Practice Policies and
Treatment Agreement
Confidentiality: Treatment and records are confidential. The legal limits to confidentiality include suicidal or homicidal intent, a court order, ongoing physical abuse or endangerment of children, elderly or disabled individuals. In these circumstances, I am legally obligated to file a report with the appropriate state agency.
Treatment: Psychotherapy sessions last 50-60 minutes. First, there will be an initial assessment session that includes working together to identify areas of concern and treatment goals. Interventions are tailored to individual needs. You are entitled to ask questions about all aspects of treatment. Therapy may involve experiencing emotional discomforts such as anxiety, fear, sadness, guilt or anger. However, psychotherapy has also been shown to have benefits such as improved relationships, solutions to specific problems and an overall reduction in feelings of distress.
Appointments: Silver Lake Psychology intake coordinators will set up clients' initial appointment with their therapist. Ongoing scheduling will then take place between the client and therapist directly. Appointment reminders will not be sent for each appointment.
Cancellation Policy: We require 24 hours notice to reschedule or cancel a session. The client is responsible for making sure they call, text, or email their therapist directly to reschedule or cancel an appointment to avoid a late or no-show charge of $50. This fee is to be paid directly to the client's therapist.
Payment is due at the end of each session. The fee is between $120 and $185, depending on the therapy choice you’ve selected from the menu of services, or the estimated copay that was provided to you at the time of intake when we checked your insurance benefits. *Session fee increases will take place as the cost of business services inflate*
Your credit card will be kept on file in our PCI compliant encrypted virtual terminal that is called Stripe and is entered into our HIPAA Compliant Medical Software system called Kareo. If you are a client that is using insurance and we are submitting on your behalf, our medical billing team ML Billing will send statements and payment notifications through our online portal system called Collectly.
Your card may be charged for all visits and any unpaid balances. Credit Cards are charged once per week on an interval basis up to 15 business days after each therapy session takes place.
*We may be in-network or out of network for your insurance plan. As a courtesy, we will check your deductible before therapy commences so that you are aware in advance of your plans’ benefits.
Disclaimer: our report on your benefits is not a guarantee that your insurance company will pay or that our information is accurate. In the event your insurance company does not pay us, you will still be responsible for the remaining balance not covered by your plan.
*Some insurance plans reimburse the member directly instead of sending the check to the clinician. The insurance then expects you to pay the provider. By signing this agreement, you agree to write a check out to Silver Lake Psychology, Inc for any insurance reimbursement checks mailed to you. The amount of the reimbursement checks is a fixed amount determined by your insurance company based on how your plan is set up, not by Silver Lake Psychology.
Contact: You are welcome to contact your therapist directly at any time. Please be sure you and your therapist exchange contact information at the time of the first session. If you need to cancel, reschedule or change your appointment in any way, please notify your therapist directly. In the event of a life-threatening emergency, please call 911. If you have payment or billing questions, please contact our medical billing company, ML Billing at 424-348-2225.
Insurance companies may require that I release any and all pertinent information regarding your treatment, including but not limited to: diagnosis, treatment plan, treatment progress, number of sessions attended, social security number (for ID purposes) and medications you have taken. In addition, you must be aware that once information is released to the insurance company, I cannot guarantee that it will remain confidential. Silver Lake Psychology uses a medical billing vendor, ML Billing to handle all claims filing, payment collection. and account management. ML has signed a BAA agreement to ensure that confidentiality standards (HIPAA Compliance) are met.
Professional records: The laws and standards of my profession require that your therapist keep treatment records. The information in your chart includes demographic information, a description of your condition, treatment goals, and progress notes describing each session. You have a right to review your records and to request a treatment summary at any time unless your therapist believes doing so would be emotionally damaging. If that is the case, your therapist will discuss the content of the records and arrange to send a summary to another mental health professional who is working with you.
Legal: You agree that any dispute against Silver Lake Psychology will be submitted to mediation. If mediation results in arbitration, you agree to arbitration in Los Angeles county. You also have a right to take matters to the California Board of Psychology.
Notice to Clients: The Board of Behavioral Sciences receives and responds to complaints regarding services provided within the scope of practice of (marriage and family therapists, licensed educational psychologists, clinical social workers, or professional clinical counselors). You may contact the board online at www.bbs.ca.gov, or by calling (916) 574-7830.
Silver Lake Psychology is a network of independently licensed therapists. Silver Lake Psychology provides administrative services to therapists and does not provide clinical services. Each therapist is responsible for the quality of care and professional clinical services.