Integrative Counseling Solutions

We are a licensed counseling clinic with several years of experience specializing in various counseling. We value our relationship with our clients and believe that such relationship is the beacon in the healing process. 

We believe that each individual is unique and has their own way of addressing resolutions. Thus, we believe in a wellness model that helps our clients empower themselves by focusing on what works for them and not in a systematic approach that provides a generic procedure on working on a treatment. One's journey is not the same as the other.

Integrative Counseling Solutions is a group counseling agency where a number of mental health professionals practice along with their supervisors. Your contract of services is with your therapist and Integrative Counseling Solutions. Due to licensing requirements, your clinician may need to seek supervision with other clinicians and scheduling staff. No identifiable information is released outside of this practice unless directly related to billing/insurance purposes. An additional consent to share information is required and may be requested should you want your clinician to share information with a 3rd party.

WELCOME

Welcome to Integrative Counseling Solutions. We are happy you have decided to begin services with us and hope that we can answer questions you may have. Let us know how we can help.

Ohio Counseling Law requires us to provide the following; Notice of Privacy Practice (sign on 2nd page), Your rights and responsibilities.

Client's Rights and Risk

• You may ask questions about any aspects of the counseling process.
• If you have been referred by a court or state agency, you have the right to divulge only what you want to be included in a report.
• Therapist is most effective when you are open and can speak honestly about your emotions and experiences.
• Therapist may include talking about emotionally provoking subjects and scenarios.

 

Confidentiality

• Information shared by you in session will be kept confidential.
• Information will not be released without your written consent, except for professional consultation within the practice if needed and unless required by law.
• I am required by law to disclose information pertaining to suspected child abuse, the inability to care for one’s basic needs for food, clothing or shelter, and threatened harm to oneself or others.
• The court may subpoena counseling records.
• It is understood that information regarding treatment and diagnosis may be provided to an insurance company.
• You may want to discuss further limits or exceptions of confidentiality.

Appointments

• All office visits are by appointment and may be scheduled through the administration office or your counselor directly.
• Please arrive on time, as you use up your own time when arrive late for an appointment. The usual length of an appointment is 45-53 minutes. 
• Late cancellations (less than 24 hours notice) and/or no-show appointments are billed to the client for $85.00. In the case of illness, please notify us no later than 9:00 am the day of the apointment. Please leave a message if you get our voicemail. If your appointment is cancelled or missed, contact the office for a new appointment time. We are not permitted to charge no show fees for medicaid clients. This means that if you have medicaid, you will lose your counseling time and possibly be dropped from the clinician's schedule for 3+ missed/late cancelled appointments. Insurance companies do not pay for no show fees or late cancellations charges.

 

In Office Privacy

• Privacy cannot be guaranteed for correspondence via text or email. Please discuss this policy with your therapist if you are wanting to email or text regularly.
• For the safety of our client's and office staff and clinicians, security cameras are active in our lobby, admin offices, hallways and common areas of building. 

 

Fees

• The patient's insurance full contracted rate or co-pay of fees is expected at the time of service.
• Your health insurance may help you recover some of your counseling costs. Most group policies, but few individual policies cover outpatient psychotherapy. Please verify with your company the amounts of coverage for outpatient pscyhotherapy by licensed professionls. If you policy requires preauthorization to receive counseling service, it is your responsibility and needs to be handled prior to your first visit.
• Insured clients are expected to take care of their fees as services are rendered. Our office will bill your insurance company for services provided. This office cannot accept responsibility for collecting your insurance claims or for negotiating a settlement on a disputed claim. You are responsible for payment (and insurance claims) on your account.  Failure to pay your part may jeopardize your benefits. Insurance Copays and full contracted rates are non-negotiable.
  • If choosing to use credit card, a convenience fee of 2.50 will be applied in the following situations. You may use other forms of payment to avoid the convenience fees such as; HSA, Check or cash.
    In-person: There will be a $2.50 flat fee for online payments and credit cards.
    Online: By selecting ‘credit,’ you agree to pay a $2.50 convenience fee.
    Over the phone: “$2.50 flat fee for phone payments using credit card.
• Clients paying on a direct/cash basis, and not billing any insurance company are expected to pay in full at time of service unless a payment plan has been previously arranged with the billing department.
• Except in the case of minors or when other arrangements are made, the person receiving the counseling service is financially liable.
• Accounts with no scheduled appointments become delinquent after thirty (30) days. Accounts over 90 days without appointments will be terminated.
• Any change in my financial situation I will discuss with my therapist. In the event you find it necessary to change mental health providers and require records to be sent from Integrative Counseling Solutions, your account will need to be paid in full.
• Integrative Counseling Solutions charges additional fees for letters, appearances in court, reports and extended phone calls. These things are not covered by insurance. Letters are written at the discretion of your therapist and their supervisors and a fee of $25 per 15 minutes is charged for letter writing, insurance form, emails and phone calls. Your therapist will discuss any additional fee with you before it is charged. Payment is required prior to any letters being released or calls made on your behalf at your request to third parties. Written consent for these services involving third parties will be required prior to the contact as well via a release of information. While we have our own attorneys and generally are not called into court, this may happen and you would be responsible for the cost of a $1,500 retainer fee plus an extra $500 per day of missed work on your behalf at a court hearing.

 

Acknowledgement

I have read, understand and agree to the above policies. I have been offered a copy of these policies to take with me if desired. I hereby authorize Integrative Counseling Solutions,  and my therapist to release any information acquired in the course of my therapy to my insurance company (if client is a minor, parent or guardian sign). I understand my insurance coverage is a relationship between me and my insurance company, and I agree to accept financial responsibility for payment of charges incurred. I understand that a re-billing fee/financial charge complying with Ohio State Law will be applied to any overdue balance, and in the event of non-payment, I will bear the cost of collection and/or court costs and reasonable legal fees should this be required.  I have read and/or received a copy of this consent.
 
 
If your insurance does not pay, you are responsible for the following prices.
 
Initial Intake Interview  $145.00
 
Session Fee (53min) $125.00
 
Non or Late Cancellation $85.00

Convenience Fee for Credit Card Processing $2.50
 
Bounced Check Fee $45.00
 
Telephonic service $45 per 15 min (not covered by insurance) Payment due before calls.
 
Letters, emails, phone calls and reports are charged at $25 per 15 minutes. Payment due before next scheduled session

 
Emergencies:

The best phone number for all offices is 513-770-1705. If you receive the voice mail, please leave a message for your personal counselor. Your counselor may be on the phone, in therapy with someone else, or out of the office. Integrative Counseling Solutions is NOT an emergency call center and is not equipped for emergency services. In a crisis situation, and your therapist cannot be reached you may call the 24-hour Mental Health Crisis Line: tel: 1-800-273-8255, or go immediately to your local hospital emergency room.

 

 

 

 Your signature below serves as acknowledgment of receipt of Consent to treat.