Kathleen Boggs, LCPC, CCDC, CAC-AD

Kathleen Boggs, LCPC, CCDC, CAC-AD

Client Information and Office Policy Statement

New Client: Welcome!

This document is designed to inform you about what you can expect from therapy, policies regarding confidentiality, emergencies, and several other details regarding treatment. Although providing this document is part of an ethical obligation to our profession, more importantly, it is part of my commitment to you, to keep you fully informed of every part of your therapeutic experience. I welcome any questions, comments, or suggestions regarding your experience during therapy at any time.

In order for therapy to be most successful, it is important for you to take an active role. This means working on the things you and the therapist talk about both during and between sessions. Generally, the more of yourself you are willing to invest, the greater the return.

A primary goal of counseling will be to help you increase personal awareness, increase personal responsibilityand acceptance to make changes necessary to attain your goals, and develop personal treatment goals.

You may be asked to complete questionnaires or to do homework assignments. Your progress in therapy often depends on what you do between sessions.

Appointments

Insurance reimburses for a 45 minute session. Clients are generally seen weekly or more/less frequently as acuity dictates and you and your therapist agree.

Financial Policy

Insurance

Insurance is a contract between you and your insurance company. It is your responsibility to understand the terms and conditions of your insurance. If you have a deductible to meet, you will need to pay for treatment out of pocket until the deductible is met. All payments for service, including co-pays, are due in full at the time service is provided. Cash, check, or money orderare accepted methods of payment. A $25.00 fee will be charged for any returned check.

If I am contracted with your insurance company, I will file claims with the insurance. If your insurance company has not paid the Full Balance within 90 days, you are responsible for the balance within 15 days upon receiving notice. You are responsible for the timely payment of your account. I will not become involved in a dispute between you and your insurance company regarding deductibles, copays, covered charges, non-covered charges.

Cancellations and Missed Appointments

A cancelled appointment delays our work. When you must cancel, please give me at least 24 hour notice. I am rarely able to fill a cancelled session unless I know at least 24 hours in advance. If you are unable to provide at least 24 hour notice when you cancel, you will be charged the full fee for your session unless I am able to fill it with another client. (You should note that insurance companies do not typically reimburse for missed appointments.) The only time I will waive this fee is in the event of serious or contagious illness or emergency.

The full fee of$115.00 will be due for a session that you cancel with less than 24 hours notice. This fee will be due before your next scheduled appointment.

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Signature of Client (Guardian)Date

Confidentiality & Records

Your communications with your therapist will become part of a clinical record of treatment, and it is referred to as Protected Health Information (PHI). Your therapist will always keep everything you say in counseling completely confidential, with the following exceptions:

1)you direct your therapist to speak with someone specifically and you sign a “Release of Information” form;

2)any threats to harm yourself, another person, or inability to care for yourself, requires the therapist to inform legal authorities;

3)suspected physical, mental, or sexual abuse or neglect of a child, elderly person or disabled person will be reported to Social Services;

4)when your insurance company is involved (i.e., in filing a claim, insurance audits, case review or appeals, etc.);

5)your therapist is ordered by a court to disclose information. Your therapist’s license does provide the ability to uphold what is legallytermed “privileged communication.” Privileged communication is your right as a client to have a confidential relationship with a counselor. If for some unusual reason a judge were to order the disclosure of your private information, you may appeal this order. I cannot guarantee that your appeal will be sustained, but I will do everything in my power to keep what you say confidential.

Please note that in couple’s or family counseling, your therapist does not agree to keep secrets. Information revealed in any context may be discussed with either partner or within family counseling. Counseling cases may be discussed with other professionals involved in the client's treatment and/or discussed in supervision sessions with other counselors. If you have any questions about confidentiality, please ask.

Complaints

You may submit a complaint to me or to the Secretary of Health and Human Services if youbelieve I have violated your privacy rights. You may also file a complaint with theBoard of Professional Counselors and Therapists of Maryland.

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Signature of Client (Guardian)Date