This Policy Statement and Treatment Consent is between Therapy Treatment Team, LLC (which includes its employees and therapists, referred to hereinafter as “Therapy Treatment Team, LLC”, “we”, “us”, “our”, and “therapist(s)”, and clients, referred to hereinafter as “client or you”.

PROCESS OF THERAPY/EVALUATION:

Participation in therapy can result in several benefits to you, including improving interpersonal relationships and resolution of the specific concerns that led you to seek therapy. Working toward these benefits requires effort on your part. Psychotherapy requires  active involvement, honesty, and openness to change your thoughts, feelings, and/or behavior. Throughout the course of your treatment, your therapist will ask for your feedback and views on your therapy and progress. You are encouraged to respond openly and honestly to this as sometimes more than one approach can help deal with a certain situation.

For the counseling process to be successful, your commitment to the process is essential. This commitment includes regular attendance, active participation, and completion of the process through planned termination of counseling services. Homework may be used between sessions to help enhance your growth process. You may initially begin to find some relief of symptoms, and this may make it tempting to terminate services. However, this initial relief is often temporary if counseling is stopped abruptly. Because all therapists want to see you have the greatest growth possible during the time you are here, we will work with you to plan a successful wrap-up. This is an important part of the counseling process, and we highly encourage you to honor your work by not neglecting this phase.

During evaluation or therapy, be mindful that remembering or talking about unpleasant events, feelings, or thoughts can result in considerable discomfort or strong feelings of anger, sadness, worry, fear, or experiencing anxiety, depression, insomnia, etc. Therapy may challenge some of your assumptions or perceptions or propose different ways of looking at, thinking about, or handling situations that can cause you to feel upset, angry, depressed, challenged, or disappointed.

Additionally, attempting to resolve issues that brought you to therapy in the first place, such as personal or interpersonal relationships, may result in changes that were not originally intended. Psychotherapy may result in decisions about changing behaviors, employment, substance use, schooling, housing, or relationships. Sometimes a decision that is positive for one family member is viewed quite negatively by another family member. The experience of you changing while in therapy will sometimes happen quickly, but more often it will take time and patience on your part. There is no guarantee that psychotherapy will yield positive or intended results.

During therapy, our therapists will utilize various psychological and motivational approaches according to the problem that is being treated and the assessment of what will best benefit you. These approaches include but are not limited to behavioral, cognitive-behavioral, psychodynamic, existential, system/family, developmental (adult, child, family, and couples), psycho-educational, solution-focused, or coaching techniques.

OFFICE POLICIES:

All clients are required to read and sign the Therapy Treatment Team, LLC informed consent and policy documents before their first visit. Please note that you may schedule an appointment by calling our offices. Your scheduled appointment indicates acceptance of our HIPAA and informed consent policies which are regularly updated.

If you are in crisis or this is a life-threatening emergency go to the nearest emergency room for assistance. Office and online appointments are NOT appropriate for acute and crisis situations. If you are a current client, please contact the office and/or your therapist and we will discuss what happened AFTER you are seen by someone in the emergency room.

In counseling sessions, confidentiality is key. Your confidence is safeguarded with the exceptions of what is outlined in the informed disclosures below. You will be seen according to your confirmed appointment. We use an online scheduling system that will send a reminder email, and/or text, and/or voice message. To schedule or reschedule an appointment please call one of our offices. All appointments (first-time and recurrent) MUST check-in with the office manager before starting your appointment with your therapist.

DUAL RELATIONSHIPS:

This is a small world and you and your therapist may see each other in the community. If you see each other outside of the office, your therapist may smile and say “Hi” in a generally friendly way as they might do with everyone in our community. The therapist will wait for you to initiate the interaction with them before they directly address you. 

In addition, we will never acknowledge working therapeutically with anyone without his/her written permission. In some instances, even with permission, we will preserve the integrity of our working relationship. For this reason, we will not accept any invitations via social media sites such as Facebook, Twitter, Linkedin, or Pinterest, nor will we respond to blogs written by clients or accept comments on our blog(s) from clients.

Not all dual relationships are unethical or avoidable. However, sexual involvement between therapist and client is never part of the therapy process as well as other actions or dual relationship situations that might impair your therapist’s objectivity, clinical judgment, or therapeutic effectiveness or that could be exploitative in nature.

TERMINATION AND REFERRAL:

 During the initial intake process and the first couple of sessions, the therapist will assess if they can be of benefit to you. If you have requested online consultation, their assessment will include your suitability for psychotherapy delivered via technology. Therapy Treatment Team, LLC does not accept clients who, in our opinion, we cannot help. An example of this may be, but is not limited to the client having symptoms that we are not trained to work with, or the situation the client is experiencing can no longer be helped by members of our team. In such a case, your therapist will give you several referrals that you may contact. 

If at any point during psychotherapy, your therapist assesses that he/she is not effective in helping you reach your therapeutic goals, your therapist is obliged to discuss this with you up to and including termination of treatment.  Your responsibility is to make a good faith effort to fulfill the treatment recommendations to which you have agreed. If you have concerns or reservations about our treatment recommendations, you are strongly encouraged to express them so that the therapist can resolve any possible differences or misunderstandings. In such a case, the therapist would give you several referrals that may be of help to you. If you request and authorize it in writing, the therapist will talk to the psychotherapist of your choice to help with the transition.

Deciding when to stop working together is meant to be a mutual process. Before termination, the therapist will discuss how you will know if or when to come back or whether a regularly scheduled “check-in” might work best for you. Noncompliance with treatment recommendations may necessitate early termination of services. Non-compliance can include but is not limited to repeated cancellations, no-shows, or showing up late to your appointments. If you do not show, repeatedly cancel your appointments, and/or show up late to your appointments, we reserve the right to terminate your treatment unilaterally and immediately.

If at any time you want another professional’s opinion or wish to consult with another therapist, we will assist you in finding someone qualified, and, if we have your written consent, we will provide her or him with the essential information needed. You have the right to terminate therapy at any time. If you choose to do so, we will offer to provide you with names of other qualified professionals whose services you might prefer. Please see the cancelation and no-show policy below for more information on how we reserve to terminate therapy due to multiple cancelations or no-shows. 

If you commit violence to, verbally or physically threaten, or harass a therapist or other personnel in our offices, or your therapist, or the family of anyone else in our offices, we reserve the right to terminate your treatment unilaterally and immediately. Failure or refusal to pay for services after a reasonable time is another condition for termination of services. Please contact the office to make arrangements any time should your financial situation change.

PRIVACY & CONFIDENTIALITY

All information disclosed within sessions and the written records about those sessions are confidential and may not be revealed to anyone without your written permission, except where disclosure is required by law. Likewise, you are expected to keep our communications confidential and you understand that all records of communication between client and therapist remain the property of Therapy Treatment Team, LLC. Verbatim material from therapy sessions remains in the client’s record and should never be revealed publicly unless both client and therapist agree. Most of the provisions explaining when the law requires disclosure were described to you in the Notice of Privacy Practices that you received with these forms.

FOR PARENTS:

At Therapy Treatment Team, LLC we work hard to gain your child’s trust so that the therapeutic process can have the utmost benefit to them. For this reason, we do not consult with parents in person during the first appointment. We may talk to parents or consult with a parent in person in front of the child at the office in some circumstances, if we determine this will benefit the progress and wellbeing of your child. After the first appointment with your child, please expect the following: a. the therapist will consult with parents on the phone or over video without the child being present, b. we request that you maintain any information discussed about your child between you and the child’s therapist, c. please communicate with your child’s therapist about your desire to have other consultation calls after future appointments, and d. our therapists are glad to schedule a consultation call after an appointment with your child at your request. If you would like to consult regarding your child every week, the therapist will end the sessions with your child anywhere from 30 to 40 minutes to give time to consult with you on the phone at a different time. 

Generally, the treatment of a minor (under the age of 18) must be authorized by a parent or someone else with legal authority. Parental control over a minor’s treatment includes parents without residential responsibility for a child who retain decision-making authority over the child’s treatment and treatment records because a court has ordered it. When parents with decision-making authority cannot agree on access to or release of their child’s confidential treatment information, a court will decide that matter following a hearing. 

Please note that by signing this document you agree that Therapy Treatment Team, LLC is not legally or ethically liable for reviewing, understanding, or assessing legal documents regarding child custody cases. If a parent who has shared custody makes an appointment without the consent of the other parent Therapy Treatment Team, LLC is not legally or ethically liable for the misconduct of the parent who is violating the legal agreement. Therapy Treatment Team, LLC reserves the right to terminate treatment for your child if your initial treatment consent was not properly or legally signed by both parents. 

We believe it is best to identify and resolve potential parental agreements before treatment begins. Therefore, it is our policy to involve both parents when treating minors, to the extent both are available. If both are available but cannot reach an agreement about treatment and access to records, it is the responsibility of the parents to resolve their differences through a court hearing before continuing treatment with Therapy Treatment Team, LLC.

If one parent is unavailable and we determine that it is appropriate to proceed with the consent of only one parent, the absent parent will have the right to the child’s treatment records upon request while the child is a minor unless there is a court order to the contrary. If the continuation of treatment becomes an issue, it is the responsibility of the parents to resolve the disagreement in court, and Therapy Treatment Team, LLC has the right to terminate and provide both parents with three different referral sources for the continuation of treatment if desired. 

Consistent attendance is especially important for effective therapy. Therapy Treatment Team, LLC will schedule follow-up sessions directly with your child. It is your responsibility to check in with your child or Therapy Treatment Team, LLC to know when the next scheduled therapy session takes place. 

Please note that upon turning 18, the child gains control over treatment, information, and records.

WHEN DISCLOSURE MAY BE REQUIRED:

Some of the circumstances where disclosure is required by the law without consent are: a. when there is a reasonable suspicion of child, dependent or elder, abuse or neglect; and b. when a client presents a danger to self, to others, to property, or is gravely disabled (for more details see also Notice of Privacy Practices form), or c. when subpoenaed by a court of law.

Disclosure may be required according to a legal proceeding or other matters.  If you are involved in a custody dispute or if you place your mental status at issue in litigation initiated by you, the defendant may have the right to obtain the psychotherapy records and/or testimony by your therapist. In couple and family therapy, or when different family members are seen individually, confidentiality and privilege do not apply between the couple or among family members. 

The Therapy Treatment Team will use clinical judgment when revealing such information. We will not release records to any outside party unless we are authorized to do so by you or in the case of children/family by all adult family members who were part of the treatment. In most situations, we can only release information about your treatment to others (teachers, primary care doctors, other professionals working with you) if you sign a written Authorization to Release Information form. You have the option to either give or decline consent to release information at any time. 

There are some situations where we are permitted or required to disclose information without your consent: 

•  Court order. If you are involved in a court proceeding and a request is made for information concerning your treatment or your child’s treatment, we will not disclose that information without your consent, unless there is a court order to do so. 
• Communication for protection. If you threaten to harm yourself, we may be obligated to contact family members or others who can help provide protection. 
• Legal complaint. If you file a complaint or lawsuit against one of our therapists, Therapy Treatment Team, LLC may disclose relevant information to defend our case. 
• Periodic consultation with mental health colleagues, all of whom are legally bound to maintain confidentiality. During these case reviews, every effort will be made to avoid revealing your name/identity. 
• Communication with your insurance company, at your request. The information we submit under your claims will become part of the insurance company’s files, which the Therapy Treatment Team,LLC has no control over. 

It is important that you discuss any questions or concerns you may have about confidentiality with your therapist. If such situations arise, your therapist and Therapy Treatment Team,LLC will make every effort to fully discuss them with you before acting, and we will limit my disclosure to what is necessary.

HARM TO SELF OR OTHERS-BAKER ACT 52:

If there is an emergency during your work with Therapy Treatment Team, or in the future after termination, in which one of the therapists becomes concerned about your personal safety, the possibility of you injuring someone else, or about you receiving proper psychiatric care, the therapist will do whatever can be done within the limits of the law to prevent you from injuring yourself or others and to ensure that you receive the proper medical care. For this purpose, we may also contact the police, hospital, or an emergency contact whose name you have provided.

CONFIDENTIALITY OF ONLINE, CELL PHONES, AND FAX COMMUNICATION:

 Therapy Treatment Team communicates via email for scheduling purposes only. All therapeutic issues are discussed in the office. If you choose to email your therapist from your email account or by text, please limit the contents to issues such as cancellation or change in appointment time. Email and text messages are not guaranteed to be confidential. If you choose to communicate with your therapist this way, you do so understanding that we cannot guarantee that these modes of communication are confidential. Additionally:

•  Text messaging via mobile phone is acceptable for appointments and housekeeping issues only.
• If you call your therapist or someone else in our team, please be aware that unless we are both on landline phones, the conversation is not confidential.
• If you send a fax to the Therapy Treatment Team, LLC, our fax is secure.
• Any computer files referencing our communication are maintained using secure and encrypted measures.
• Our therapists will not respond to personal and clinical concerns via regular email.
• If you wish to use email as a way to “journal” information between sessions, you understand that your therapist may not have the opportunity to review your journal emails until your next scheduled session.
• You understand that emails between sessions that contain confidential information may be intercepted in transmission.

Therapy Treatment Team, LLC makes every effort to keep all information confidential. Likewise, if we are working online together, Therapy Treatment Team, LLC asks that you determine who has access to your computer and electronic information from your location, including: family members, co-workers, supervisors, and friends, and whether or not confidentiality from your work or personal computer may be compromised.  We encourage you to only communicate through a computer that you know is safe i.e. wherein confidentiality can be ensured.  Be sure to fully exit all online counseling sessions and emails.

 If you used location-based services on your mobile phone, you may wish to be aware of the privacy issues related to using these services. We do not place our practice as a check-in location on various sites such as Foursquare. However, if you have GPS tracking enabled on your device, others may surmise that you are a therapy client due to regular check-ins at our office weekly. Please be aware of this risk if you are intentionally “checking in,” from our offices or if you have a passive LBS app enabled on your phone.

 It is not a regular part of the practice to search for client information online through search engines such as Google or social media sites such as Facebook. Extremely rare exceptions may be made during times of crisis. If your therapist has a reason to suspect that you are in danger and you have not been in touch with them via usual means (coming to appointments, phone, or email) there might be an instance in which using a search engine (to find you, find someone close to you, or to check on your recent status updates) becomes necessary as part of ensuring your welfare. These are unusual situations and if Therapy Treatment Team, LLC ever resorts to such means, Therapy Treatment Team, LLC will fully document it and discuss it with you at your next session.

COUPLES:

Treatment records of couples sessions contain information about each person. Both clients should be aware that either person has a right to obtain treatment records. If one of you requests your records, it is the Therapy Treatment Team, LLC policy to notify the other member of the couple and to afford that individual an opportunity to receive a copy of the records as well. Additionally, couple’s treatment is done with the couple and with the relationship being the goal of each treatment session.  A couple’s sessions is for the couple, not for each individual in the relationship.

COURT-ORDERED TREATMENT:

If you are seeing one of our therapists due to a court order requiring you to seek treatment, it is our policy that we do not proceed with treatment until we have received a copy of the court order and have had the opportunity to review it. Because you have been ordered by the court to obtain treatment, there are limits to confidentiality in addition to ones described in the paragraph entitled Confidentiality. For example, we may be obligated to file a report with the court that ordered you to seek treatment or with someone else. By signing below, you understand that your limits of confidentiality are different if you are seeking treatment from one of the Therapy Treatment Team, LLC therapists because you were court-ordered to do so.

GROUP THERAPY:

Unlike individual treatment, the confidentiality of group therapy is not privileged, and therefore not protected by law. Group members must sign and abide by a written confidentiality agreement prior to participating in the group. Clients with concerns about confidentiality should discuss them before beginning treatment.

DIAGNOSIS:

Therapy Treatment Team, LLC will diagnose based on the discussions, disclosures, and symptoms you share during  sessions. Insurance companies require diagnosis and treatment planning which can dictate treatment. If you do not want your diagnosis to be shared with your insurance company, you have the option of being self-pay which will not require for your diagnosis to be shared with the exceptions listed above under the section called WHEN DISCLOSURE MAY BE REQUIRED. You have the right to know your diagnosis and to discuss any questions you have about it with your therapist. Therapy Treatment Team, LLC will only discuss your diagnosis in person or via video Telehealth appointments. Therapy Treatment Team, LLC will not respond, answer, or engage in conversations regarding your diagnosis or other details of your session via email, text, or other forms of communication. To discuss your diagnosis or any other questions you have about the treatment we provide or provided you, please schedule an appointment with your therapist. If your therapist is not available, an appointment can be made with one of our clinical directors. 

LITIGATION AND FORENSIC LIMITATIONS:

Due to the nature of the therapeutic process and the fact that it often involves making a full disclosure concerning many matters which may be of a confidential nature, it is agreed that should there be legal proceedings (such as, but not limited to divorce and custody disputes, injuries, lawsuits, etc.), neither you (client) nor your attorney, nor anyone else acting on your behalf will call on one of our therapists to testify in court or at any other proceeding, nor will disclosure of the psychotherapy records be requested. We do not participate or get involved in litigation matters unless we have been hired as an expert witness.

It is the stated philosophy and policy of Therapy Treatment Team, LLC that we do not participate in lawsuits, court proceedings, or litigations of any type on a plaintiff’s behalf unless compelled to do so by a court order signed by a judge. If you become involved in legal proceedings that requires your therapist’s participation due to a court order signed by a judge, you will be expected to pay for all of the therapist’s professional time, including but not limited to: preparation, documentation, report writing, evaluation writing, note preparation, deposition, telephone time, transportation costs, court appearance, report writing, consultation, and supervision, even if we are called to testify by another party. Because of the complexity of legal involvement, any court appearance or telephone contact with the court during a court case regarding the client or the client’s family members in a civil or criminal matter will be charged at $2500.00 per day, payable two weeks in advance and non-refundable. Travel time will be billed at an hourly rate of $175.00 per hour, plus mileage portal to portal. Depositions will be charged at $175.00 per hour plus travel time, wait time, and transportation costs portal to portal. If records or other materials are subpoenaed, the office’s regular fees for records will be charged for copying and file preparation.

CONSULTATION AND PEER SUPERVISION:

The therapists of Therapy Treatment Team, LLC consult regularly with other professionals including other TTT team members regarding clients. During a consultation, we make every effort to avoid revealing any identifying information about clients. The consultant is also legally bound to keep the information confidential. The client’s identity remains completely anonymous, and confidentiality is fully maintained. 

Considering all of the above exclusions, if it is still appropriate, upon your request, we will release information to any agency/person you specify unless we conclude that releasing such information might be harmful in any way.

TEXT MESSAGES, TELEPHONE & EMERGENCY PROCEDURES

If you text or email your therapist, please know that the TTT policy regarding text messages and emails will apply. Texting your therapist will not warranty that you will receive a response. TTT cares about our therapists’ well-being, self-care, and health, so we do not require our therapists to respond to text messages or emails frequently or consistently. Our therapists may respond to text messages or emails infrequently and inconsistently. Therefore, communicating with your therapist over text messages or emails regarding an emergency, a trigger, a conflict, or symptoms may not get an immediate response or response at all. 

The best way to communicate with your therapist is to call the office and leave a message or during your next appointment. Using your appointment time for your therapy rather than a text or email will allow you and your therapist to fairly and adequately respond to the emergency, trigger, conflict, or symptoms you are experiencing. TTT thanks you for understanding and respecting our therapists’ boundaries and efforts to exercise self-care.

LIMITATIONS REGARDING ONLINE THERAPY:

 You, as the client, understand that distance therapy is a different experience as compared to in-person sessions, among those being the lack of “personal” face-to-face interactions and the lack of visual and audio cues in the therapy process to which you may have previously come to expect. Clients understand that telephone/online psychotherapy with one of our therapists is not a substitute for medication under the care of a psychiatrist or doctor. You understand that online and telephone therapy is not appropriate if you are experiencing a crisis or having suicidal or homicidal thoughts.

As stated previously, if a life-threatening crisis should occur, you agree to contact a crisis hotline, call 911, or go to a hospital emergency room. You also understand that we follow the laws and professional regulations of the State of Florida (USA) and the psychotherapy treatment will be considered to take place in the State of Florida (USA) or other states to which we hold a license to practice psychotherapy. Typically, Therapy Treatment Team does not conduct online therapy with clients whose permanent domicile is located outside of the therapist’s license jurisdiction. Any online sessions outside of the state of Florida are consultations only and should be viewed as such. Any online consultations when you are outside of the state of Florida will not be billed to your insurance company. If you want to consult with your therapist while you are traveling or living outside of the state of Florida, you will be considered a self-pay client and the fee for these consultation meetings is 85 dollars. A credit card on file is required before setting up the consultation appointments with your therapist. 

PROFESSIONAL RECORDS:

 The laws and standards of our profession require that we keep treatment records. You are entitled to receive a copy of your records unless we believe that viewing your records would be emotionally damaging, in which case we will be happy to send them to a mental health professional of your choice. Alternatively, we can prepare a summary for you instead. Because these are professional records, they can be misinterpreted by and/or upsetting to untrained readers. If you wish to see your records, we recommend you review them in our presence so that we can discuss the contents. Clients will be charged a fee for any professional time spent in responding to information requests. Here is our protocol for a record request:

Adult Individual Records:

1. The individual requesting the record calls the TTT office and speaks to the TTT Client Care Coordinator or has a third party company send a record request via fax or informs their TTT therapist. TTT is not responsible for the way a third party company chooses to deliver a record request (fax, secure email, or mail).
2. The TTT therapist sends the patient requesting the record the information release form through Simple Practice and explains we will need 48 hours to 7 business days to provide the record. We will provide records in person, via fax, or by secure mail. We do not provide records for walk-ins or stopping by or unsecure mail and we do not provide records without a consent completed and signed in Simple Practice. The consent to release information cannot be completed or signed in person.
3. The Patient signs the consent to release the record in Simple Practice.
4. The TTT therapist informs the TTT Client Care Coordinator about the record request.
5. The Client Care Coordinator prepares records and gives to the patient in the way they desire or approved per request in the record request form(mail, in person, fax). The client is responsible for understanding and knowing which third party company requested records and states the name of that company or organization in the record release form.
6. If a patient has any question about records, the patient will have to make an appointment in person or via Telehealth to discuss the record with the therapist.
7. The patient understands that a record request is a request to provide progress notes and treatment plan. A record request is NOT an initiation or expectation that your therapist will engage or get involved in a litigation, disability claim, an evaluation,  or court proceeding on your behalf. 
8. By signing a release of information, you understand that the company or organization reviewing your records may use the information in the notes and/or treatment plan to deny your claim, litigate against you, or deny you services you have requested. TTT therapists do not conduct evaluations for legal or civil litigations, therefore, we will not be able to refute, evaluate, or change decisions made by a company that reviewed the records you agreed to release.

MENTAL HEALTH BILL OF RIGHTS:

Pursuant to the Florida Mental Health Bill of Rights, clients have certain rights. A copy of the Mental Health Bill of Rights is included here: leg.state.fl.us

Please review the bill of rights carefully and let me know if you have any questions. In addition, here is the code of ethics for mental health professionals at  http://www.apa.org/ethics/code/

CONSULTATION VS. COUNSELING

Mental Health Consultation Services:

Our consultation services are recommended for individuals that are seeking Professional knowledge and information regarding specific challenges.  Consultants are able to meet with you to assist with sharing suggestions or information directly related to a specific problem.  During the consultation, the Clinician may provide teaching or training and can work with families, groups or organizations. During consultation services are able to be communicated directly or indirectly.  Consultation services are helpful for an individual, family or group that is seeking advice or gathering input related to Mental Health issues and provide strategies to a person so they are able to deal with the problem independently.  Consultation services may be limited to a few sessions and may result in a referral for psychological treatment, processing techniques, crisis intervention, or other recommendations your mental health consultant may have.

APPOINTMENTS

Please arrive promptly for all appointments. Our practice management systems will send out (unless you decide to opt-out of it) an email, and/or text, and/or voice message reminder for all appointments 24-48 hours in advance. It is your responsibility to read the reminder or reminders you received. Therapy sessions are 45-50 minutes long. Double sessions are 90 minutes. Evaluations are typically 90 to 120 minutes per session and may take several sessions. 

FEE FOR SERVICES

Current rates for therapeutic services vary per therapist, treatment technique, insurance copay, deductible, co-insurance, and time spent in a session. Therapy Treatment Team, LLC  is “fee for services” and that means that fees are due at the time of your appointment. Most health insurance plans provide for some outpatient mental health benefits. Therapy Treatment Team, LLC participates on some insurance panels as either a preferred or in-network provider. Therapy Treatment Team, LLC will do a double verification of your insurance plan to understand your mental health benefits. 

Quoted benefits are not a guarantee of benefits, and the client is ultimately responsible for verifying their insurance benefits. It is possible that Therapy Treatment Team, LLC will be given the wrong information by the insurance company regarding your benefits (copay, deductible, etc). If this happens, by signing below, you understand that you are financially responsible for paying any outstanding balance your insurance plan did not cover.  Equally, if Therapy Treatment Team, LLC overcharged you because your insurance plan covered more than initially stated in the verification process, we will reimburse you the overcharged money. Insurance can take 2-4 weeks to process. Once Therapy Treatment Team, LLC has received an Explanation of Benefits (EOB) from your insurance company, you may be sent an invoice for any remaining balance due. Payment is expected within 15 days of the invoice date. After 15 days your credit card on file will be billed for any remaining balance.

If Therapy Treatment Team, LLC is out of network with your insurance plan and you choose to schedule an appointment with us regardless, please note the appointments will be self-pay until we receive authorization from your insurance plan.  Therapy Treatment Team, LLC  may help you fill out forms and provide you with whatever assistance we can in helping you receive the benefits to which you are entitled; however, you (not the insurance company) are responsible for full payment of our fees. 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 about the coverage, call your plan administrator. We reserve the right to refuse an out of network insurance provider.

Not all services provided by Therapy Treatment Team, LLC are covered by insurance. Meetings, consultations, additional reports, paperwork, cancelations, lateness, and absences (that do not conform to our cancellation policy) are not covered services and will not be billed to private insurers.

You will need to have a card on file to secure your first appointment. We will obtain your credit card information while we are making your appointment on the phone with you. 

Therapy Treatment Team, LLC has a first-time appointment paperwork policy. If you have not filled out your required initial paperwork 24 hours before your appointment, your therapist reserves the right to cancel your appointment and reschedule it when your paperwork is completed. Please note, we cannot see you, treat you, or consult with you until your initial paperwork is filled out and all required documents are signed.

Please note that a credit card on file is required for any telehealth or distant counseling session. Therapy Treatment Team, LLC will collect telehealth or distant counseling session fees using the credit card you have on file. If you are scheduled for an online synchronous chat, audio, or video conference and you are unable to connect or are disconnected during a session due to a technological breakdown, please try to reconnect within 10 minutes.  If re-connection is not possible due to technology (this does not apply to lateness, no-show, or last-minute cancellations), contact us to schedule a new session time.  If your therapist is experiencing a technical issue, Therapy Treatment Team, LLC will not charge for your appointment and will reschedule your appointment.

Please note that the co-payment, deductible, co-insurance payment, or self-pay fees for in-person and telehealth appointments are all due at the time of service. We currently accept cash and all major credit cards. If you wish to pay by credit card, Therapy Treatment Team participates in a HIPAA compliant payment system. Please note a 3.5% processing fee will be applied to all credit card payments. Unpaid fees could be eligible for referral to a collection agency contracted with Therapy Treatment Team, LLC. 

Services will be suspended if there are unpaid invoices past 30 days without any communication to us regarding your balance. Additionally, bills that remain unpaid following 60 days will be forwarded to an outside collection agency.

GOOD FAITH ESTIMATE

You have the right to receive a “Good Faith Estimate” (GFE) explaining how much your medical 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 bill for medical items and services when an appointment has been scheduled 3 or more days in advance. The GFE is not a contract and does not require the uninsured (or self-pay) individual to obtain the items or services from  Therapy Treatment Team or the provider you are scheduled to see.This information is given as an overview of potential charges when a patient is seen at our office. The GFE is only an estimate of items or services reasonably expected to be furnished at the time it was issued, and that actual items, services, or charges may differ from the GFE. The patient may initiate the patient-provider dispute resolution process if the actual billed charges are “substantially in excess of” the expected charges included in the Good Faith Estimate, as specified in 45 CFR 149.620.  

You may contact our office to let us know the billed charges are higher than the Good Faith Estimate. You can ask us to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.  Initiating the patient-provider dispute will not adversely affect the quality of healthcare services furnished to the patient. To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 1-800-985-3059. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Below is a list of potential charges for you, your family, or your child’s upcoming visit to our office: