Office Policies
My treatment contract and supporting documents represent a legally enforceable business relationship and your signature on these documents represents a binding agreement between us. Careful review of these policies and procedures can help us avoid risks of such business issues that may become the bases for misunderstandings, boundary violations, and ethical dilemmas or complaints. Please take as much time as necessary to completely understand my policies and procedures. After you have had sufficient time to review them, you will have an opportunity to ask any questions and I will address any concerns to your satisfaction before you affix your signature.
Communication Procedures
Generally, my typical workweek is Monday, Tuesday, Thursday, and Friday, 9:00am-8:00pm, but my days/hours can vary greatly. Further, I am often not available during work hours because I am a sole practitioner, do not have an administrative assistant, and will not answer the phone or email when I am with another client. I will make every effort to return your call/email within 48-72 hours (2-3 days), not including weekends, holidays, absences, and vacations. While this may seem like an inordinate amount of time, I believe that it is crucial for maintaining the personal-professional boundaries necessary for my mental and physical health so that I can provide you, to the best of my ability, with the service you deserve.
Email is the best means of contacting me; and yet, while I am the only person with access to my email account, I cannot vouch for the security, privacy, or confidentiality of electronic transmissions in general. Therefore, my preference is to limit email to logistical issues (i.e., scheduling) or requesting a more confidential communication (i.e., phone call). However, if you are comfortable with general confidentiality parameters, or the potential lack thereof, you can email information you would like me to have that can be discussed in subsequent in-office or phone sessions. Please understand that I will not reply directly to such email but will use them to prepare for our next scheduled session. Under no circumstances are you to use email to address crisis issues. I consider email to be a privilege, not a right, and if you abuse that privilege by sending messages of a critical, desperate, or threatening nature, I will consider it a boundary violation and will refuse to accept subsequent emails by blocking your address from my email account.
Because the nature of my sole-practitioner practice does not allow me to be a crisis counselor or available outside of business hours, it is important for us to have an agreed-upon plan to manage any between-session difficulties if they occur. If, during the course of our work together, you experience a psychological emergency (one involving potential life threat or harm to self or others) and you feel that you cannot wait for at least 48-72 hours (not including weekends, holidays, absences, and vacations) to speak with me, you are to call 911 and/or contact your local hospital emergency room (e.g., nearest or one covered by your insurance) and ask for the psychiatrist on call.
Psychological emergencies are not the only problems that can arise in therapy. At times people find that they are not ready to approach their problems with CBT. At other times there can be difficulties prioritizing therapy efforts given work, family, or other obligations. Sometimes the fit between psychologist and client is not as suitable as initially thought. Occasionally, financial realities necessitate prematurely ending therapy. Any of these can result in therapy disengagement. I understand that some people can be especially uncomfortable having conversations about issues such as these. Please understand that, because I cannot control your behavior, communications with me are ultimately your responsibility. I will make appropriate efforts to contact you; however, if you do not respond to or initiate communications for a three-month period, I will have no choice but to assume that you are no longer interested in pursuing therapy at the time and/or with me, and I will close your file whether or not I have been able to communicate directly with you. If three months lapse without me hearing from you, by default, that means our therapy relationship has ended, and I will make referralsto other practitioners as requested. Conversely, if you are waiting on a response from me about anything, and you feel that it has been an inordinate amount of time, it is your responsibility to follow up – a brief email or voicemail will suffice.
Attendance Policy
Regular attendance in therapy is important to your progress and goal attainment. Because there is no arbitrary timeframe for session frequency, we have the flexibility of scheduling our meetings according to your needs and schedule. I do ask that you thoughtfully consider scheduling within the realities of your therapy needs and other life obligations. In order to minimize scheduling confusions, at the end of each session I send an appointment confirmation email to clearly identify what I consider to be the date and time of our next meeting. It is your responsibility to check this appointment confirmation email and contact me if there is any discrepancy in our calendars. If you miss a session due to a mistake about dates or times, the appointment confirmation email will be considered the definitive agreed-upon understanding, and you will be charged for a missed session (see the next section on Financial Policy for further details).
Irregular attendance can create unanticipated disruptions in therapy momentum and progress, especially given that the nature of my work schedule can create as much as a two-to-three-week lapse between regularly-scheduled appointments (longer if I have an upcoming vacation or conference). Of course, I understand that life at times has a way of interfering with the best-laid plans, and as a result, sessions sometimes need to be cancelled/rescheduled. It is your responsibility to see that I am informed of any necessary cancellation. A minimum of 24-hours is needed to cancel without consequence (see the next section on Financial Policy for further details). The preferred method of rescheduling is via email, complete with current appointment time to be cancelled and two or three specific date/time options for rescheduling. I will make every effort to confirm receipt of your email, but it is your responsibility to confirm that I receive the message with sufficient notice.
Because changing appointment times too often forfeits appointment times that other clients could have used and increases time lost to scheduling/rescheduling administrative activities, if you cancel, miss, or reschedule two appointments in a two-month period, we will discuss engagement obstacles and make alterations accordingly. If you cancel, miss, or reschedule three appointments in a three-month period, we will assume that there are engagement problems, we will suspend therapy for at least a period of six months, and I will make referrals to other practitioners as requested.
Winter Weather Exception: Because living in New England implies harsh winters, the cancellation policy of 24-hours is waived for perceived unsafe travel conditions due to weather conditions. I do not expect or want you to endanger yourself in order to keep an appointment. So, if the weather is bad, contact me as soon as you can to let me know that you will not be able to make the appointment, and regardless of how short the notice before your appointment, it will not be held against your attendance record.
Financial Policy
Because psychotherapy can often be a more emotionally-laden undertaking than some other healthcare interventions, and the psychologist/client relationship can often be more confidential/private than it is with other healthcare professionals, financial considerations can often be confusing for some clients. In fact, this is a professional relationship that represents my livelihood, and the actualities of life and the skills/expertise that I bring to our therapeutic relationship demand that I be appropriately reimbursed for the services I provide. Further, in order to set realistic treatment goals, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for behavioral/mental health treatment; however, you (not an insurance company) are responsible for full payment of my fees. In the interest of fairness, no exceptions will be made; however, if you expect or experience undue hardship as a result of these policies, please do not hesitate to approach me with options.
Service fees are based on a $175 “therapy hour” (45-50 minute psychotherapy session; 38-52 minute insurance schedule) rate (with a subsequent increase to $200 in May 2025 in order to bring my fees to within industry standards, after which only normal cost-of-living, inflation-based increases of a much smaller percentage are expected). Fees for services of longer/shorter duration are a percentage of this rate. These rates apply, but are not limited, to in-office or telehealth psychotherapy sessions, communications of a clinical nature (not administrative, i.e., rescheduling), report writing, records preparation/transmission, collaborative contacts with third parties (i.e., insurance companies, other providers), attending meetings with other professionals, and generating balance due statements and/or other efforts to collect fees/late cancellations/missed appointments.
Payment is expected at the time of service, and prompt payment is your responsibility. Acceptable forms of payment include check, credit card, or cash. My preference is to have credit card information on file with your permission to charge the session fee or co-pay to your credit card automatically. If you prefer to make arrangements to have your bank send an electronic check, I am agreeable with that plan, provided that the payment is received within a week of the session. In order to streamline administrative activities and keep costs in check, “balance due” statements/email/reminders will not be provided. If you do somehow get behind on your payments, such that I have to provide you with a “balance due” statement as a reminder, you will also be billed, at the aforementioned rates, for the amount of time spent creating the statement ($43.75 administrative fee, the 0-15 minute rate). If I do not receive payment for the balance in full by the time of our next appointment, I will not be able to schedule subsequent sessions with you until your balance is current.
Late Cancellation/Missed Appointments: You will be charged the full standard fee ($175) for sessions canceled with less than 24 hours-notice or if you do not show up for an appointment that you did not cancel – regardless of the reason (with the standard exception of inclement weather in the winter – see above). If this seems harsh, please recognize that missing an appointment without sufficient notice for me to fill your spot forces me 1) to forfeit an appointment that another client could have used, which 2) results in double lost revenue from the session, as well as 3) incurs additional
administrative expenses in scheduling, canceling, and rescheduling your appointment. Further, it is my preference to enforce the policy “regardless of the reason” because I believe that is a fairer arrangement than trying to determine what constitutes extenuating circumstances in one case and not
another. Payment will be made immediately via automatic withdrawal from credit card information you provide on the signature page. If I do not receive payment for the missed appointment in full by the time of our next appointment, I will not schedule subsequent sessions with you until your balance is current. Please be aware that insurance companies will not reimburse for late-cancelled or missed sessions.
Failure to pay for services may result in my seeking outside assistance to collect charges due. Balances left unpaid beyond 60 days will be referred to a collection agency or small claims court. If such action is necessary, an additional 33% of the balance will be due to cover associated collection fees. In most collection situations, the only information I will release regarding a client’s treatment is name, nature of services provided, and amount due.
The only exception to the above rate scale is for services of a more legal (less healthcare) nature: if you become involved in legal proceedings that require my participation, you will be expected to pay for my professional time, even if I am called to testify by another party. Because of the added efforts/difficulties associated with legal involvements, I charge a different per hour rate for preparation and attendance at any legal proceeding. These rates will be negotiated on an as-needed basis.
Insurance Procedures
CIGNA is the only insurance company with whom I am a contracted provider. If you have any questions or concerns about insurance coverage or benefits, contact CIGNA directly for confirmation of coverage. Because your health insurance policy is a contract between you and CIGNA, it is your responsibility to obtain an authorization for service prior to your first visit, and to pay for any balance on your account, not to exceed the contracted rates I have agreed to accept from CIGNA for covered services. In the event that CIGNA does not reimburse for mistakes they or you have made (e.g. claims processing errors or data losses, failure to let me know that your plan has renewed or changed), you will be responsible for full payment of my standard fees.
By signing this contract, you are authorizing me to bill CIGNA to obtain direct payment for any contracted service. I will provide you with a Health Insurance Claim Form (CMS-1500) that you will need to complete, sign, and return so that I can submit claims directly to CIGNA on your behalf. Typically, I submit all insurance claims for the month at the end of the month via an online processing site (Office Ally) with whom I have a Business Associate Agreement (on file), and reimbursements are usually received in the middle of the following month. Your contract with CIGNA requires that I provide them with information relevant to the services that I provide to you in order to secure payment. I am required to provide a clinical diagnosis. Sometimes I am required to provide additional clinical information such as treatment plans or summaries, or copies of your entire Clinical Record. In such situations, I will make every effort to release only the minimum information about you that is necessary for the purpose requested. This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, I have no control over what they do with your information once it is in their hands. In some cases, they may share the information with a national medical information databank. I will provide you with a copy of any report I submit, if you request it. By signing this Treatment Contract, you agree that I can provide requested information to your carrier.
If you have health insurance through a company other than CIGNA, it will usually provide some coverage for behavioral/mental health treatment. Upon request, I will provide you with a statement of services and fees that you can independently submit to your insurance carrier, but you will be responsible for paying for our sessions at the time the service is rendered at my full rate.
