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Terms and Policy

Informed Consent for Improve Everyday, PLLC dba Flexible Counseling

Flexible Counseling         

Improve Everyday, PLLC

San Antonio, Tx

210-485-9608

Welcome to Flexible Counseling, a company of the Professional Limited Liability Company (PLLC) Improve Everyday. This document contains important information regarding your treatment at this practice. Please read this document carefully as there is information that will apply prior to and throughout treatment. Please do not hesitate to ask any questions this document raises.

Confidentiality- Your privacy is extremely important and is a sensitive aspect of counseling. You will be given a copy of the privacy practices to review. All protected health information (PHI) will be kept confidential, with exceptions noted below and under the EAP section:

________    Physical, Sexual, Emotional abuse or neglect of minors or the elderly, or abuse by a former therapist which must be reported by law

________    If there is a danger to yourself or to others                                                            

________    In certain legal proceedings, the courts may subpoena information regarding your treatment

________    Limited information may be released to insurance companies to obtain payment

________   I have been provided a copy of the privacy policy & understand that my treatment is protected by HIPAA

Technology Privacy- Please note that Flexible Counseling email addresses are equipped with an add-on provided by Virtru for encryption in both sending and receiving. Once an email is initiated with Virtru, the email chain remains encrypted, but only when Virtru has been activated. If you would like to communicate with your therapist via email, please send an initial email requesting a reply with Virtru so that your privacy can be protected. We also utilize Microsoft Office 365 products which have been designed to meet HIPAA compliance standards. We also text our clients about appointments and other general updates if you consent to that. We also use a web system for communication about healthcare information called Klara, which is also HIPAA compliant.

During session, please keep your phone under wraps!! Many people have apps and programs on their phones which are voice activated. This means that your phone could inadvertently become a breech in confidentiality. Under no circumstances should a client record any part of the session without the therapist's knowledge.

Out and About- San Antonio is a big small town. If we were to run into each other outside of the counseling environment, your therapist is going to respectfully "snub" you. This is in order to best protect your privacy. If you would like to speak to the therapist, be the first to say hi and the therapist will be happy to acknowledge your presence as someone who is familiar. J

Emergency/On Call Service:  If you are feeling as though you need immediate intervention to prevent harming yourself or others, you must dial 911 or go to the nearest hospital emergency room. It is not possible for the practice to provide 24 hour on call service and your safety is our number one concern. 

Treatment of Minors: Treatment of children under the age of 18 years old will be provided with the consent of the parents or legal guardians. In cases of divorce, a copy of the custody agreement must be provided before the first session. If you consent to treatment of a minor, you are acknowledging that you have legal authority to do so. You should know that most custody decrees entitle the non-custodial parent to access the health record of the minor without consent from the custodial parent. A copy of the divorce decree and/or custody agreement must be provided in these cases, or both custodial parents must be present at the first counseling session.

Minors have privacy rights as well. In the treatment of minors, it is extremely important that the relationship between client and therapist is one based on trust. In optimal situations, the parent or guardian and child are initially seen together for all or part of the first session. It is important that the parent's perspective on the problem is heard, but the session is reserved for the minor if s/he is the identified patient. In the initial session, the minor will state preference for how to deliver non-safety related information about the session to the parent. This may be a summary with therapist guidance, it may be left to discuss outside of the session, or the client may withhold information until a comfort level is reached with guardian. It is important to note that treatment is most successful when these boundaries are accepted. Parents can be assured that if the minor client presents with severe symptoms, or in the case of a clear threat of harm to self or to others, confidentiality may be broken.

Session Times/Duration:  

Insurance sessions-Most insurance companies limit covered counseling services to only one 50 minute session per day up to a certain covered number of sessions per calendar year. The first session is dedicated to gather data about your history and symptoms so that the therapist can provide a diagnosis. You should know that insurance only covers disorders, it does not cover problem solving necessarily. This means that if you are opposed to your insurance company having a diagnosis for you on file, or if you are opposed to giving your insurance company access to your mental health charts with our practice, you should consider self-payment as a way of receiving mental health treatment. You can still use your flexible spending account for this purpose. Any therapeutic time not covered by the insurance is the responsibility of the client and you agree to these terms when you request that we submit bills to your insurance company.

Self Payment-  Flexible Counseling's intent is to provide caring counseling with flexible appointment times, frequency and duration of sessions and this is best accomplished with self-payment. We specialize in longer sessions because we see better outcomes with clients and find that they overall have to dedicate less time for counseling. We offer sessions as long as 3 hours to accommodate rapid healing.

                Employee Assistant Programs- EAP sessions are contracts for a very limited number of sessions for 45-50 minutes only. You may use more than one session per week, but no more than one per day. If you are present for only a portion of the time reserved for you, or if you fail to show, you may be forfeiting one of your sessions and/or your case with our practice may be closed.

Payment: Payment for full service or copays is expected at the time of treatment or at the time of scheduling the treatment. Visa, Master Card, American Express, and cash are acceptable forms of payment. We require that a credit card be kept on file to cover copays and possible cancellations.

I give my permission to bill my credit card on file for sessions and for any cancellation fees that may apply during the course of my treatment.

______________________________               _________________________

                      Signature                                                 Printed Name

Insurance payments- You are responsible for any services not covered by your insurance company. We use a clearinghouse to obtain your benefits, and although insurance companies direct providers to use this online tool, it is always with the caveat that the information may not be correct. We strongly encourage you to also call your insurance company and obtain your mental health coverage benefits.

EAPs- EAPs are great for clients as they do not require a diagnosis in most cases and they are designed specifically for short term problem solving. They provide a set number of sessions to be used in a short period of time. If you do not adhere to a weekly schedule to accomplish this, your case may be closed. Keep in mind that Flexible Counseling has made special concessions to see EAP clients. Some practices will not agree to any EAP contracts because EAPs reimburse at a much lower rate than insurance companies AND the practice cannot submit a request for payment until ALL sessions have been completed, or until the case is closed. We appreciate your attention to making sure that your sessions are completed in a timely manner.

Current Rates for Treatment: Our current rates are as follows: $25 per 15 min increment and any portion thereof with a minimum appointment consisting of 30 mins. For interns, there is a 40% discount when receiving treatment from an intern. Our rates may change, however, without notice. Please refer to our website www.flexiblecounseling.com for the most up to date pricing.

Treatment by Interns: We are fortunate to have some very exceptional therapists in training in our practice. Licensed Marriage and Family Therapists (LMFT) and Licensed Professional Counselors (LPC) are called "Associates" and "Interns" respectively during the time post-graduation in which they are accumulating the clinical hours that earn them full licensure. The Associates and Interns have completed many hours of supervised clinical therapy prior to graduating with their master's degrees. After obtaining their degrees, they are allowed to practice independently but are required by their boards to disclose the names and license numbers of their clinical supervisors.  Because this is a learning environment, please be advised that your case may be staffed by supervisor therapists and you may at some point during treatment be contacted by a senior staff member in order to gain feedback from you about your treatment and the therapist's work. Please be open and honest in these situations and know that giving candid feedback will not adversely affect your treatment. If you have ANY CONCERNS during your treatment, please do not hesitate to initiate contact with office management and/or clinical supervisors.   Please see our website for supervisory information.

Couples Sessions: In this practice, couples are treated as a unit. We do not provide individual sessions concurrent with couples counseling by the same therapist. If you are entering into couples counseling at this practice, please know that all of your sessions will be scheduled for both persons in the unit. We will not conduct an individual session but will instead refer the individuals to therapy with a different therapist when appropriate. Cancellation fees will apply in cases in which only one person in the unit attends counseling, because of this policy.

Cancellation of Appointments: We understand that it is sometimes very difficult to make it to appointments when you are not feeling well. However, because treatment is designed to help you feel better, it is very important that you attend sessions to which you have committed. There is a 24 hour courtesy policy for cancellations and if you do not notify our office within 24 hrs that you do plan on attending a session that has been scheduled for you, you will be charged the full amount of the appointment (see website for current rates). This includes cases in which only one person appears for an appointment and the session was reserved for multiple clients.  If you are using EAP benefits, you will not be charged a fee, but please know that more than one short notice cancellation or one no show will result in referral back to your EAP for reassignment to another counselor. _______(Initial).

I have received a copy of the informed consent policy from Flexible Counseling. I am aware that these standards may change and that the website www.flexiblecounseling.com will reflect most current policies and updates. We do take responsibility for letting our clients know if the policies change during their treatment.

__________________________       ________________________      ________________

   Printed Adult Name                           Adult Client Signature                      Date            

Consent for Minor Child(ren) Being Treated, if Applicable: ________________________        ____________    

                                                                                                Printed Name                             D.O.B.                   

I attest that I am the custodial parent or legal guardian or sole conservator of the minor receiving counseling services and that I have the legal authority to consent for treatment of this child without limitations, as defined by Texas State Statutes. If there is any custodial agreement in place for a child who is scheduled to be treated in our office, that custodial agreement must be presented prior to treatment.

__________________________       ________________________      _____________________            ___________

   Printed Adult Name                           Adult Client Signature                   Relationship to Minor(s)                 Date            

Questions or Concerns: If you have questions or concerns, please feel free to raise them at any time, during the session, by email, or by phone. Our hope is to build an open and collaborative relationship between clients and therapists and one which supports questions and concerns in productive discussion. However, if there is an issue that has not been resolved satisfactorily, there is a formal complaint process in situations in which you feel there has been a breach in our ethical duty. We are governed by two Boards and complaints about serious concerns in treatment practice or about a failure to provide ethical treatment may be addressed to:

Texas State Board of Examiners of Licensed Professional Counselors

Texas State Board of Examiners of Licensed Marriage & Family Therapists

Complaints Management and Investigative Section
P.O. Box 141369 
Austin, Texas 78714-1369

1-800-942-5540

Flexible Counseling

EAP CLIENT ADVANTAGES & RESPONSIBILITIES

Employee Assistance Program (EAP) Caveats-Please read and sign, even if you are not using your EAP. 

EAP clients will enjoy certain advantages and will also have certain responsibilities. The following is a summary of aspects of your service of which you should be aware:

Advantages:

Your EAP has secured the counseling services of Flexible Counseling on your behalf. The EAP has done the legwork of finding a counselor who works with the problem areas you presented for treatment. Through the EAP, a set number of sessions has been approved and paid for on your behalf. You have no copay for your services under the EAP.

Because the EAP functions as an insurance company of sorts, your counselor is obligated to share with them summary information about your presenting problem, dates attended, and progress. The EAP is ethically bound to protect your specific identifying information from your employer if your case was not a mandatory case referred by the employer.

Mandatory Cases:

Mandatory counseling for job protection is, in many ways, a very unique form of counseling. In these cases, the employer has required an employee to complete counseling as a condition of continued employment. In these cases, the therapist will be providing specific feedback on progress and possible conflicts within the work environment to the EAP, who in turn provides that feedback to the HR department and/or referring supervisor. In these cases, please know that YOU are the client, but the EMPLOYER and EAP also have a role in the counseling process. What this means to you is that we want to work specifically on the issues for you that are affecting the work product or behaviors in the work environment which the employer feels are troubling. Therefore, you may find that there would be room for additional, private counseling from another therapist who is not in the position of providing feedback about you back to your employer.

Responsibilities:

While using your EAP sessions, you will not be charged "Cancellation Fees". However, after the second "late cancellation" (less than 24 hours) or "no show" for an appointment, Flexible Counseling reserves the right to refer you back to the EAP. This means that our sessions and work together will end and it is up to the EAP to determine further course of treatment for you, if any, under the EAP.

Because the EAP contracts with providers for the workforces they represent in the area, there is a possibility that multiple employees from the same employer opt to accept services with the same counseling agency. Though Flexible Counseling takes precautions to schedule employees with the same employer during non-sequential appointment times, it is possible that you may cross paths with someone from your organization. Should this occur, it is your responsibility to maintain that employee's confidentiality just as it the other employee's responsibility to maintain your confidentiality. Please be mindful of this responsibility; even if you are very open about your counseling experience, others may not share your openness and would not want you to share that they have chosen counseling to improve life performance.

Authorizations

EAPs are different from insurances in several ways. One way is that they offer a set number of sessions to be used within a set amount of time. This means that if your sessions are not used within the time they set, you may be in danger of forfeiting your sessions. For this reason, it is ultimately your responsibility to see that you request to have your sessions completed within that timeframe. We will be helping you to utilize those sessions appropriately in a relatively short amount of time.

Confidentiality

In most cases, EAPs act as independent agencies and do not report back to your employer. However, in some cases, EAPs do contract with providers with caveats for breaking this confidentiality. For example, some EAPs require that the therapist contacts the EAP

immediately if the client is suicidal or homicidal. Some EAPs for individuals with particular security clearance positions require that the

EAP is contacted if there is substance abuse or domestic violence. These are only some of the examples of ways in which confidentiality with EAPs can be different.  Please ask your therapist for specific ways in which your relationship with the EAP may affect the confidentiality of your sessions.

Disadvantages

EAPs are intended for short term counseling needs. It is possible that after the first session, your EAP may determine that your needs are best suited for coverage under your insurance and for that reason, you may receive a referral to other therapists at different junctures in your EAP covered therapy.

You may develop a relationship with your therapist at Flexible Counseling during your EAP sessions, and then be referred out at the end of that EAP counseling. This is so that you can take advantage of your insurance benefits in which we may not participate.

I have read and understand the limits of Employee Assistance Program coverage with this practice:

____________________________            _______________________             ______________________

             Printed Name                                                             Signature                                                        Date

( Type Full Name )