Practice Policies

 

Thank you for choosing Grace and Gratitude Counseling, PLLC (hereafter referred to as "GGC") for your healthcare needs. We are committed to providing high-quality, personalized, compassionate, and comprehensive patient care. Please review the following policies.

PHI Disclosure: GGC may use and disclose PHI in the course of providing, coordinating, or managing your medical treatment, including the disclosure of PHI for treatment activities at another healthcare facility. These types of uses and disclosures may take place between physicians, nurses, technicians, students, and other healthcare professionals who provide you health care services or are otherwise involved in your care.

Confidentiality and Privacy Practices: GGC is required by law to maintain the privacy of your protected health information (PHI). All information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your written authorization. GGC may use and disclose PHI without your written authorization under the following circumstances:

When required by law, such as where there is a reasonable suspicion of child, dependent, or elder abuse or neglect; where a client presents a danger to self, to others, to property, or is gravely disabled; or when a client's family members communicate to GGC staff that the client presents a danger to others. Disclosure may also be required pursuant to a legal proceeding by or against you. 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 GGC staff. In addition, GGC may disclose PHI under the following circumstances: specialized government functions, for public health purposes, for health care operations, for health oversight activities, to avoid a serious threat to health or safety, workers compensation, and disclosure to HIPAA compliance investigations. In couple and family therapy, or when different family members are seen individually, even over a period of time, confidentiality and privilege do not apply between the couple or among family members, unless otherwise agreed upon. GGC staff will use his/her clinical judgment when revealing such information. GGC will not release records to any outside party unless s/he is authorized to do so by all adult parties who were part of the family therapy, couple therapy or other treatment that involved more than one adult client.

Emergency: If there is an emergency during therapy, or in the future after termination, where GGC becomes concerned about your personal safety, the possibility of you injuring someone else, or about you receiving proper psychiatric care, s/he will do whatever s/he can within the limits of the law, to prevent you from injuring yourself or others and to ensure that you receive proper medical care. For this purpose, s/he may also contact the person whose name you have provided on the biographical sheet or emergency contact.

E-mails, cell phones, computers, and faxes: It is very important to be aware that computers and unencrypted email, texts, e-faxes and faxes communication (which are part of the clinical records) can be relatively easily accessed by unauthorized people and hence can compromise the privacy and confidentiality of such communication. Emails, texts, e-faxes and faxes in particular, are vulnerable to such unauthorized access due to the fact that servers or communication companies may have unlimited and direct access to all emails, texts, faxes and e-faxes that go through them. While data on GGC's laptops are encrypted, emails, texts, faxes and e-fax are not. It is always a possibility that e- faxes, faxes, texts, and email can be sent erroneously to the wrong address and computers. Please notify GGC staff if you decide to avoid or limit, in any way, the use of email, texts, cell phone calls, phone messages, faxes, or e-faxes. If you communicate confidential or private information via unencrypted email, texts, faxes or e-fax or via phone messages, will assume that you have made an informed decision, will view it as your agreement to take the risk that such communication may be intercepted. Please do not use texts, email, voice mail, or fax for emergencies.

Minors in Treatment: If you are under eighteen years of age, please be aware that the law may give your parents or guardians the right to obtain information about your treatment and/or examine your treatment records. It is GGC's policy to request a written agreement from your parents or guardians indicating that they consent to give up access to such information and/or, to your records. If they agree, GGC will provide them only with general information subject to your approval, or, if GGC staff feel it is important for them to know in order to make sure that you and people around you are safe. GGC will involve them if there is a high risk that you will seriously harm yourself or another/others. Before giving them any verbal or written information, GGC staff will discuss the matter with you, if possible.

Group : In groups, it is of utmost important that all members maintain confidentiality and neither disclose the content of sessions nor the identity of fellow group members. It is highly recommended that any meaningful exchange outside the group also be discussed in the group. In group therapy, the other members of the group are not therapists. They are not regulated by the same ethics and laws that bind your therapist. The limits of confidentiality and the reporting laws have been outlined earlier in this document. While the expectation is that all group members will maintain confidentiality regarding anything said in the group, you cannot be certain that they will. You are ultimately responsible for what you say and what you think, feel, or do with the feedback you receive in the group.

Outstanding Balances: I understand that GGC has the right to refuse any and all services of which they provide including but not limited to; the cancellation of appointments, and/or revoking the ability to book future appointments for any patients who carry an account balance greater than $250.00. These services may not be restored until the balance has been paid off, or an acceptable payment plan has been agreed upon, including the initial payment of said plan.

No Insurance: Patients who do not have health insurance coverage are expected to make payment in full at the time of service. For staff clinicians, intake sessions are $225 and subsequent one hour appointment slots are $185. For practice Owner/Executive Director Sarah Czopek, the fee is $275 for intake sessions and $225 for subsequent one hour appointment slots. Group therapy or support groups vary in cost; support groups are not billable to insurance. Sliding Scale is available for clients seeing our Interning masters-level clinicians.

Insurance: I acknowledge that it is my responsibility to understand my benefits. I understand that it is my responsibility to contact my health insurance carrier and obtain eligibility and coverage benefits. I understand that a quote of benefits is not a guarantee of payment. I understand that I will be held responsible for prompt payment of all copays, deductibles, coinsurance and non-covered services deemed patient responsibility by my health insurance carrier. I understand if I see a provider who is not contracted with my health insurance carrier, I am required to remit payment in a timely manner for services rendered.

I understand that in the event my account is sent to a collection agency, a service fee may apply and any outstanding balances will need to be settled prior to scheduling any future appointments. 

Late Cancellation/No Show Fees for regular therapy appointments: If you are unable to keep your scheduled appointment, you understand that you will need to contact GGC at least 24 business hours prior to your appointment. The fees for a missed appointment are the full service fee as outlined above. Insurance does not cover or reduce the cost of missed appointments or late cancellations.

Credit/Debit Card Consent: GGC requires your credit card or debit card information to help facilitate the settlement of your account. GGC partners with an integrated credit card processor that has been PCI and QRI certified to ensure your credit/debit card information is protected. GGC will only charge you for outstanding balances applied to your responsibility by your health insurance carrier o(e.g. co-pays, deductibles, co-insurances, non-covered services deemed patient responsibility) and any no show or late cancellation fees as outlined in this policy.

Release of Insurance Related Information: I authorize GGC to send my health insurance claims to my health insurance carrier for payment. I authorize my health insurance carrier to send payments directly to GGC for services rendered.

Follow Up Appointments by Phone: GGC providers charge for clinical phone consultations with patients. Charges are according to the Patient Telephone Session Rate form.

Medical Records: We take the time and consideration to ensure your records are kept confidential. There is a standard processing rate of $30 for released medical records to cover the cost of time and materials required for copying and mailing the record.

Medical records releases take a minimum of 10 business days from the date GGC received a signed release form. You will be informed of our decision to approve or deny the request within 30 days. If GGC is unable to comply, it may extend the deadline for up to 30 more days by notifying me in writing.

Court Policy: 

Please be advised that the therapists of Grace and Gratitude Counseling, PLLC do not participate in person, by phone or in writing in any court related matter that the client of Grace and Gratitude Counseling, PLLC may be a party to or become a party to in any way. The therapists of Grace and Gratitude Counseling, PLLC do not write letters regarding their client’s treatment to any entity, including court. The therapists of Grace and Gratitude Counseling, PLLC at no time will offer an opinion or recommendation in any court matter, especially as it relates to custody.

Please be advised that should the therapists from Grace and Gratitude Counseling, PLLC be ordered by court to write a letter to the court, the time shall be billed at $300 per hour. Please be advised that should the therapists from Grace and Gratitude Counseling, PLLC be court ordered to appear in court, the fee stipulation is as follows:

$3,000 per day plus $500 per hour for travel to and from the court.

$500 per hour for preparation.

The therapists of Grace and Gratitude Counseling, PLLC will NOT be ON-CALL at anytime. Should a case be trailed, the therapist will be paid in full for each day as well as an additional $1,000 per day as it hinders the therapist’s ability to be available to their other clients. All court fees must be received by cashier’s check 14 days prior to the court date. Should the court calendar the hearing for another date, the therapist must be re-issued a court order with the new court hearing date. Should the therapist be on vacation, the party initiating the court order must take reasonable steps to avoid imposing undue burden or expense on a person subject to the subpoena.

Completion of Forms/Letters: The charge for any type of letter (e.g. emotional support letters for flying or housing, letters for school, diagnosis, or accommodations, letters for a blood tests) is $30. The charge for paperwork completed outside of an appointment excluding FMLA/Disability paperwork, will be $10 a page.

Discharge from Care: You have control over your care, and you have the right to eliminate your care with us at any time. We reserve the right to discharge any patient from this practice at any time for failure to comply with office policies or treatment recommendations. We will provide referral suggestions for continuation of treatment.

Expectations of Readiness for Therapy:
I understand if I arrive for my appointment:

• Under the influence of alcohol
• Under the influence of drugs (including marijuana) and excluding appropriate medical use with unexpired and active medical card 
• Operating or as a passenger of a motor vehicle

• In a non-private teletherapy space
• Or any other situation deemed unsafe or inappropriate by my clinician

that my provider reserves the right to refuse the appointment and I will be charged the late cancellation fee. 

Fragrances/Breathe Free: GGC adheres to a breathe free, scent-free, fragrance-free and smoke-free office. Please refrain from using any scented products, including lotion or scented sanitizer, and smoking/vaping prior to session. Any cancellations enforced under this policy adheres to GGC's cancellation policy.

Emergency and Crisis Support: GGC affirms that any person, at any time, can be faced with a mental health crisis regardless of where one is in the therapeutic process, how much progress one has been made in therapy, how much support one has, or how well one may feel their life is going.

However, GGC is not equipped to and does not provide 24-hour crisis services. As an individual provider, your therapist will generally be in a therapy session during working hours and are unavailable outside of working hours. If it is likely that you may need crisis support, please discuss this so that your clinician can work with you to have access to the level of care you need. You deserve support that matches your needs.

If a life-threatening crisis should occur - either in session or out of session - contact a crisis hotline, call 911, or go to a hospital emergency room.

National Suicide Crisis Hotline: 800-273-8255 (En Español/Deaf/Hard of Hearing) Crisis Text Line: Text “Home” to 741741

Communication Between Sessions: Your therapist will not be immediately available by telephone for housekeeping issues or otherwise. If you need to contact your therapist between sessions, please message through portal for fastest response, and your message will be returned as soon as reasonably possible. Your therapist makes no guarantee about when, or how often, messages, emails or voice messages are checked.

Cancellation/Timeliness: Most sessions last for approximately 53 minutes. Since the scheduling of an appointment involves the reservation of time specifically for you, a minimum of 24 business hours’ notice is required for rescheduling or cancelling an appointment (as a reminder, voicemails have a time/date stamp on them). You will be charged your full fee for missed appointments without notification in line with the cancellation policy. Insurance companies do not reimburse for missed sessions or cancelled appointments. If you are late to an appointment, your therapist will wait for you for up to 10 minutes beyond the schedule time. If there is no notification within 10 minutes, it will be considered a missed appointment. If you no-show for two sessions in a row and do not respond to your therapists attempts to reschedule, GGC will presume you have dropped out of therapy and will make the space available to another individual. However, you are welcome to reschedule at an alternate time.

Lastly, frequent cancellations may warrant discharge from treatment. For example, frequent cancellations are defined as cancelling 2 appointments within 4 weeks or 3 appointments within 8 weeks (regardless of how frequent a client is seen).

Emergency phone calls of less than ten minutes are normally not charged. However, if we spend more than 10 minutes in a week on the phone, if you leave more than ten minutes worth of phone messages in a week, or if your therapist spends more than 10 minutes reading and responding to emails/messages from you during a given week, GGC will bill you on a prorated basis for that time, rounded up to the nearest 15 minute increment.

Therapist No Show: If a therapist is late/no show for your scheduled session, it is reasonable to leave your scheduled session after waiting 10 minutes.

Therapist Medical Emergency/Death: Your therapist has worked toward a plan for therapist medical emergency or death. It is expected your phone calls will be returned within 10 business days should such an event happen.

Social Media: It is the practice of GGC not to accept any invitations via social networking sites such as Facebook, Twitter, LinkedIn, Pinterest, or otherwise. Nor will GGC respond personally, request, or suggest blogs, recommendations, reviews or social media check-ins.

Additionally, it is not a regular part of clinical 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, for example, if GGC has a reason to suspect you are in danger and you have not been in touch with your therapist via usual means (coming to appointments, phone, or email). 

Severe Weather Policy: GGC follows the closure schedule of the local public school system to the business office. If your appointment falls within the closure announced by the local public school system, your appointment will be automatically converted to a telehealth/video session.. However, if you show up to the office for a session that is cancelled due to the policy, you will not receive financial credit for future sessions.

Audio/Video Recording: Audio and/or video recording of sessions is generally not allowed. Clients must seek the permission of the counselor before recording any portion of a session. Recording without the consent of all parties is appropriate for immediate termination from the therapeutic process.

Weapons in the Office: Whether mace, pepper spray, pocket knife, or a gun, it is not clinically appropriate to bring any personal weapon or personal safety device that could cause harm whether appropriately, or inappropriately used, into the office or building in which the office resides. If discovered, termination from the therapeutic process may be appropriate.

Client and Clinician Safety: Client and clinician safety is paramount to the work of GGC. If either client or clinician engages in any action either party feels puts their personal safety in jeopardy, please address concerns directly with Sarah Czopek, Owner/Executive Director of GGC, to determine appropriate next steps.

Childcare During Sessions: Any minor accompanying a client may not be left unattended for any duration of time during sessions. It is not the responsibility of staff to provide childcare. Please speak to your clinician about any childcare concerns so a compromise can be reached. At times, it may be appropriate and viable to bring small children to sessions.

HIPAA: Our HIPAA disclosure is located here.

Privacy Policy: Our Privacy Policy disclosure is located here.

Gifts: At times, clients want to express their appreciation for the work of therapy through a monetary gift beyond the scope of services. While typically frowned upon, and not encouraged, it is also important to address the topic as it is a frequent enough occurrence. As such, your therapist can only accept gifts valued at up to $10.

Proof of Location: Your therapist reserves the right to request you affirm your physical location at the beginning of any session. A client must be in the state in which the therapist is licensed at all sessions–even during vacation or otherwise. There are no exceptions. Any cancellations enforced under this policy adheres to GGC's cancellation policy.

Insurance: While most insurance plans cover mental health treatment, it is the client’s responsibility to be aware of what is and is not covered under their policy. Any benefits verification at the beginning of treatment is a courtesy and any quoted coverages are not guaranteed. Most insurance agreements require you to authorize your therapist to provide a clinical diagnosis and sometimes additional clinical information such as a treatment plan or summary or additional protected/private health information in order to successfully process claims. The information provided will become part of the insurance company’s files. The therapist has no control over, or knowledge of what insurance companies do with the information submitted, or who has access to the information. 

Legalities: Due to the nature of the therapeutic process and the fact that it often involves making a full disclosure with regard to 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 your therapist to testify in court or at any other proceeding, nor will a disclosure of the therapy records be requested.

GGC does not provide or perform evaluations for custody, visitation, or other forensic matters. Therefore, it is understood and agreed that your therapist cannot and will not provide any testimony or reports regarding issues of custody, visitation or fitness of a parent in any legal or administrative proceeding. If your therapist is contacted by an attorney regarding your treatment or treatment of your child (either at your behest or related to a legal matter you are involved in), please be aware GGC charges $500 per hour to prepare for and/or attend any legal proceeding and for all court related services including travel time to and from the location of the proceeding. Fees for legal and court related services must be paid prior to the scheduled court hearing or deposition. Charges for court related services are not covered by insurance.

Court related services includes talking with attorneys, preparing and reviewing documents, traveling to court or deposition venue, attending depositions and court hearings/trials. You will be charged for any costs GGC incurs responding to attorneys in your case, including but not limited to, fees GGC is charged for legal consultation and representation by our attorneys.

If GGC's fees are not paid by the court or attorneys, you will be charged for the time GGC spends responding to legal matters. All fees for legal matters must be paid in advance of the legal proceeding in question.

Payment: Clients are expected to pay the agreed upon fee per hourly session at the beginning of each session unless other arrangements have been made in writing. Your therapist will not have clients run a bill. Your therapist cannot accept barter for therapy. Any overdue bills will be charged 1.5% per month interest. If a client refuses to pay the debt, GGC reserves the right to give your full legal name, contact information, amount due, and any other pertinent information (including protected health information), to a collection agency.