LCMHC Professional Disclosure Statement

Jessica Condon, LCMHC, LCAS, NCC, CCMHC

Lifescapes Counseling Associates, PLLC

jessiecondon@lifescapescounseling.com

Licensed Clinical Mental Health Counselor (LCMHC) #12260 Licensed Clinical Addiction Specialist (LCAS) #22166 National Certified Counselor (NCC) #684030 Certified Clinical Mental Health Counselor (CCMHC) #684030

Bachelor of Science, Psychology, Western Carolina University, 2012 Master of Arts, Clinical Mental Health Counseling, North Carolina Central University, 2015

I work with various clientele in individual and group sessions. I have trained to work as a Mental Health Counselor and an Addiction Counselor. My areas of special interests are working with substance use issues, mental health, trauma, depression and anxiety.

As a client, you will work with me individually. I work from an eclectic therapy approach, meaning I use techniques and styles from several different theoretical models. I base my counseling approach off of a person- centered platform, building a solid therapeutic relationship that offers unconditional positive regard and empathy to obtain goals in therapy. Together, we will create a treatment plan to help you reach the goals that you have determined. Our sessions are designed to cater to your needs. Other approaches I use are Cognitive Behavioral Therapy, Dialectical Behavior Therapy, Motivational Interviewing, Acceptance and Commitment Therapy, and Trauma-Focused interventions.

I offer 45-60 minutes sessions for intake, psychotherapy, and telecounseling appointments. Session fees vary on a person to person basis. Lifescapes is happy to file insurance claims for our clients. Most of our clinicians are network-credentialed providers for Blue Cross Blue Shield, Cigna, MedCost, Aetna, Magellan, and United Behavioral Health, United Health Care, Optum and others. If you have out of network mental health benefits, we will be happy to file your claim, but generally your out-of-pocket expense will be greater than if you were utilizing in-network benefits. Our office staff will be happy to assist you with authorizations, pre-certifications, and understanding your mental health benefits. We also provide services for several Employee Assistance Programs. Cash, check and major credit cards accepted for payment, either at our office, or online.

We do our best to verify your benefits prior to your initial session so that you know the out of pocket cost for treatment prior to beginning therapy. Unfortunately, because mental health benefits are a separate ancillary benefit from one's standard medical coverages, we are sometimes provided with inaccurate information initially, and will correct your out of pocket responsibility once we receive the explanation of benefit from your insurance carrier.

Most of the time, your outpatient mental health copay is not listed on your insurance card. Please note that we are not considered "specialists" so your specialist copay does not apply. However, for some plans the specialist copay and your mental health office visit copay may coincidentally be the same amount.

In an effort to make our services affordable and accessible, we also offer a sliding scale fee that is based on household income and your ability to pay. Reduced fee services are available on a limited basis.

There is a $60 fee for no shows and appointments cancelled within 24 hours of the scheduled time. We do not charge a fee for appointments cancelled due to illness or emergency situations.

Some health insurance companies will reimburse clients for counseling services and some will not. In addition, most will require that a diagnosis of a mental-health condition and indicate that you must have an “illness” before they will agree to reimburse you. Some conditions for which people seek counseling do not qualify for reimbursement. If a qualifying diagnosis is appropriate in your case, I will inform you of the diagnosis before we submit the diagnosis to the health insurance company. Any diagnosis made will become part of your permanent insurance records.

I adhere to the Code of Ethics and Standards of Practice of the North Carolina Board of Licensed Clinical Mental Health Counselors (NCBLCMHC This means the information you share with me is held in strict confidence unless you or your legally assigned representative give me written permission.

However, I must release confidential information under the following circumstances: 1 Reasonable suspicion of child, elder, or vulnerable adult abuse; 2 Threat to cause serious harm to self or others; 3 Voluntary, signed release from the client; 4 Court order; 5 In defense against a legal action or formal complaint which the client makes before a court or regulatory board; and as required by licensure; 6 During supervisory consultations.

Please inform me if you have any questions or concerns regarding our work together. This will make our relationship more effective and productive for you. If you believe that you have been treated unethically by me, and cannot resolve this problem with me, you may file a complaint against me with the organization below should you feel I am in violation with any of these code of ethics. I abide by the ACA Code of Ethics. (http://www.counseling.org/Resources/aca-code-of-ethics.pdf

NC Board of Licensed Clinical Mental Health Counselors P.O. Box 77819 Greensboro, NC 27417 Phone: 844-622-3572 or 336-217-6007 Fax: 336-217-9450 E-mail: complaints@ncblcmhc.org.

We agree to these terms and will abide by these guidelines.