• Fees
• Health Insurance
• Cancellation Policy
• Client Bill of Rights
• Privacy Practices
• Confidentiality Exceptions

Fees

Please contact me for my current fees.  The clinical evaluation and ongoing session length is 50 minutes.  The same fee is charged for individual or couple sessions.  Fees for groups vary.  Insurance may cover some or all of the cost of psychotherapy. 

I will provide you with a clinic policy and procedures form with a specific fee agreement that we both sign. 

Back to top

Each insurance policy is different.  Please look in your policy coverage booklet and contact the customer service department for your insurance provider to find out what mental health services are covered and exactly how much outpatient mental health coverage you are allowed in your benefits package.  This may be reported as a number of sessions per period of time, i.e. a year, starting at a specific month (which may vary), or it may be reported as a dollar amount with a specific deductible amount and/or a co-pay that you pay each session.

As a courtesy my office will bill to your insurance company for services rendered, but you are ultimately financially responsible for payment of your account including any deductible and for your portion of the co-pay if insurance does not cover the services provided.  

I accept payment by cash, check or credit card.

Back to top

I request that you give me at least 24 hour verbal notice for cancellations.  You can leave a private confidential voice mail message for me 24 hours a day at 608-237-8000 extension 109.    I do not charge for sessions missed with at least 24 hour notice. 

I understand that sometimes illness for yourself or a child or emergencies necessitate cancellation with less than 24 hour notice.  Sometimes this happens for me as well.  I do not charge for this situation.  I ask that you give me as much notice as possible so that I can offer this appointment time to another client who may be in need of services.

Insurance will not pay for missed appointments.

Back to top

When you receive psychotherapy services in a Wisconsin State Certified Outpatient Clinic you have certain rights under Wisconsin State Statutes. These rights are explained in a Clients Bill of Rights form that you will receive when you begin psychotherapy services with me.  I will review this with you before we proceed with therapy.  It is important that you know what your rights are as a consumer of services.

Back to top

I comply with all provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPA).  Midwest Center for Psychotherapy and Sex Therapy has an established policy to guard against unnecessary disclosure of your health information.  I will give you a pamphlet that describes your rights regarding these issues.

At times it will be valuable to coordinate psychotherapy services with other treatment providers, i.e. your partner or child’s therapist, your psychiatrist or other health care provider or a former therapist in order to provide comprehensive treatment.  In order to share this information I will ask you to sign an authorization for release of information form that gives permission for me to talk to these other providers and for them to talk to me.  This may include sharing of written records as well. 

You have the right not to sign these forms or allow me to speak to other providers.  If you do give permission for me to do so, you have the right to rescind that permission at any time.  What is already discussed is done and cannot be changed.  I would have to stop any communication from that point on. My hope is always that we are able to discuss the
reason behind your choice to stop communication as well as mine to continue it.  I reserve the right to use my clinical judgement if I feel that I cannot continue effective treatment without the ability to communicate with other appropriate providers.

Back to top

As discussed above in Privacy Practices I follow all HIPA privacy practices.  There are exceptions to this.

If I am convinced of any of the following I will notify appropriate authorities, i.e. social services and legal agencies, whether or not you give informed consent:

• Danger of suicide or other self-injurious behaviors.
• Danger of causing physical harm to others.
• Occurrence or suspicion of child abuse or neglect.

I do this for your safety and the safety of others. 

Back to top