Policy Agreement


Listed below are WPG’s policies. WPG reserves the right to change these policies as needed to provide the highest level of service to its patients.

PSYCHOLOGICAL SERVICES
All psychologists at WPG are licensed clinical psychologists, with a doctoral degree in clinical psychology. All psychologists are competent in psychotherapy and psychological assessments. Each WPG psychologist has specific areas of expertise, experience, and training. Please speak with your psychologist directly to inquire about training to address specific needs.

CONFIDENTIALITY
Confidentiality ensures that all information shared with your psychologist will remain private. It is the foundation of psychotherapy. Confidentiality is essential to creating a successful relationship between the patient and psychologist. Patients should feel comfortable sharing personal information with their psychologist and not have to worry about information being released to others.

What information is confidential?
All communication between you and your psychologist is confidential. This includes all oral, written, and electronic communication. The federal government passed the HIPAA Privacy Law to protect your personal health information. By law, WPG is not allowed to share any information that may identify you. This includes:
• Any of your past, present and future health and medical conditions
• WPG cannot discuss any information you share or tell anyone that you are a patient.

Exceptions to Confidentiality
Legally, there are some circumstances where your psychologist will have to violate confidentiality. These circumstances are listed below.
  • If WPG suspects that you are a threat yourself or others WPG will have to take protective actions. If you threaten to harm yourself WPG will either contact a friend or family member to arrange for them to monitor you, encourage you to voluntarily admit yourself to a hospital, or involuntarily admit you to a hospital. If WPG believes you may harm another individual WPG will contact and warn the potential victim, and WPG will also notify the police.
  • If WPG suspects that there is evidence of child abuse or neglect WPG will file a report with Child Protection Services.
  • If WPG suspects there is evidence of elderly or disabled person’s abuse WPG will file a report with Adult Protection Services.
  • If a court orders or subpoenas your records, WPG is legally required to provide them with your records.
Confidentiality with Minors
In cases of therapy with minors, parents or legal guardians have a right to information regarding treatment and may request copies of the treatment record. However, in order for therapy to be effective the child/adolescent must also have an assurance of privacy. When requesting children’s records, we advise deference to the opinion of the treating psychologist whether disclosure is appropriate. We strongly discourage parents from requesting access to their child’s records. Your child may be threatened by invasion of their privacy and betrayal of trust. Your child may no longer feel that therapy is a time where they can be honest they may withhold important information that compromises progress. If the treating psychologist believes that your child is in danger, at risk for danger, or may cause danger to another, you will be informed without delay. Upon reaching the age of 18, your child assumes all responsibility for releasing information contained in his or her medical record unless this right is otherwise limited by a court of law.
Unless informed otherwise, it is assumed that every child coming to WPG has two parents with equal legal rights to initiate treatment and make treatment decisions. It is also assumed that either parent may initiate treatment, give informed consent, or sign Releases of Information without the expressed consent of the other parent. Information that is shared by one parent within the context of the child’s therapy cannot be considered confidential from the other parent. Should one parent’s right be limited or terminated, or if a court has ordered that both parents must give consent for treatment, it is the parents’ responsibility to provide documentation from the court showing the limits on, or termination of, parental rights. Should parents disagree about the interpretation of a court order (including divorce decrees), written clarification from attorney(s) and/or presiding judge is required before treatment commences and/or continues.

Confidentiality with Couples
When there is more than one person involved in treatment, such as with couples therapy, confidentiality is more complicated. Usually, and unless otherwise specified, information that is shared by one party cannot be concealed from the other parties involved in the therapy. Treatment records of couples sessions contain information about both persons. Therefore, both patients must understand and agree that treatment records will not be released to either party without a court order.

Confidentiality with Your Insurance Company or Third-Party Payer
All insurance companies and third-party payers (including collection agencies) must also follow the HIPAA Privacy Law. Although WPG makes every effort to maintain confidentiality of records in our office, WPG cannot guarantee confidentiality once these documents are given to your insurance company. Many insurance and third-party payers require specific information for payment including a diagnosis, type of services provided, date(s) the services took place, current symptoms, treatment plan, and the duration of the treatment.

Confidentiality and Office Staff
All office staff must sign a confidentiality agreement and abide by the HIPAA Privacy Law. Staff members are given access to health records on a need-to-know basis. They are permitted to access and use information that is required for them to perform their jobs.

Confidentiality and Audio/Video Recording
Patients are not permitted to record sessions in any manner without prior written consent from their provider. Personal notes are acceptable, and in some circumstances may be encouraged. However, if family members object to note-taking, you may be asked to wait until the conclusion of the session to record information. WPG may record sessions for training purposes. We will ask for your written consent before any session is recorded.

RELEASE OF INFORMATION
As a patient you have the right to release your records to others. When sending your records to another party you do NOT have to send your entire file. You have the right to limit what information is sent or shared with a third party. For example, you may not want to provide your progress notes to your general health provider, but you want to provide them with everything else in your file. If this were the case, WPG would provide your general health provider with everything in your file except for your progress notes. Prior to releasing any information, you will be required to complete and sign the “Authorization for Disclosure of PHI” form.

SCHEDULE OF FEES
New Patient Appointment/Interview (90791) $250 (untimed, but typically 60-90 minutes)
Individual Therapy (90832) $100 (16-37 minutes)
Individual Therapy (90834) $150 (38-52 minutes)
Individual Therapy (90837) $175 (53+ minutes)
Family Therapy (90847/90846; with/without patient) $195 (untimed, but typically 60-90 minutes)
Psychological Testing by Psychologist (96101) $175 per hour
Psychological Testing by Technician (96102) $70 per hour
Group Therapy (90853) $85
Psychological Testing by Computer (96103) $50 per unit

Your psychologist/provider will discuss with you the frequency of appointments and duration of treatment during your New Patient Appointment.

Psychologists have the right to charge for additional services that include, but are not limited to report and letter writing, travel time, telephone conversations lasting more than 15 minutes, e-mail correspondence, professional meetings, school observations, and consultations. You are responsible for paying all fees at the time of your appointment. In the case of minors whose parents do not share the same household, payment for services is the responsibility of the parent who accompanies the child to the appointment. If the parent or financially responsible party is unable to accompany the patient to the appointment, a credit card must be on file for payment.

From time to time, WPG may have doctoral students on staff to provide therapy and/or testing at reduced rates that are not reimbursable by insurance. All services by a doctoral student are performed under the direct supervision of a licensed psychologist. You must sign a waiver indicating your consent for such services.

Payment is due at the time of service. Cash, check, Visa, MasterCard and Discover are accepted. Any check returned for insufficient funds will incur and additional bank fee. If you fail to pay your balance within 90 days, WPG will submit your account to a collection agency and an additional service fee will be added.

CANCELLATION POLICY/MISSED APPOINTMENT
In an event that you have to cancel a therapy appointment, WPG will need notification 24 hours prior to your appointment time. New patient appointments and evaluations (testing sessions) require 48 hours’ notice for cancellation. When you schedule an appointment, WPG reserves time for you. Our cancellation policy allows WPG time to offer this time to another patient on our waiting list. If you miss your appointment time or fail to contact the office within the required time, you will be charged for the time reserved. Missed appointment fees are not covered by insurance plans. WPG understands that in rare circumstances, an emergency situation may occur. These emergency situations will be taken into consideration if you are unable to provide WPG with advance notice.

INSURANCE REIMBURSEMENT
WPG providers are in-network with Sagamore Health Network insurance. You must provide accurate and updated healthcare/insurance information to WPG and give consent for WPG to release any required information to your healthcare insurance to assist in the processing of claims, including protected healthcare information in accordance with the Health Insurance Portability and Accountability Act (HIPAA). Please refer to Confidentiality with Your Insurance Company or Managed Care Company for additional information.

If your mental health coverage is with another insurance company, you are responsible for filing with your insurance company for reimbursement. It is your responsibility to contact your insurance company to determine benefits. Regardless of your health insurance coverage, you are responsible for all charges incurred for WPG services.

If you have Medicaid, Medicare, or Tricare coverage, services provided at this office are non-Medicaid/Medicare or Tricare reimbursable, and you assume full financial responsibility for all services rendered.

CONTACTING YOUR PSYCHOLOGIST
WPG’s office hours are Monday through Thursday, 8:30 am to 6:00 pm. WPG psychologists maintain different work schedules/hours. Please check with your psychologist for their specific availability. During office hours, WPG’s office manager or administrative assistant will answer all calls. During their work schedule, psychologists are generally seeing patients; therefore, he/she may not be able to speak with you directly. If your psychologist is not available, you may leave a message on your psychologist’s confidential voicemail and can expect a return call within 24 business hours. If there is an emergency after hours, you may contact your psychologist by cell phone (provided on your psychologist’s voicemail). If you are unable to reach your psychologist and need to speak to someone immediately, please admit yourself to the nearest emergency room.

EMAIL COMMUNICATIONS
WPG must have your written consent to send to and receive e-mail communications as part of treatment. There are risks of sending PHI through e-mail, and with your consent, you accept these risks will not hold WPG held responsible for any exposure of email communications at your home or place of employment. Email communications can fail in their transmission, and you agree to contact WPG if you have not obtained a response within three business days.

TEXT MESSAGING
WPG must have your written consent to receive text messages from WPG providers. The content of text messages may relate to any aspect of you (or your dependent’s) medical record. Text messages should never be used for emergency situations. WPG utilizes the public telephone network and as such full security is not guaranteed and there is a risk that text messages can fail in their transmission.

TELECONFERENCE/SKYPE
For a variety of reasons, including continuity of care, there may be a need to conduct therapy over the phone or via Skype/video sessions (once a therapeutic relationship has been established in office, after intake and/or consultation in person). These off-site sessions make it possible to maintain the continuity of the therapy. Off-site therapy may be required under the following circumstances: medical condition that limits travel or job/school that requires extensive travel out of state or country.

In order to effectively conduct off-site/video sessions, the following points need to be addressed and WPG must have your written consent indicating your agreement:

  • The patient and therapist agree to the same professional standards of behavior and ethical conduct that would apply to in-person/in-office therapy sessions. Start and end times will be respected as they are in the office sessions.
  • WPG providers will make every effort to keep all information confidential. If we are working online, we will ask that you determine who has access to your computer from your location. We encourage you to only communicate through your personal computer that is secure and password-protected. It is your responsibility to find a private and secure location to conduct the video/phone session as the therapist cannot control who enters your area or overhears your discussion.
  • It is highly recommended that the patient use headphones to hear the therapist as this will help minimize potential over-hearing of sensitive information that is being stated by the provider.
  • Once the session is over, it is up to the patient to ensure that their personal computer is logged out of the communication application (i.e., Skype).
  • If we are unable to establish a connection or a connection is lost, all attempts will be made to reconnect during that session time. In the event of technical difficulties, sessions will not continue beyond their scheduled time.
  • Video/phone sessions may not be appropriate during a crisis, and referral to a crisis care center in your area may be required. If a life-threatening crisis should occur, you agree to contact a crisis hotline or go to a local emergency room.
  • Video/audio recording of the session will not be conducted without the written consent of the therapist and the patient.
  • Most insurance companies will not reimburse costs for phone/video sessions. Costs for phone/video sessions are the same as in-office sessions, based on time (see Schedule of Fees).
PARENTAL DIVORCE AND SEPARATION
If parents decide to separate or divorce during therapy, WPG will abide by the following policies:

  • Documentation: Current divorce decrees will be provided prior to the initial session to verify custody agreements and financial responsibility for mental health treatment.
  • Testifying in Court: Generally, WPG does not testify in court. If WPG is subpoenaed to testify in court, WPG will request a release of information from both parents.
  • Disputes: WPG will not take sides with either parent during a dispute. WPG’s primary interest is the mental health of the child/adolescent. Parents will refrain from making disparaging comments about the other parent when children are present.
  • Secrets:WPG will not to keep secrets from the child or the other parent if it negatively affects the mental health of the child.
  • Financial Arrangements: Following a separation or divorce, WPG will meet with both of the parents to discuss financial arrangements. The parent who brings the child/adolescent to the session is responsible for paying for the session.
THERAPEUTIC PROCESS
During therapy, WPG will address your individual concerns, needs, and difficulties. Therapy is not the same for every patient. It varies based on the personality of the patient and the psychologist. Throughout therapy, you and WPG will work towards several goals, which will ultimately lead to a more fulfilling life.

Therapy has both risks and benefits. At times you may discuss difficult aspects of your life, which may lead to feelings of sadness, guilt, anger, frustration, loneliness, and helplessness. Although these feeling are quite unpleasant, there are also benefits to therapy. Your work with WPG may lead to better interpersonal relationships, the ability to create solutions to problems, increased awareness and insight, increased use of skills to reduce stress, and a reduction in your symptoms and distress. Even though there are several benefits to therapy, there are no guarantees that therapy will benefit you.

TERMINATION
Therapy entails a significant amount of time, energy, and money. Therefore, it is important that both you and WPG feel as though the process is beneficial. Throughout therapy, WPG will evaluate your progress and during the first few sessions WPG will determine if he/she can benefit you in meeting your treatment goals. If at any time you or WPG feel that that your treatment is not helping you reach your therapeutic goals, then you and WPG will discuss this situation and, if appropriate, decide to terminate treatment. If WPG feels that another setting or clinician is more appropriate, WPG will provide you will several referrals to contact. You have the right to terminate treatment at any time.