Terms of Service

Cancellation and No Show Policy

We understand that situations arise in which you must cancel your appointment.

***A 24 HOUR NOTICE OF CANCELLATION IS REQUIRED IN ORDER TO AVOID A CANCELLATION FEE OF $200. AGAIN, THE NO-SHOW/LATE-CANCEL FEE (IF NOT PROVIDED WITHIN 24 HOURS OF THE APPOINTMENT) WILL BE THE ENTIRE AMOUNT OF YOUR APPOINTMENT FEE, NOT JUST YOUR COPAY. ***

This will enable another client who is waiting for an appointment to be scheduled in that appointment slot. Clients who do not show up for their session and do not call/email to cancel beforehand will be considered a NO SHOW. No Shows will be charged the full cost of the session. Late cancellation and No Show fees are not covered by insurance and you will be 100% responsible for the fee. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late for a session, you may lose some of that session time. We understand that special unavoidable circumstances may cause you to cancel within 24 hours. Fees in this instance may be waived but only with management approval.

Financial Policy

It is important to our professional therapeutic relationship to have a clear understanding of our financial policy. Payment for services is due at the beginning of each session via the stored credit card you have on file, check or cash. Our office participates with a variety of insurance plans and hospitals. It is your responsibility to:

• Provide your insurance information before the start of services.

• Be prepared to pay your copay or coinsurance at each visit.

• For medical care NOT COVERED under your insurance, payment in full is due at the time of service~unless prior arrangements have been made with our office.

If you have special needs we are here to work with you. As extenuating circumstances may occur, clients may be able to set up payment arrangements on as needed basis. However if a client accumulates two unpaid balances or does not pay as agreed in the payment arrangement, services will not be able to continue until payment has been received. A $10.00 service charge will be charged for any checks returned for any reason for special handling.

Commercial Insurance

As a courtesy to our clients we will submit our claims to your insurance company. Your insurance policy is a contract between you and your insurance and our practice is not a part of that contract. It is your responsibility to determine what benefits are covered by your insurance plan. We will make reasonable effort to provide you with information regarding your copay or coinsurance; however, information quoted to us from your insurance provider does not guarantee payment or coverage. Client balances are required to be paid in full within 3 months (unless arrangements are made with our office) or the account will be forwarded to collection.

Collections

In the event of non-payment for clinical services, the practice will have the right of recovery for all collection expenses, including court cost and reasonable attorney fees incurred for the purpose of obtaining payment of the amount due. If your account does go to a collection agency or we are listed in a bankruptcy suit we may be unable to provide services unless arrangements can be made to put your account into good standing.

Court Policies and Fees

Please be advised that should the therapists and/or therapist interns of Citrine and Indigo Counseling and Wellness PLLC be requested to write a letter on any court related matter, that they will not be stipulating in writing or in person as to an opinion. Therapists and/or interns may only provide observations and feedback. At no time will any therapists or interns of Citrine and Indigo Counseling and Wellness PLLC make a recommendation in regards to custody or any other court related matter. If a court order is served and is requesting that a therapist or intern of Citrine and Indigo Counseling and Wellness PLLC be present in person and/or there is a request for records, the client's consent will be requested before turning over confidential information. When obtaining this consent, the client will be told exactly what has been requested by court, and there is no guarantee that the information will be kept confidential. This includes a client’s mental health history; current status and inclusive records and may not be in the best interest of the client. The therapist client relationship does not render the therapist as an advocate. The therapist will withhold any opportunity to engage in a dual relationship with the client. If called to testify in a deposition or court hearing, the client may not discern between information and records provided. All information and records are available for discovery. This may not be in the best interests of the client. The therapist reserves the right to discuss the implications of releasing information and records. Please be advised that should a therapist or intern from Citrine and Indigo Counseling and Wellness PLLC be court ordered to appear in court or at a deposition, the fee stipulation is as follows:

• $800 per day

• $150 per hour for preparation billed in quarterly segments ($37.50)

Please be advised that should a therapist or intern from Citrine and Indigo Counseling and Wellness PLLC be ordered by court to write a letter to the court, the time shall be billed at $150 per hour billed in quarterly segments.

All therapists and interns of Citrine and Indigo Counseling and Wellness PLLC will NOT be ON-CALL at any time. Should a case be trailed, or continued, the therapist will be paid in full for each day as it hinders the therapist’s or intern’s ability to be available to their other clients.

Subpoenas

Please coordinate with our office scheduler to ensure that the therapist can be available for the date and time of the deposition or court hearing. The therapist may agree to accept the subpoena via email if agreed upon. Reminder: A subpoena in which the client provided the therapist as a potential witness shall be billed in full for all court related activity. All court fees must be received 2 days prior to the court date unless other arrangements are made. Should the court calendar the hearing for another date, the therapist or intern must be re-issued a new subpoena with the new court hearing date. Should the therapists or interns 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.

Couples

When working with couples, it is imperative that both clients understand that if they wish to access their records during or after completion of therapy, both participants must consent to the release of such records. This also includes court letters and testimony. Both participants must consent to disclosure, otherwise the therapist shall invoke privilege.

Minors

If you are a minor, your parents may be legally entitled to some information about your therapy. I will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately kept confidential. In the state of Illinois please be advised that minors at the age of 12 must consent to their own treatment as well as the consent to release their records. As the minor’s therapist, it is the therapists’ ethical duty to inform the minor of the significance of releasing records (both verbally and in writing) as it may or may not benefit them therapeutically.

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. We may terminate treatment after appropriate discussion with you and a termination process if we determine that the psychotherapy is not being effectively used or if you are in default on payment. We 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 therapist, we will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.

Should you fail to schedule an appointment for three consecutive sessions (unless otherwise agreed upon having engaged in maintenance sessions between which, a longer amount of time intentionally lapses), unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued.

Contact

The best way to get in contact with your therapist is via the client portal messaging option. If there is a clinical emergency that you cannot wait for a return call, please call 911 for a medical emergency (or go to your nearest emergency room), or call 988 for a mental health emergency. Secure methods of contact are reviewed in our informed consent where you can speak with your therapist directly on the best method (such as secure email, secure texting). Social networking sites are not confidential and we are not able to respond to the sensitive nature of your request via these methods. Should this occur, expect that we will follow up with you via the phone number you have provided.

Additional Services

All phone calls exceeding 15 mins (clinical support, school personnel, Guardian ad Litem (GAL), physicians, evaluators, etc.), report writing, and other work including but not limited to file review, FMLA paperwork completion, coordination with hospital staff, human resources, etc. will be billed at quarter hour segments ($37.50). Please note that our staff makes the best effort to advocate for you and what is in your best interest. However we cannot guarantee the outcome of any decision and will remain ethical and objective when providing information both written and verbally provided.