Policies

Client-Counselor Service Agreement

Welcome to Meadowlark Counseling, Supervision, and Consultation (Meadowlark CSC). This document contains important information about our professional services and business policies. It also contains a summary of information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights around the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. Although these documents are long and sometimes complex, it is very important that you understand them. When you sign this document, it will also represent an agreement between us. We can discuss any questions you have when you sign them or at any time in the future.

Counseling is a relationship between people that works in part because of clearly defined rights and responsibilities held by each person. As a client in counseling, you have certain rights and responsibilities that are important for you to understand. There are also legal limitations to those rights that you should be aware of. Your counselor has corresponding responsibilities to you. These rights and responsibilities are described in the following sections.

Goals of Counseling

There can be many goals for the counseling relationship. Some of these will be long term goals such as improving the quality of your life, learning to live with mindfulness and increase self-actualization. Others may be more immediate goals such as decreasing anxiety and depression symptoms, developing healthy relationships, changing behavior or decreasing/ending substance use. Whatever the goals for counseling, they will be set by the clients according to what they want to work on in counseling. The counselor may make suggestions on how to reach that goal but you as the client decide where you want to go.

Risks/Benefits of Counseling

Counseling is an intensely personal process which can bring unpleasant memories or emotions to the surface. There are no guarantees that counseling will alleviate all symptoms or fix problems entirely. Progress may happen slowly and if often non-linear. Counseling requires a very active effort on your part. In order to be most successful, you will have to work on the things we discuss outside of sessions (e.g. you will likely have therapeutic “homework.”)

However, there are many benefits to counseling. Counseling can help you develop coping skills, make behavioral changes, reduce symptoms of mental health disorders, move past distressing life events, improve the quality of your life, learn to manage strong emotions, learn to live in the present, and many other advantages.

Appointments

Appointments will ordinarily be about 60 minutes in duration, at an agreed upon frequency (from twice per week to once per month) at a time we agree on. Some sessions may be more or less frequent as needed which would be discussed and agreed upon by both client and counselor. The time scheduled for your appointment is assigned to you and you alone (i.e. I will never double book your scheduled time). If you need to cancel or reschedule a session, I ask that you provide me with 24 hours’ notice. If you miss a session without canceling, or cancel with less than 24 hour notice, you will be automatically charged the cost of your session. This will be charged to your card on file. It is important to note that insurance companies do not provide reimbursement for cancelled sessions; thus, you will be responsible for the cancelation fee. In addition, you are responsible for coming to your session on time. Sessions will be considered cancelled if the client is later than 15 minutes without giving notice. Sessions that begin late will still end at their originally scheduled time.

Confidentiality

Your counselor will make every effort to keep your personal information private. If you wish to have information released, you will be required to sign a consent form before such information will be released. There are some limitations to confidentiality to which you need to be aware. Your counselor may consult with a supervisor or other professional counselor in order to give you the best service possible. In the event that your counselor consults with another professional, no identifying information such as your name would be released. Counselors are required by law to release information when the client poses a risk to themselves or others and in cases of abuse to vulnerable individuals (e.g. children or the elderly). If your counselor receives a court order or subpoena, they may be required to release some information. In such a case, your counselor will consult with other professionals and limit the release to only what is necessary by law.

If you are a minor, your parents may be legally entitled to some information about your therapy. I will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately kept confidential.

Confidentiality and Group Therapy

The nature of group counseling makes it difficult to guarantee confidentiality. If you choose to participate in groups, be aware that your counselor cannot guarantee that other group members will maintain your confidentiality. However, your counselor will make every effort to maintain your confidentiality by reminding group members frequently of the importance of keeping what is said in group confidential as well as limiting use of outside technology. Group facilitators will remind you and other group members that no pictures, screenshots, videos, or other forms of recording are allowed and to only use first names in group. Your counselor also has the right to remove any member from the group should they discover that a group member has violated the confidentiality rule.

Confidentiality and Technology

For contact purposes, some clients may choose to use various forms of technology (phone, text, email, etc). Your counselor will take every precaution to safeguard your information but cannot guarantee that unauthorized access to electronic communications could not occur. Please be advised to take precautions with regard to authorized and unauthorized access to any technology used in counseling contact. Be aware of any friends, family members, significant others or co-workers who may have access to your computer, phone or other technology used in your counseling contact. Should a client have concerns about the safety of their email/ technological messaging, it is suggested to avoid using personal identification information in said contact. For example, please do not send an email containing your full name, birthday, and social security number. Instead, identify your first name, last initial, and a phone number where I can reach you.

Other Telehealth Considerations

In regards to telehealth counseling, your counselor will take every precaution to maintain your confidentiality while working from home. This may include conducting your session with headphones, ensuring no other family members are home, or isolating to a section of the house where no one else can hear your conversation. Similarly, we ask the client to also provide themselves with a safe and secure location for sessions.

The client is responsible for providing her or his own technology and service plan for telehealth. Meadowlark CSC is not responsible for loss of connectivity, data usage, or any other technological needs.

There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel / childcare costs. Effective therapy is often facilitated when the therapist gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third person consultations, but also from direct visual and olfactory observations, information, and experiences. When using information technology in therapy services, potential risks include, but are not limited to the therapist’s inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: your physical condition including deformities, apparent height and weight, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), facial and body language, and congruence of language and facial or bodily expression. Potential consequences thus include the therapist not being aware of what he or she would consider important information, that you may not recognize as significant to present verbally the therapist.

Due to the importance of your confidentiality and the importance of minimizing dual relationships, I do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.

Electronic and Phone Communication

I cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations (non-clinical correspondence), I will do so. While I may try to return messages in a timely manner, I cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.

Counselor will request client’s email address for Simple Practice client portal access. Counselor may also use email for nonclinical correspondence. Counselor may use email addresses to periodically check in with clients who have ended therapy suddenly. Counselor may also use email addresses to send newsletters with valuable therapeutic information such as tips for depression or relaxation techniques. Counselor also has a blog/ website and if this is appropriate for the client, counselor may send information through email about subscribing to the blog or information related to mental health and wellness. Counselor’s email is kristy@meadowlarkcsc.com and website is meadowlarkcsc.com. If you would like to opt out of email correspondence, please inform your counselor.

I am often not immediately available by telephone. I do not answer my phone when I am with another client or otherwise unavailable. At these times, you may leave a message on my voicemail (Kristy- (609)-269-4732) Erin- (732)-931-5775) and your call will be returned as soon as possible, but it may take a day or two for non-urgent matters. If you feel you cannot wait for a return call or it is an emergency situation, call 911 or your mobile mental health response service for your county. Please do not send texts of clinical or urgent nature.

Record Keeping

Your counselor will keep an electronic health record of your counseling sessions, treatment plans, forms, documents, and payments. These records are kept to ensure a direction to your sessions and continuity in service. They will not be shared except with respect to the limits to confidentiality discussed in the Confidentiality section. Should the client wish to have their records released, they are required to sign a release of information which specifies what information is to be released and to whom. Records will be kept for at least 3 years but may be kept for longer. Records are securely hosted with the HIPAA compliant electronic health record system, Simple Practice.

Professional Fees

You are responsible for paying at the time of your session unless prior arrangements have been made. Payment can be made by cash, check, or credit card. If you refuse to pay your debt, your counselor reserves the right to use an attorney or collection agency to secure payment.

If you anticipate becoming involved in a court case, I recommend that we discuss this fully before you waive your right to confidentiality. If your case requires my participation, you will be expected to pay for the professional time required.

Fees are non-negotiable. To receive sliding scale fees, you must present proof of income through recent pay stubs or tax forms. Fees are subject to change at counselor’s discretion.

A valid credit/debit or HSA/FSA card is required to be on file prior to the first intake appointment. For ongoing sessions, a credit card is also required to be on file for the following reasons:

Session payment (if the patient or parent/guardian chooses)
Failure to pay for scheduled sessions
Appointments canceled with less than 24 hours notice
No show appointments
HSA/FSA cards will not authorize payment for appointments that were not attended. If either of these cards are on file, you will be required to pay a no-show appointment or late cancel session fee with a valid debit or credit card

Insurance

If you have a health insurance policy, it will usually provide some coverage for mental health treatment. With your permission, I will assist you to the extent possible in filing claims and ascertaining information about your coverage, but you are responsible for knowing your coverage and for letting me know if/when your coverage changes.

You should also be aware that most insurance companies require you to authorize your counselor to provide them with a clinical diagnosis and additional clinical information which will become part of the insurance company files. By signing this Agreement, you agree that Meadowlark CSC can provide requested information to your carrier if needed.

For accessing out-of-network benefits, I will supply you with a receipt of payment for services (superbill), which you can submit to your insurance company for reimbursement. Payments must be made directly to Meadowlark CSC Please note that not all insurance companies reimburse for out-of-network providers.

Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. Your Good Faith Estimate will not include any voluntary add-on services that you select during your course of treatment and were not anticipated at the time of the estimate’s creation. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.

Termination

Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve a degree of closure. The appropriate length of the termination depends on the length and intensity of the treatment. I may terminate treatment after appropriate discussion with you and a termination process if I determine that the psychotherapy is not being effectively used or if you are in default on payment. I will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, I will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.

Should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued.

Inquiries and Complaints

If you are concerned your treatment or that your privacy rights have been violated, or you disagree with a decision made about your care, you are encouraged to speak with your therapist regarding the issue. If the complaint is regarding your therapist, you may also outreach an owner of the agency (Kristy or Erin). If this issue cannot be addressed internally within 10 business days, you have the right to notify the Professional Counselor Examiners Committee, PO Box 45007, 124 Halsey Street, Newark, New Jersey 07101, www.njconsumeraffairs.gov.