Policies
POLICIES AND AGREEMENT FOR SERVICES:
AGREEMENT FOR PSYCHOTHERAPY, PSYCHOEDUCATIONAL, CONSULTING, AND ASSESSMENT SERVICES
This form is subject to HIPAA preemptive analysis.
Unless otherwise specified as an employee of InPsych Center, A LCSW Corporation, the mental health practitioners at 127 E. 3rd Ave, Ste. 201 Escondido, CA, 92025 have no affiliation other than to share office space.
Confidentiality: All information disclosed within session and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your written permission except where the disclosure is required by law.
When Disclosure Is Required Or May Be Required By Law: Some of the circumstances where disclosure is required or may be required by law are: 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 InPsych Center, A Licensed Clinical Social Worker Corporation, hereinafter referred to as IPC or your therapist 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 IPC or your therapist. 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. IPC or your therapist will use clinical judgment when revealing such information. IPC and your therapist will not release records to any outside party unless 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 IPC or your therapist become concerned about your personal safety, the possibility of you injuring someone else, or about you receiving proper psychiatric care, IPC or your therapist will do whatever can be done within the limits of the law, to prevent you from injuring yourself or others and to ensure that you receive the proper medical care. For this purpose, IPC or your therapist may also contact the person whose name you have provided as your emergency contact.
Health Insurance & Confidentiality of Records: Disclosure of confidential information may be required by your health insurance carrier or HMO/PPO/MCO/EAP in order to process the claims. If you so instruct IPC or your therapist, only the minimum necessary information will be communicated to the carrier. IPC nor your therapist have control over, or knowledge of, what insurance companies do with the submitted information or who has access to this information. You must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk to confidentiality, privacy, or to future capacity to obtain health or life insurance or even a job. The risk stems from the fact that mental health information is likely to be entered into big insurance companies’ computers and is likely to be reported to the National Medical Data Bank. Accessibility to companies’ computers or to the National Medical Data Bank database is always in question as computers are inherently vulnerable to hacking and unauthorized access. Medical data has also been reported to have been legally accessed by law enforcement and other agencies, which also puts you in a vulnerable position.
Litigation Limitation: 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 nor your attorney(s), nor anyone else acting on your behalf will call on IPC or your therapist to testify in court or at any other proceeding, nor will disclosure of the psychotherapy records be requested unless otherwise agreed upon. Should anyone issue a legal subpoena on your behalf, a fee shall be assessed based on the provider’s hourly rate.
Consultation: IPC and your therapist consult regularly with other professionals regarding clients; however, each client’s identity remains completely anonymous, and confidentiality is fully maintained.
Emails, Cell Phones, Computers, and Faxes: It is very important to be aware that computers and unencrypted e-mail, texts, and e-fax communication can be relatively easily accessed by unauthorized people and hence can compromise the privacy and confidentiality of such communication. E-mails, texts, and e- 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 e-mails, texts, and e-faxes that go through them. Data on IPC’s and your therapist’s computers are protected, and IPC uses HIPAA-compliant e-mail and e-fax. However, it is always a possibility that e-faxes, texts, and emails can be sent erroneously to the wrong address and computer, or digital device.
IPC’s and your therapist’s computers are equipped with a firewall, virus protection, and a password. Also, be aware that phone messages may be transcribed and sent to IPC or your therapist via unencrypted e-mails. Please notify IPC or your therapist if you decide to avoid or limit, in any way, the use of e-mail, texts, cell phones calls, phone messages, or e-faxes. If you communicate confidential or private information via unencrypted e-mail, texts, e-fax or phone messages, IPC and your therapist 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, and will honor your desire to communicate on such matters. Please do not use texts, e-mail, voice mail, or faxes for emergencies.
Telephone & Emergency Procedures: If you need to contact IPC or your therapist between sessions, please leave a message at (760) 489-1092 and your call will be returned as soon as possible. IPC and your therapist check messages a few times during the daytime only, unless out of town. If an emergency situation arises, indicate it clearly in your message, and if you need to talk to someone right away call the 24-hour crisis line (San Diego): 1-888-724-7240 or the Police: 911. Please do not use email, text messages, or faxes for emergencies. IPC and your therapist do not always check email or faxes daily.
Records and Your Right To Review Them: Both the law and the standards of IPC’s and your therapist’s profession require that treatment records are kept for at least 7 years. Unless otherwise agreed to be necessary, IPC and your therapist retain clinical records only as long as is mandated by California law. If you have concerns regarding the treatment records, please discuss them with IPC or your therapist. As a client, you have the right to review or receive a summary of your records at any time, except in limited legal or emergency circumstances or when IPC or your therapist assesses that releasing such information might be harmful in any way. In such a case, IPC or your therapist will provide the records to an appropriate and legitimate mental health professional of your choice. Considering all of the above exclusions, if it is still appropriate, and upon your request, IPC or your therapist will release information to any agency/person you specify unless IPC or your therapist assesses that releasing such information might be harmful in any way. When more than one client is involved in treatment, such as in cases of couple and family therapy, IPC or your therapist will release records only with signed authorizations from all the adults (or all those who legally can authorize such a release) involved in the treatment.
Payments & Insurance Reimbursement: Clients are expected to pay the agreed-upon fee at each session unless other arrangements have been made. Ancillary telephone conversations, site visits, writing and reading of reports, consultation with other professionals, the release of information, reading records, longer sessions, travel time, etc. will be charged at the same rate unless indicated and agreed upon otherwise. Please notify IPC or your therapist if any problems arise during the course of therapy regarding your ability to make timely payments. IPC and its providers are not contracted with insurance companies (except OPTUM/TERM). Likewise, IPC and its providers DO NOT accept or submit claims to MEDICARE or MEDI-CAL. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance companies. If requested, IPC will provide you with information on accessing your statement(s), which you can then submit to your insurance company for reimbursement, if you so choose. As was indicated in the section, Health Insurance & Confidentiality of Records, you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems, which are dealt with in psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage. If your account is overdue (unpaid) and there is no written agreement on a payment plan, IPC or your therapist can use legal or other means (courts, collection agencies, etc.) to obtain payment.
Mediation & Arbitration: All disputes arising out of, or in relation to, this agreement to provide psychotherapy, psychoeducational, consulting, or assessment services shall first be referred to mediation, before, and as a pre-condition of, the initiation of arbitration. The mediator shall be a neutral third party chosen by agreement of IPC and your therapist and the client(s). The cost of such mediation, if any, shall be split equally unless otherwise agreed upon. In the event that mediation is unsuccessful, any unresolved controversy related to this agreement should be submitted to and settled by binding arbitration in San Diego County, CA in accordance with the rules of the American Arbitration Association which are in effect at the time the demand for arbitration is filed. Notwithstanding the foregoing, in the event that your account is overdue (unpaid) and there is no agreement on a payment plan, IPC and your therapist can use legal means (court, collection agency, etc.) to obtain payment. The prevailing party in arbitration or collection proceedings shall be entitled to recover a reasonable sum as and for attorney’s fees. In the case of arbitration, the arbitrator will determine that sum.
The Process of Therapy/Evaluation and Scope of Practice: Participation in therapy can result in a number of benefits to you, including improving interpersonal relationships and resolution of the specific concerns that led you to seek therapy. Working toward these benefits, however, requires effort on your part.
Psychotherapy requires your very active involvement, honesty, and openness in order to change your thoughts, feelings, and/or behavior. IPC and your therapist will ask for your feedback and views on your therapy, its progress, and other aspects of the therapy and will expect you to respond openly and honestly. Sometimes more than one approach can be helpful in dealing with a certain situation. During evaluation or therapy, remembering or talking about unpleasant events, feelings, or thoughts can result in you experiencing considerable discomfort or strong feelings of anger, sadness, worry, fear, etc., or experiencing anxiety, depression, insomnia, etc. IPC and your therapist may challenge some of your assumptions or perceptions or propose different ways of looking at, thinking about, or handling situations, which can cause you to feel very upset, angry, depressed, challenged, or disappointed. Attempting to resolve issues that brought you to therapy in the first place, such as personal or interpersonal relationships, may result in changes that were not originally intended. Psychotherapy may result in decisions about changing behaviors, employment, substance use, schooling, housing, or relationships. Sometimes a decision that is positive for one family member is viewed quite negatively by another family member. The change will sometimes be easy and swift, but more often it will be slow and even frustrating. There is no guarantee that psychotherapy will yield positive or intended results. During the course of therapy, IPC and your therapist are likely to draw on various psychological approaches according, in part, to the problem that is being treated and an assessment of what will best benefit you. These approaches include, but are not limited to, behavioral, cognitive-behavioral, cognitive, psychodynamic, existential, system/family, developmental (adult, child, family), EMDR, Lifespan Integration, humanistic or psycho-educational. Neither IPC nor your therapist provide custody evaluation recommendations, medication or prescription recommendations, nor legal advice, as these activities do not fall within the scope of IPC’s or your therapist’s practice.
Treatment Plans: Within a reasonable period of time after the initiation of treatment, IPC or your therapist will discuss with you a working understanding of the problem, treatment plan, therapeutic objectives, and view of the possible outcomes of treatment. If you have any unanswered questions about any of the procedures used in the course of your therapy, their possible risks, IPC’s or your therapist’s expertise in employing them, or about the treatment plan, please ask, and you will be answered fully. You also have the right to ask about other treatments for your condition and their risks and benefits.
Termination: As set forth above, after the first couple of meetings, IPC and your therapist will assess if our services can be of benefit to you. IPC and your therapist do not work with clients who, in our opinion, we cannot help. In such a case, if appropriate, we will give you referrals that you can contact. If at any point during psychotherapy IPC or your therapist either assesses that our services are not effective in helping you reach the therapeutic goals or perceived you as non-compliant or non-responsive, and if you are available and/or it is possible and appropriate to do, we will discuss with you the termination of treatment and conduct pre-termination counseling. In such a case, if appropriate and/or necessary, you would be given a couple of referrals that may be of help to you. If you request it and authorize it in writing, IPC or your therapist will talk to the psychotherapist of your choice in order to help with the transition. If at any time you want another professional’s opinion or wish to consult with another therapist, IPC or your therapist will give you a couple of referrals that you may want to contact, and if given your written consent, will provide them with the essential information needed. You have the right to terminate therapy and communication at any time. If you choose to do so, upon your request and if appropriate and possible, IPC or your therapist will provide you with names of other qualified professionals whose services you might prefer.
Dual Relationships: Despite popular perception, not all dual or multiple relationships are unethical or avoidable. Therapy never involves sexual or any other dual relationship that impairs IPC’s or your therapist’s objectivity, clinical judgment or can be exploitative in nature. IPC and your therapist will assess carefully before entering into non-sexual and non-exploitative dual relationships with clients. It is important to realize that in some communities, particularly small towns, military bases, university campuses, etc., multiple relationships are either unavoidable or expected. IPC nor your therapist will ever acknowledge working with anyone without their written permission. Many clients have chosen IPC or your therapist because they knew of IPC or your therapist before entering therapy at IPC, and/or are personally aware of professional work and achievements. Nevertheless, IPC and your therapist will discuss with you the often-existing complexities, potential benefits, and difficulties that may be involved in dual or multiple relationships. Dual or multiple relationships can enhance trust and therapeutic effectiveness but can also detract from it and often it is impossible to know which ahead of time. It is your responsibility to advise IPC or your therapist if the dual or multiple relationships becomes uncomfortable for you in any way. IPC and your therapist will always listen carefully and respond to your feedback and will discontinue the dual relationship if it is found to be interfering with the effectiveness of the therapy or your welfare and, of course, you can do the same at any time.
Social Networking and Internet Searches: At times, IPC or your therapist may conduct a web search on clients before the beginning of therapy or during therapy. If you have concerns or questions regarding this practice, please discuss them with IPC or your therapist. IPC and your therapist do not accept friend requests from current or former clients on social networking sites, such as Facebook. IPC and your therapist believe that adding clients as friends on these sites and/or communicating via such sites is likely to compromise their privacy and confidentiality. For this same reason, IPC and your therapist request that clients do not communicate with IPC or your therapist via any interactive or social networking websites.
Cancellation: Since the scheduling of an appointment involves the reservation of time specifically for you, a minimum of 24 hours (1 day) notice is required for re-scheduling or canceling an appointment. The full fee will be charged for sessions missed without such notification. Most insurance companies do not reimburse for missed sessions.
