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Practice Policies

Alicia Mittleman, LCSW requires a 48-hour notice to cancel your appointment. If you do not notify us of the cancellation before your scheduled appointment, you will be charged a $75 late fee, this also applies to any late cancellations.  This fee can be waived in case of an emergency or illness but will be reviewed by your therapist on a case-by-case basis. The credit card on file will be used for this charge.

To cancel your appointment, you will need to call or text our office at (916) 425-7733 or email Alicia Mittleman, LCSW directly.  Replies to automatic SimplePractice notifications are not received by our office and will not result in a cancelled appointment.  If you do not receive confirmation of your cancellation from your therapist before your appointment, you will be charged a no-show fee. If you are more than 15 minutes late arriving for session it is considered a “no show”. You might still be seen if your therapist is available, but your session will still end at the scheduled end time.

Payment for service is made at each session. The private pay rate for a 50-minute therapy session is $170. Payment for sessions may be made by cash, check or credit card. Payment in full is expected at the time of your session or arrangements should be made to pay for the session at a prearranged time with the therapist. If utilizing your health insurance, fees will be determined by the therapist’s contracted rate with the insurance company and co-pays/co-insurance/deductibles will be collected at each session. If utilizing health insurance for therapy services, by signing this consent, you are authorizing your health insurance to make payments directly to Alicia Mittleman, LCSW. We will check your insurance coverage as a courtesy. However, If for any reason your health insurance does not cover a service or misquotes your benefits, you are responsible for that service at the full contracted rate or for any costs associated with your appointment that was misquoted by insurance.

When you request to use your health insurance to pay for psychotherapy, information, including psychological diagnosis and dates of service, must be provided to your health insurance provider. In many cases, explanations of symptoms, treatment plans and, in rare cases, the entire client record are also included. If health coverage is provided by an employer, the employer may have access to such information. Only the minimum necessary information will be provided to the insurance company. By signing this consent, you are authorizing to release information about your case to your health plan for, but not limited to, claims, authorization, and case management for the purpose of treatment/payment. Your therapist will have no control or knowledge over what insurance companies do with the information or who has access to the information. If you are using insurance for your session, you are responsible for obtaining any needed pre-authorizations prior to our first session. Please provide your insurance information prior to your first session in order for coverage to be verified. If you are no longer able to use insurance for payment, please notify your therapist prior to your next session to discuss payment.

The standard meeting time for psychotherapy is approximately 50 minutes. It is up to you, however, to determine the length of time of your sessions. Requests to change the 50-minute session needs to be discussed with the therapist in order for time to be scheduled in advance. Please note that some insurance companies only authorize 45-minute sessions. You will be informed if your insurance company only authorizes 45 minute sessions.

A service charge will be charged for any checks returned for any reason. You will be charged the cost of the returned check fee from the bank. Any credit card disputes filed by you for properly billed services or missed appointment fees will also be charged the cost of any service fee imposed by the credit card company.

We request that a credit card be kept on file with Alicia Mittleman, LCSW. If you need to make alternative arrangements, please discuss with us in advance of your appointment. By signing this agreement, you agree that Harbor Counseling Services will charge your credit card after each session and/or in the event of a late cancellation or no-show appointment.

Telephone conversations longer than 10 minutes, reports, letters, phone consultations with other providers, in community site visits, drive time, and court subpoenas and testimony services are additional services to therapy sessions and are not covered by health insurance. If you require any of these services you will be billed at the full private pay hourly rate (prorated in 15 minute increments) unless otherwise indicated and agreed upon. Mileage for driving related services will be charged at the federal rate of allowance.

 

If your therapist is subpoenaed for court, you will be required to pay a retainer of $1000 at least 72 hours prior to the hearing regardless of who provided the subpoena. Any time used for court appearances will be charged to the retainer and any unused balances will be refunded to you. An hourly rate of $170 per hour, including driving time, will be charged for court appearances and time in preparing for court appearances.

EMERGENCIES

Alicia Mittleman, LCSW is not an emergency/on-call therapy provider and is not always immediately available by phone. If your therapist is unavailable, your call will be returned as soon as possible, typically during next available business hours. If you are having a life threatening or mental health emergency you should call 911, telephone a crisis line, or proceed to the nearest hospital emergency room for assistance.

SOCIAL MEDIA AND TELECOMMUNICATION Due to the importance of your confidentiality and the importance of minimizing dual relationships, your therapist does not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). Your therapist believes 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.

ELECTRONIC COMMUNICATION

Your therapist cannot ensure the confidentiality of any form of communication through electronic media. While your therapist may try to return messages in a timely manner, she cannot guarantee immediate response and requests that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.

Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail is considered telemedicine by the State of California. Under the California Telemedicine Act of 1996, telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another. If you and your therapist chose to use information technology for some or all of your treatment, you need to understand that: (1) You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled. (2) All existing confidentiality protections are equally applicable. (3) Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee. (4) Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent. (5) 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, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel 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, body type, attractiveness relative to social and cultural norms or standards, 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), sex, chronological and apparent age, ethnicity, 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.

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