GENERAL INFORMATION

This notice describes Emerald Path Therapy LLC’s policies related to operation management and therapeutic practices. Please review it carefully and in its entirety.

 

FINANCIAL RESPONSIBILITY

All co-pays, deductibles, and private pay fees are subject to be paid in full at the time of the service unless other arrangements have been made in advance. The full fee for an intake session is $175, and the full fee for a 55-minute session is $150. Payment is accepted in the form of cash, check, or credit card. Regardless of your preferred payment form, we require a credit card to be on file as a contingency for late cancellations or missed sessions. By submitting your credit card information, you are granting Emerald Path Therapy permission to charge your credit card for services rendered. As a healthcare provider, we also accept payment through a Health Savings Account (HSA) and Flexible Spending Account (FSA). A $25.00 service charge will be charged for any checks returned for any reason for special handling.
 

We accept Blue Cross Blue Shield PPO, Aetna PPO, and United Health Care insurance plans. Please contact your insurance provider directly to ascertain your plan’s coverage for mental health services. Please also be advised that by providing your insurance information to Emerald Path Therapy LLC, you are verifying that you have the authority to file under the listed insurance plan.
 

We can offer a reduced rate for those who experience financial hardship and are not covered by insurance. Your rate will be based on family income and circumstances and can be discussed with your therapist.

 

APPOINTMENTS AND CANCELLATIONS

Please cancel or reschedule any sessions that you are unable to attend at least 24 hours in advance. You will be responsible for the entire fee if a cancellation is made less than 24 hours in advance (except in the case of an emergency).

 

The standard meeting time for psychotherapy is 55 minutes. Any request to change the 55-minute session length needs to be discussed with the therapist in advance.

 

Cancellations and rescheduled sessions will be subject to a full charge IF NOT RECEIVED AT LEAST 24 HOURS IN ADVANCE. This is necessary because a time commitment is made for you and is held exclusively for you. If you are late for a session, you may lose some of that session time. If you miss your first scheduled session without giving at least 24 hours’ notice, you will be charged $50 for the missed appointment or late cancellation.

 

TELEPHONE ACCESSIBILITY

Your therapist may not be immediately available to answer or return your call. However, they will attempt to return your call within 24 hours during the standard work week. Please note that in-person sessions are preferable to phone sessions. In the event that you are out of town, sick, or need additional support, phone sessions may be available. If a true emergency situation arises, please call 911 or visit your local emergency room.

 

SOCIAL MEDIA AND TELECOMMUNICATION

Due to the importance of your confidentiality and the importance of minimizing dual relationships, therapists do not accept friend or contact requests from current or former clients on any social networking sites (e.g., Facebook, LinkedIn, etc.). Adding clients as friends or contacts on these sites can compromise the client’s confidentiality and the privacy of both the client and the therapist. It may also blur the boundaries of the therapeutic relationship. If you have questions about this, please discuss this further when you meet with your therapist.

 

ELECTRONIC COMMUNICATION

While therapists at Emerald Path Therapy LLC have HIPAA compliant and secure emails, Emerald Path Therapy LLC cannot guarantee the confidentiality of any form of communication through electronic means. If you prefer to communicate via email for issues regarding scheduling or cancellations, please contact your therapist directly. While they strive to respond to messages in a timely manner, they may not be able to respond immediately. We also recommend that you do not use this form of communication to discuss therapeutic content and/or request assistance in emergencies.

 

Services provided by electronic means, including but not limited to an interactive telecommunications system, asynchronous store and forward system, remote patient monitoring technologies, e-visits, or virtual check-ins is considered telehealth services by the State of Illinois. Under Illinois’ Telehealth Act (225 ILCS 150/), “telehealth services” is broadly defined as ‘evaluation, diagnosis, or interpretation of electronically transmitted patient-specific data between a remote location and a licensed health care professional

that generates interaction or treatment recommendations’ and includes telemedicine and the delivery of health care services, including mental health treatment and substance use disorder treatment and services to a patient, regardless of patient location. If you and your therapist chose to use information technology for some or all your treatment, you need to understand that:

 

1. You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled.

2. All existing confidentiality protections are equally applicable.

3. Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee.

4. Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent.

5. There are potential risks, consequences, and benefits of telemedicine.
    

• BENEFITS - Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel costs. Effective therapy is often facilitated when the therapist gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, a diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third person consultations, but also from direct visual and olfactory observations, information and experiences.

• RISKS - Potential risks include, but are not limited to the therapist’s inability to make visual and olfactory observations of clinically or therapeutically relevant issues such as: your physical condition including deformities, apparent height and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression.

• CONSEQUENCES - Potential consequences thus include the therapist not being aware of what he or she would consider important information that you may not recognize as significant to present verbally to the therapist.

 

MINORS

If you are a minor, your parents may be legally entitled to some information about your therapy. The therapist will discuss with you and your parent(s) what information is appropriate for them to receive and which issues are more appropriately kept confidential.

 

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. Your therapist may terminate treatment after appropriate discussion with you about a termination process if they determine that the psychotherapy is not being effectively used or if you are in default on payment. Your therapist will not terminate the therapeutic relationship without first discussing and exploring the reasons for and purpose of termination. If therapy is terminated or you request another therapist, your therapist 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 weeks, unless other arrangements have been made in advance, for legal and ethical reasons, your therapist will consider the professional relationship discontinued.