SESSION LENGTH & PROFESSIONAL FEES: Unless otherwise noted below, all fees listed are per session and standard sessions are 50 minutes in length.
Individual Counseling – $120 per session
Couples Counseling – $135 per session
Suboxone Counseling – $45 (30 minutes) or $80 (50 minutes)
EMDR Extended Session (90 minutes) – $200
Drug & Alcohol Assessment (60 – 75 minutes) – $200
Sessions begin and end on time. It is understandable that occasionally you may be late. If you are late for your session, please understand that the session will not extend past 50 minutes, nor will the time be added to future sessions.
COVID-19 PRECAUTIONS: Masks must be worn at all times while in the office building. You are encouraged to bring your own mask, but in the event you do not, The Counseling Center will provide one for you. The Counseling Center encourages clients to wash their hands frequently and to use hand sanitizer that is provided in the therapy room. If you have a fever (>99.6 F), cough, shortness of breath, loss of taste and/or smell, or if you have had contact with someone diagnosed with, or suspected of having, COVID-19 in the last two weeks, please do not come to the office. Call and inform us of your symptoms.
APPOINTMENTS AND CANCELLATIONS: Cancellations must be made at least 24 hours in advance. Your session time has been reserved exclusively for you and it is unlikely to be filled with another patient in the event you cancel. Canceling with less than 24 hours notice will result in being charged the full session fee.
NO SHOWS: If you do not show up for a session, you will be charged the full session fee.
ONGOING CANCELLATIONS OR MULTIPLE NO-SHOWS: It is understandable that you may occasionally need to cancel or miss an appointment due to illness or emergency. However, your appointment time has been reserved especially for you. Frequent cancellations missed appointments, late payments, or non-payment could result in the need to discontinue your treatment.
SESSION PAYMENTS: Professional fees may be paid via cash, credit card, or debit card and are due at the time of service. If you plan to pay by credit or debit card, please complete the Credit Card Information form. Your card information will be stored in our password-protected, encrypted system. We charge patients on the day of their session. If you prefer to pay by cash, please bring the exact amount with you. We are unable to make change. We do not “carry over” session balances from week-to-week or extend credit as this could constitute an unethical dual relationship. Please be prepared to pay the entire balance each week.
INSURANCE: I do not currently take insurance. I can provide you with a monthly billing statement for reimbursement if you wish to submit it to your insurance company. This monthly statement is your receipt for tax or insurance purposes.
Some or all your fees may be covered by your health insurance, if you have outpatient mental health coverage. However, insurance companies do not reimburse all conditions that may be the focus of psychotherapy. It is your responsibility to verify the specifics of your coverage. Please remember that my services are provided and charged to you, not your insurance company, so you are responsible for payment. Fees you pay for therapy services that are not reimbursed by insurance may be deductible as medical expenses if you itemize deductions on your tax return.
TELEPHONE ACCESSIBILITY: If you need to contact your counselor between sessions, please leave a message on their voice mail. Calls are usually returned within 24 hours. If you call in the evening, over the weekend, or on a holiday, your call will be returned on the next working day.
If your situation is an acute emergency and you need to speak to someone right away, please call 911, go directly to your nearest emergency room or crisis center, call the Community Health Network Crisis Line at 317-621-5700, or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
SOCIAL MEDIA AND TELECOMMUNICATION: Due to the importance of your confidentiality and the need to minimizing dual relationships, we do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). We 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 choose to follow our business-related social media accounts, please know that this may be visible to others who view the sites.
ELECTRONIC COMMUNICATION: We cannot ensure the confidentiality of any form of communication through certain electronic media such as text messages. Therefore, I will not use text messaging to communicate with you. Messages sent to you through the Client Portal or via Jason.Lynch@counselingmail.com are encrypted, HIPAA compliant forms of confidential communication.
MINORS: If you are a minor, your parents may be legally entitled to some information about your therapy. We will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately kept confidential.
TERMINATION: Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. Your counselor may terminate treatment after appropriate discussion with you, if he determines that the counseling is not being effectively used, or if you are in default on payment. Your counselor 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 counselor, your counselor will provide you with a list of qualified counselors to treat you. You may also choose someone on your own or from another referral source.
CONFIDENTIALITY: Your confidentiality as a client is of utmost importance. To secure your clinical information, we use an electronic health record to store and protect your information in a confidential and protected capacity. All client protected health information is covered under the Health Insurance and Portability Act of 1996 and 45 C.F.R., Part 164, Subpart C under HIPAA.
As a therapy client, you have privileged communication. This means that your relationship with me as my client, all information disclosed in our sessions, and the written records of those sessions are confidential and may not be revealed to anyone without your written permission, except where law requires disclosure. Most of the provisions explaining when the law requires disclosure are described in the Notice of Privacy Practices.
When Disclosure Is Required by Law: Disclosure is required when there is a reasonable suspicion of child, dependent or elder abuse or neglect and when a client presents a danger to self, to others, to property, or is gravely disabled.
When Disclosure May Be Required: Disclosure may be required in a legal proceeding. If you place your mental status at issue in litigation that you initiate, the defendant may have the right to obtain your psychotherapy records and/or my testimony. If you have not paid your bill for treatment for a long period of time, your name, payment record and last known address may be sent to a collection agency or small claims court. In couples or relationship therapy, or when different family members are seen individually, confidentiality and privilege do not apply between the couple or among family members. I will use my clinical judgment when revealing such information.
Emergencies: If there is an emergency during our work together or after termination in which I become concerned about your personal safety, the possibility of you injuring someone else, or about you receiving psychiatric care, I will do whatever I can within the limits of the law to prevent you from injuring yourself or another, and to ensure that you receive appropriate medical care. For this purpose I may contact the person whose name you have provided as your emergency contact.
Health Insurance and Confidentiality of Records: Your health insurance carrier may require disclosure of confidential information in order to process claims. Only the minimum necessary information will be communicated to your insurance carrier, including diagnosis, the date and length of our appointments, and what services were provided. Often the billing statement and your company’s claim form are sufficient. Sometimes treatment summaries or progress toward goals are also required. Unless explicitly authorized by you, Psychotherapy Notes will not be disclosed to your insurance carrier. While insurance companies claim to keep this information confidential, I have no control over the information once it leaves my office. Please be aware that submitting a mental health invoice for reimbursement carries some risk to confidentiality, privacy, or future eligibility to obtain health or life insurance.
NON-DISCRIMINATION POLICY: The Counseling Center does not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. We are committed to providing an inclusive and welcoming environment for all clients and visitors.
PHYSICAL CONTACT: Sexual contact is never acceptable in the therapeutic relationship. Romantic or sexual conversation, flirting, or sexual innuendos and sexual jokes are also unacceptable. If you direct a sexual comment or joke toward your counselor while in session, they will explore the comment professionally and in a non-shaming way with the confines of a non-sexual therapeutic relationship.
REFERRAL OF FRIENDS, FAMILY, CO-WORKERS: The greatest compliment a counselor can receive is a referral from current or former clients. Please understand that your confidentiality is extremely important. Your counselor will never acknowledge you as a client to other clients, or to anyone outside of The Counseling Center without your written consent, or unless mandated by a court of law.
Court Reports or Letters: I do not write legal letters or court reports on behalf of clients involving divorce, custody, or lawsuits. I do not write letters pertaining to legal matters to any outside person (i.e. doctor, school, attorney, etc.) or agency regarding your treatment. If you are referred for a substance abuse assessment, the summary of that assessment along with recommendations will be sent to the referring agency. If a special circumstance arises where a letter is required, it will require your written consent and will be billed to you at $25.00 per page in addition to my hourly fee. I reserve the right to refuse to write letters on your behalf (unless court-mandated) if I do not feel this would be in your best interest, if it places us in a dual relationship, or it would compromise our therapeutic relationship. If you are involved in a lawsuit, please understand that entering your mental health into a court hearing may not always be in your best interest as it may compromise your confidentiality and your clinical files may be requested. I will not be your advocate in a court hearing or speak on your behalf as that is not the nature of the counselor/client relationship. I reserve the right to agree to or deny any requests regarding appearance at a court proceeding in which I will testify as a fact witness and not as an advocate.
Court Fees: If you become involved in legal proceedings that require my mandated participation, you will be expected to pay for all my professional time, including preparation and transportation time and costs, even if called to testify by another party. Because of the time involved and the interruption to my clinical work, you will be charged $250 per hour for time out of practice, time for preparation, travel time, and attendance at any legal proceeding on your behalf. Additionally, if other client sessions must be canceled, these must be covered at the rate of those sessions and will be billed to you.
ADDITIONAL RIGHTS AND RESPONSIBILITIES: In addition to your right to confidentiality, you have the right to end your counseling at any time, for whatever reason and without any obligation, except for payment of fees for services already provided. You have the right to question any aspect of your treatment with your counselor. You also have the right to expect that your counselor will maintain professional and ethical boundaries by not entering into other personal, financial, or professional relationships with you.
The Counseling Center reserves the right to discontinue counseling services at any time and for any reason, including, but not limited to, a violation of these Practice Policies, a change or reevaluation by The Counseling Center of your therapeutic needs and The Counseling Center’s ability to address those needs, or other circumstances that lead The Counseling Center to conclude in its sole and absolute discretion that your counseling needs would be better served by another practitioner. Under such circumstances, The Counseling Center will suggest an appropriate counselor(s) or counseling agency.
I HAVE THOROUGHLY READ, AND FULLY UNDERSTAND THE PRACTICE POLICIES DOCUMENT. FURTHERMORE, I AGREE:
- I UNDERSTAND THAT I AM FINANCIALLY RESPONSIBLE FOR CHARGES AND FEES INCURRED.
- I AGREE TO HONOR THE 24-HOUR CANCELLATION POLICY AND UNDERSTAND THAT I WILL BE CHARGED FOR LATE CANCELLATIONS AND NO-SHOW SITUATIONS.
- I AGREE TO RESPECT THE BOUNDARIES OF CONTACT BETWEEN SESSIONS AND UNDERSTAND EMAIL AND TEXT MESSAGES ARE NOT AN APPROPRIATE WAY TO PROCESS WHAT SHOULD BE DISCUSSED IN SESSION.
- I UNDERSTAND AND AGREE TO THE SOCIAL MEDIA POLICY.
- I HAVE HAD ALL QUESTIONS ABOUT THIS DOCUMENT ANSWERED, AND SIGN IT WILLINGLY.
- I AUTHORIZE MY COUNSELOR WITH THE COUNSELING CENTER TO PROVIDE COUNSELING SERVICES TO ME, THE CLIENT, BY SIGNING BELOW.
Effective Date: 6/30/19
Last Revised: 11/14/20
Approved By: Jason Lynch, Owner/CEO