Rights, Responsibilities, and What to Expect
What is Psychotherapy?
Psychotherapy is a collaborative journey between you and your therapist, built on mutual trust and active participation. Your therapist will contribute their professional expertise and clinical experience to support your growth. Progress is most likely when you engage openly and honestly, both during sessions and in your daily life.
It is important to understand that psychotherapy may involve discussing challenging or distressing topics. This process can evoke strong or uncomfortable emotions, including sadness, anger, anxiety, or frustration. At the same time, therapy aims to foster positive outcomes such as reduced emotional distress, deeper self-understanding, stronger relationships, healthier coping strategies, and meaningful personal change.
Please note that psychotherapy is not a crisis or emergency service. If you are experiencing an emergency or feel you may be at risk of harming yourself or others, call 911 or go to the nearest emergency room.
Initial Evaluation and Treatment Planning
During our first sessions, your therapist will conduct a comprehensive evaluation to understand your needs, concerns, and goals. Together, you will discuss treatment recommendations. You are encouraged to ask questions and reflect on whether you feel comfortable proceeding with your therapist. If you wish to consider alternative options, referrals to other providers can be provided.
Appointments and Cancellations
Therapy appointments are scheduled at mutually agreed-upon times. Timely communication is essential—please provide advance notice if you need to cancel or reschedule an appointment. Missed appointments or late cancellations may result in a fee, in accordance with your therapist’s policy.
Records and Documentation
Your therapist will maintain confidential records of your care, including session dates, diagnoses, treatment goals and progress, relevant medical history, and billing information. You have the right to access your records, except in rare cases where disclosure could be harmful. In such situations, you may request an independent review by another licensed mental health professional.
Confidentiality
Your privacy is a core principle of psychotherapy. Communications with your therapist are confidential and protected by law. Information about your treatment will not be shared without your written permission, except in the following circumstances where disclosure is required by law:
- Suspected abuse or neglect of a child, elder, or dependent adult
- Serious and immediate risk of harm to yourself or others
- Disclosure of child sexual exploitation through digital means
- If your mental health records are brought into legal or court proceedings
- When a valid court order requires the release of records
Whenever possible, your therapist will discuss the need to break confidentiality with you before sharing information.
Your Rights and Responsibilities
As a client, you have the right to:
- Discontinue therapy at any time, with financial responsibility limited to services already provided
- Be treated with dignity, respect, and without discrimination
- Inquire about your therapist’s credentials, treatment approach, and professional boundaries
- Expect your therapist to avoid dual or conflicting relationships
- Receive referrals to other providers if needed
If you have questions or concerns about your care, you are strongly encouraged to bring them to your therapist’s attention, so they can be addressed together in a respectful and constructive manner.
Privacy Policy and Confidentiality
Disclosure of Health Information without Patient Permission
- Treatment: Sharing information for referrals, care coordination, and managing your treatment.
- Payment: Using your information for insurance verification, billing, and reimbursement.
- Healthcare Operations: Activities such as quality review, provider compliance, and technology improvements.
- Health Information Exchanges (HIEs): Your data may be available for care coordination; you may opt in or out, depending on state law.
Permissible Disclosure of Health Information without Patient Permission
- Emergencies: Sharing limited information to address urgent needs.
- Judicial/Administrative Proceedings: Disclosures as required by valid legal orders.
- Public Health & Safety: If you are a danger to yourself or others, or in cases of suspected abuse.
- Criminal Activity: On premises or against personnel.
- Health Oversight: For government audits, inspections, or compliance checks.
- Business Associates: Vendors under contract must protect your privacy and report any breaches.
- Research: Limited to non-identifiable information for planning or permitted research.
- Marketing: Non-sensitive outreach, such as newsletters.
- Scheduling: Appointment reminders by email or phone.
Disclosure of Health Information with Patient Permission
- Release of psychotherapy notes.
- Uses for marketing purposes.
- Sale of personal information.
- You may revoke your authorization at any time, except where action has already been taken.
Your Rights
- Right to Inspect and Copy: You may request to view or obtain copies of your records (written request required; fees may apply).
- Right to Amend: You may request corrections to your records (requests may be denied in some cases due to legal actions).
- Right to Accounting of Disclosures: Obtain a list of non-treatment/payment/operations-related disclosures (available for the past six years).
- Right to Request Restrictions: You may request limitations on disclosures (requests may be denied unless payment is made in full out-of-pocket and the restriction relates to payment).
- Right to Confidential Communications: You may request a copy of your records and transmission of these records are only provided via mail with tracking information.
- Right to File Complaints: You may report privacy violations without fear of retaliation by contacting Dr. Jarhed Peña at adminis@recoveryandbalance.com, (734) 465-6615.
Communication Risks
- Email and text messages are not secure and may become part of your medical record.
- Do not use email or text for urgent or emergency situations—call 911 instead.
Consent to Pay Fees
Payment of Fees
- I agree to pay for services rendered by providers affiliated with Recovery and Balance.
- Payment methods include online debit/credit card or ACH transfer, unless another method is mutually agreed upon.
- Payment is due after each session.
- Charges will be applied to my designated card or account for my portion of the service fee.
- Receipts are issued for each transaction automatically using Stripe.
- I understand that I will be charged for missed sessions as indicated by my provider's cancellation policy.
- Canceled sessions cannot be submitted to insurance or managed care for reimbursement.
Insurance and Managed Care Plans
- I agree to pay:Deductibles
- Co-payments
- Co-insurances
- Any other applicable cost-sharing amounts as defined by my plan.
If my insurance benefits expire, I will be notified and held responsible for any charges from that date forward.
If insurance denies a visit—even after Recovery and Balance completes all required steps—I may be responsible for full payment of the session.
Assignment of Insurance Fees & Release of Information
- I authorize insurance or managed care payments to be sent directly to Recovery and Balance for covered services.
- If my insurer sends payment to me directly, I will promptly forward the payment to Recovery and Balance unless I have already paid for those services.
- I authorize Recovery and Balance to:
- Share required information with my insurance company or managed care plan for the purposes of benefit authorization, claims, and payment processing.
- Obtain relevant clinical records from any previous treatment providers as necessary for my ongoing care.
- Communicate and share relevant information with other providers involved in my treatment as appropriate.
- I may submit written requests for exceptions or limits to these authorizations at any time to adminis@recoveryandbalance.com.
Financial Responsibility and Guarantee of Payment
I understand that I am financially responsible for all charges related to services received, regardless of insurance coverage, except when fully covered by an employer-sponsored benefit (e.g., Employee Assistance Program). I acknowledge my duty to know my insurance terms, including copayments, deductibles, and coverage limits. If I choose to self-pay, I confirm that I have reviewed and signed a financial responsibility agreement. I accept full responsibility for the timely payment of any outstanding balances owed for services rendered. If I am self-paying, a separate financial responsibility agreement will be reviewed and signed.
Financial Hardship
If at any point I have trouble paying for my services, the provider affiliated with Recovery and Balance may provide the services free of charge. To initiate this process, I will discuss with my provider financial hardship to pay for my services. Afterwards, any remaining balance under my account with Recovery and Balance may be voided and nulled. I understand that Recovery and Balance will never send my unpaid bills to any collection agency for any reason.
Consent for Telehealth Services
Consent to Telehealth Services
I consent to receive behavioral health services through telehealth, including but not limited to counseling, psychotherapy, biopsychosocial assessment, or other clinically appropriate care. These services may be delivered via HIPAA compliant audio and/or platforms as arranged by my provider.
My provider has explained the general nature and scope of treatment, including the proposed treatment plan, the potential risks and benefits of telehealth, and any alternative treatment options available to me. I understand that I have the right to decline telehealth services at any time and to be informed of in-person alternatives when available.
I recognize the following risks of telehealth:
- Possible technology failures or interruptions that could disrupt care or communication.
- Privacy and security vulnerabilities, including the risk of unauthorized access to electronic information or data breaches.
- A reduced ability for providers to observe non-verbal cues, which may affect assessment or support.
- Potential limitations to accessing other services if telehealth is not available.
I also acknowledge the benefits of telehealth:
- Greater flexibility and convenience in scheduling and attending appointments from a location of my choosing.
- Expanded access to care when in-person visits are impractical or unavailable.
I understand that confidentiality is fundamental to behavioral health care. My provider is legally and ethically required to protect the privacy of my communications. I may have legal rights to review my treatment records; however, my provider may withhold specific information if deemed clinically necessary and in accordance with federal and state privacy laws.