Agreement for Psychotherapy Services and Office Policies
Confidentiality: 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 permission, except where disclosure is required by law. Most of the provisions explaining when the law requires disclosure were described to you in the Notice of Privacy Practices that you received with this form.
Please be aware that the clinicians at BMHC provide one another with consultation on cases. This means that we will discuss cases with one another in order to receive clinical recommendations and professional feedback. In doing so, we disclose only that information which is necessary, and always limit the disclosure of PHI to every extent possible. However, by participating in services through BMHC, you understand that your case may be discussed with other professionals at BMHC, all of whom are bound by the same confidentiality laws.
Confidentiality of E-mail, Cell Phone and Faxes Communication: This practice uses a scheduling system which is able to send appointment reminders via email or text. Please let us know if you would like to participate in this reminder system. It is very important to be aware that e-mail and cell phone communication can be relatively easily accessed by unauthorized people and hence, the privacy and confidentially of such communication can be compromised. E-mails, in particular, are vulnerable to such unauthorized access due to the fact that servers have unlimited and direct access to all e-mails that go through them. You may decide to avoid or limit in any way the use of any or all of the above-mentioned communication devices. Please do not use e-mail or faxes for emergencies.
Telephone & Emergency Procedures: If you need to contact your clinician between sessions, please leave a message at 508-769-7812 and your call will be returned as soon as possible. If an emergency situation arises, please indicate it clearly in your message. If you are in crisis and you are unable to reach your clinician, please contact the on-call clinician by selecting extension 4. If you are in danger of hurting yourself or someone else, or are in crisis and cannot reach a clinician at BMHC, you should proceed to the Emergency room designated by your insurer, contact 911, or contact Emergency Mental Health Services at 508-856-3562.
Payments & Insurance Reimbursement: Clients are expected to pay the standard fee of $100.00 for a 45-minute individual/couples/family counseling, and $125.00 for a 60-minute session unless other arrangements have been made. We offer a sliding scale fee, which is attached. Please notify your clinician if any problem arises during the course of therapy regarding your ability to make timely payments. Clients who carry insurance may authorize their clinician to bill the insurer on their behalf. As indicated in the section, Health Insurance & Confidentiality of Records, please be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems, which are the focus of psychotherapy are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage.
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 claims. Only the minimum necessary information will be communicated to the carrier. Your treatment team has no control over or knowledge about what insurance companies do with the information they submits 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 eligibility to obtain health or life insurance. The risk stems from the fact that mental health information is entered into insurance companies’ computers and soon will also be reported to the Congress-approved National Medical Data Bank. Accessibility to companies’ computers or to the National Medical Data Bank database are always in question, as computers are inherently vulnerable to break-ins and unauthorized access. Medical data has been reported to have been sold, stolen, or accessed by enforcement agencies; therefore, you are in a vulnerable position.