dependent adult abuse, when a Client makes a serious threat of violence towards a reasonably identifiable victim, when a Client’s records or other information are sought by federal law enforcement under the USA Patriot Act, or when a Client is dangerous to him/herself or the person or property of another.
Consent for Treatment/Treatment Philosophy: During the initial evaluation period we will clarify the nature of the problems for which you are seeking treatment, define some reasonable treatment goals, and develop a treatment plan that will assist you in achieving these goals. You will participate in ongoing review of your progress and updating of your treatment plan as appropriate. While the course of treatment is designed to be helpful, it may, at times, be difficult and uncomfortable.
Emergencies: If you are in imminent danger, call 911 or your nearest police department or hospital emergency room. I am not available for after hours clinical emergencies. Generally, all calls received are returned by me Monday through Friday from 9 AM to 5 PM.
Records Policy: Client records will be kept by this office for 7 years beginning with the last day of treatment.
License: I am a Licensed Marriage & Family Therapist (LMFT) (MFC# 33118),a Certified Alcohol & Drug Counselor I (CADCI) (C8538404) and a Board Certified Behavior Analyst (BCBA) (1-10-6767).
Fictitious Business Name: Palm Springs Psychotherapy Associates is owned by J.M. Evosevich. All Clinicians in this office conduct independent practices and are not affiliated.