Insurance Reimbursement In order for us to set realistic treatment goals and priorities, It is I important to evaluate the resources you have available to pay for your treatment. I am a “fee for service” provider and therefore am not on any insurance panel. Therefore, it is very important that you find out exactly what “out of network” 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. Of course, I will provide you with whatever information I can based on my experience and will be happy to help you in understanding the information you receive from your insurance company. If you choose to submit for reimbursement, I will provide you with an invoice that has the information you well need to complete the forms for your insurance company. Please be aware that most insurance companies require your clinical diagnosis be included on any reimbursement form. Sometimes your insurance company request I submit additional clinical information, such as treatment plans, progress notes or summaries, or copies of the entire record (in rare cases). This information will become xxx of the insurance company files. Although all insurance companies claim to keep such information confidential, I have not control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. I will provide you with a copy of any records I submit if you request it. You understand that, by using your insurance, you authorize me to release such information to your insurance company. I will try to keep that information limited to the minimum necessary. It is important to remember that paying for services yourself, without the use of insurance, avoids the problems described above SERtfICE DELItfERY Modalities of services delivered are on based treatment goals developed from the diagnostic process. In general there are several principles that underlay the approach to treatment. *Children are not typically treated in isolation; therefore parent involvement is often part of the intervention plan. Sessions will be scheduled based on need and may either be conjoint (with the child) or separate in parenting sessions. * This practice includes the use of nurturing touch for young children when appropriate to child’s diagnosis and to promote eye-contact, shared attention and/or reciprocal interaction. Touch provided may include tickling, light and deep pressure touch and is directed by the child’s experience of comfort. Touch provided in the course of treatment is consistent with the goals of promoting in the child physiological regulation, comfort, stress reduction, reciprocal interaction and/or playfulness. *Parents must accompany minors to and from sessions. I am often not available immediately by telephone. Though I am usually in the office between 9am and 9pm, I won’t answer the phone when I am with a patient. When I am unavailable, my telephone is answered by voicemail that I monitor frequently. I will make every effort to return your call on the same day you make it, with the exception of weekends and holidays. If you are difficult to reach, please inform me of some times when you will be available. If you are unable to reach me and feel that you cannot wait for me to return your call, contact your family physician or the nearest emergency room and ask for the psychologist or psychiatrist on call. If I will be unavailable for an extended time, I will provide you with the name of a colleague to contact if necessary LIMITS ON CONFIDENTIALITY The law protects the privacy of all communications between a patient and a psychologist. In most situations, I can only release information about your treatment to others if you sign a written Authorization form that meets certain legal requirements imposed by state law and/or HIPAA. But, there are some situations where I am permitted or required to disclose information without either your consent or Authorization: ● I may occasionally find it helpful to consult other health and mental health professionals about a case. During a consultation, I make every effort to avoid revealing the identity of my patient. The other professionals are also legally bound to keep the information confidential. Ordinarily, I will not tell you about these consultations unless I believe that it is important to our work together. ● If I believe a patient is threatening serous bodily harm to another, I am required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the patient. If the patient threatens to harm himself/herself, I may be obligated to seek for him/her or to contact family members or others who can help provide protection. In a similar situation occurs on the course of our work together, I will attempt to fully discuss it with your before taking any action. ● In most legal proceedings, you have the right to prevent me from providing any information about your treatment In some legal proceedings a judge may order my testimony if he/she determines that the issues demand it, and I must comply with the court order. ● If a patient files a complaint or lawsuit against me, I may disclose relevant information regarding that patient in order to defend myself. ● If a patient uses health insurance HMO/PPO/EAP/MCO, disclosure of confidential information may be required by your health insurance carrier in order to process the claims. I will provide only the minimum necessary information. I have no control or knowledge over what insurance companies do with information that is submitted. You must be aware that submitting a mental health invoice of reimbursement carries a certain amount of risk of confidentiality, privacy or future capacity to obtain health or life insurance. ● If I observe or have knowledge of an incident that reasonably appears to be physical abuse, abandonment, abduction, isolation, financial abuse or neglect of an elder or dependent adult, or if an elder or dependent adult credibly reports that he or she has experienced behavior including an act or omission constituting physical abuse, abandonment, abduction, isolation, financial abuse, or neglect, or reasonably suspects that abuse, the law requires that I report to the appropriate government agency. Once such a report is filed, I be may be required to provide additional information.
