Introduction

Welcome to Capstone Behavioral Health. This document (Patient Information and Policies) contains important information about our professional services and business policies. Although this document is long and sometimes complex, it is very important that you read it carefully before you begin therapy. Your therapist will discuss any questions you have about the procedures prior at your first appointment.

 

Nature of Treatment

Psychotherapy is not easily described in general statements. It varies depending on the personalities of the psychologist/therapist and client, and the particular problems you are experiencing. There are many different methods a therapist may use to manage the problems that you hope to address. Psychotherapy is not like a medical doctor visit. Instead, it calls for a very active effort on your part. In order for the therapy to be most successful, you will have to work on things you talk about with your therapist both during sessions and at home.

Psychotherapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, psychotherapy also has been shown to have many benefits. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. But there are no guarantees of what you will experience.

It is important that you and your therapist agree on mutual goals for your sessions. Then you will work together on a treatment plan to examine and question the ways you are coping with your situation in hopes of finding more effective strategies. If your caseworker, judge, or spouse has insisted that you attend therapy, you may be angry or defensive and focus on trying to end the process rather than using it to make your life better. Remember the therapist's focus is you and what changes could make a difference in your life. With that as the focus, therapy may be one of the most significant experiences of your life.

If you are receiving any psychotherapeutic services from another clinician at the present time, please inform your therapist. In most instances it is important for us to coordinate your treatment with the other clinician; in some cases it is inappropriate for us to begin until you have concluded your treatment with the other practitioner.

It is difficult to specify up front how many sessions you will need. That is why we must periodically review your goals to see if they've been met or to see if they must be revised. The decision to continue or stop treatment is, ideally, one that you will make together with your therapist. Please discuss

any concerns you have about your therapist with him/her. If at any point you wish to seek treatment with another clinician within or outside of our agency, you will be provided with referral information.

You may participate in concurrent services if you feel this would be beneficial.

You have the right to know the entirety of your treatment team.

If you would like assistance with access to legal entities for appropriate representation or self-help services Capstone can assist.

Capstone’s therapist adhere  to the ethical codes of conduct outlined by the American Psychological Association and the American Counseling Association.

Capstone adheres to a policy of no seclusion or restraints.

If you are prescribed medications, you should be aware of the poison control center.  Its phone # Is 1-800-222-1222.

 

Nature of Assessments

Psychological evaluations will be performed by licensed psychologists are the scientifically-based means used to diagnose behavioral, cognitive, and emotional disorders. They also are used to assess parenting skills, family dynamics, intelligence, personality, or to estimate levels of functioning in various areas. Although assessment is usually intellectual, emotional, or behavioral in focus, it often includes a combination of these areas. Standardized tests and procedures are used as well as interviews.

Psychological assessment usually includes a clinical interview and a battery of psychological, neuropsychological, cognitive, and educational tests.

 

Appointment/ Cancellation Policy

Therapy sessions typically are held once per week, although the frequency may vary depending upon your needs. Your sessions are held by appointment, and they are one “therapy hour.” Our “therapy hour" is about 45 to 50 minutes in length. That period is reserved for you, so please provide at least 24 hours advance notice if you must cancel. If such notice is not given you may be charged for the session. Your insurance does not cover charges for missed appointments. If you miss multiple sessions your treatment may be discontinued. We have a “3 consecutive no-show” policy which states that if you miss three consecutive appointments without calling 24 hours in advance to cancel, treatment will be discontinued. If you arrive more than 10 minutes late for your scheduled appointment, your therapist has the right to cancel your appointment and you may have to reschedule. If your therapist agrees to see you if you arrive late, your appointment still will end on time and you will be charged for the entire session.  If your attendance is mandated and you consent to release of information, your information will be shared with mandating officials regardless of discharge outcome.

 

Confidentiality

As mental health care providers, we are required to follow the procedures of the Health Insurance Portability and Accountability Act (HIPAA) and Nebraska state law, as well as the ethical standards of our professions. We maintain psychotherapy notes regarding your sessions in a secure location. In general, the confidentiality of all communications between a client and a psychologist or therapist is protected by law, and we can only release information with your written permission. However, there are some exceptions in which we are legally obligated to share client information without a patient release. These exceptions are as follows:

If we believe that a child, elderly person, or disabled person is being abused, we must file a report with the appropriate state agency. If we believe that an abuser has continued interactions with children, we must file a report, even if that abuse occurred in the past.

If a client threatens serious bodily harm to him- or herself, we may be required to seek hospitalization for the client.

If we feel that you are at potential risk, we will notify you of this.

If a client threatens serious bodily harm to another, we must take protective actions, which may include notifying the potential victim, notifying police, or seeking appropriate hospitalization.

In some legal proceedings, upon a court order, testimony and/or records may be rendered.

If legal actions are brought against the psychologist/therapist by the client and/or family, information may be disclosed if necessary and relevant to the case.

Limited client information may be disclosed to a billing or collection service for the purpose of collecting any long-owed payments.

These situations rarely arise. However, should such a situation occur, we would make every effort to discuss it fully with you before taking any action. Please note that if testing and evaluations are paid for by a school district, state, or attorney, they must receive a copy of the completed report.

Limitations

Individuals receiving services from Capstone shall not bring weapons or illegal substances on the premises.  Prescription medications and tobacco products are allowed on the premises, but are not to be in sight of other individuals.

Individuals who are threatening or act out physically will be discharged from treatment  and will not be allowed to referred to another agency.  These individual will not be allowed to return to Capstone.

 

Fees/Insurance

It is our office policy to bill your insurance carrier as a courtesy to you, although you are responsible for the entire co-pay and/or deductible at the time of service. However, you (not your insurance company) are responsible for full payment of your fees.

The standard fees are as follows: pretreatment assessment (initial appointment) $260 (Ph.D.)/$175 (therapist), individual therapy $165 (Ph.D.)/$130 (therapist), family therapy $205(Ph.D.)/$130 (therapist), mental status exam $260, chemical dependency evaluation $260, and psychological testing $175/hr. Please be advised that if your insurer does not pay the claim within 45 days from the date of filing, the unpaid fees will be your responsibility. If any payment is subsequently made by your insurance carrier in excess of the balance, we will promptly refund the credit amount to you. As with other health care situations, you also will be responsible for your deductible and co-payment at the beginning of your scheduled appointment. Also, we recognize the need to set up payment plans for clients who require extended therapy. Arrangements may be made with our business office. A $25 fee will be charged for all bounced checks.  Nebraska clients without insurance will be assessed for financial eligibility based on the policy and fee schedules developed by DBH in accordance with Title 206 Regulations.

If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, we have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court which will require us to disclose otherwise confidential information. In most collection situations, the only information released regarding a client's treatment is his/her name, the nature of services provided, and the amount due. [If such legal action is necessary, its costs will be included in the claim.]

In addition to therapy sessions, hourly fees apply to other professional services you may need if you are a non-Medicaid client, though we will break down the cost for periods of less than one hour. Other services include: telephone conversations lasting more than 5 minutes, consulting with other professionals with your permission, preparation of records or treatment summaries, and the time spent performing any other service you may request. If you become involved in legal proceedings that require your therapist’s participation, you will be expected to pay for all of the professional time, including preparation and transportation costs, even if your therapist is called to testify by another party. [Because of the difficulty of legal involvement, we charge $225 per hour for preparation and attendance at any legal proceeding.]

Many insurance plans require preauthorization prior to your receiving services. Your therapist will obtain any such prior authorizations with your insurance company. However, you are responsible for obtaining any information regarding mental health services covered by your plan. Any services provided without proper authorizations will not be covered by the plan and you will be responsible for any balances due. Additionally, many insurance plans have additional restrictions and requirements. Be sure to check with your plan to make sure all requirements for services to you are met. If your insurance company does not cover the services that we provide, you will be responsible for the balance.

 

Availability

Due to your therapist’s work schedule, he/she often is not immediately available by telephone. Additionally, the therapist will not answer the phone when with a client. When your therapist is unavailable, please leave a message, or contact the office phone number 402-614-8444 if during normal business hours. Your therapist will make every effort to return your call on the same day you make it, with the exception of weekends and holidays.  If you are difficult to reach, please inform your therapist of some times when you will be available. Please be sure to leave a number where you can be reached. If you are unable to reach your therapist and feel that you can't wait for the return call, contact your family physician or the nearest emergency room and ask for the psychologist or psychiatrist on call, or call 911. Additionally, you may contact the on-call emergency pager at 402-281-5162 after business hours for the on-call therapist.  If your therapist has provided you with his/her cell phone number, this is not to be used for emergencies.  Rather, the above office number should be used during regular business hours and the Emergency Number should be used after business hours.

Client’s who feel that they have a grievance against the agency or an individual are encouraged to address this grievance with the individual directly.  If the grievance is not resolved, the client may speak with the individual’s direct supervisor.  At any time a client may complete a “client concern form” and return this to the administrative assistant as a means of addressing concerns. Clients can address such issues without the fear of retaliation.  It will be addressed within 48 hours.  Notification regarding the actions to be taken to address the complaint may be available in writing if requested.

Each party in the grievance has the right to be treated with full respect and dignity.  It is each party’s responsibility to treat the matter seriously and to act in a professional manner.

If client concerns are not resolved internally, an external review or an external advocate may be requested.

** Please note, the agency reserves the right to revise policies and to amend this notice. Should you wish to obtain a revised Patient Information and Policies, contact the Business Office of this agency. 

No person shall be discriminated against because of race, color, national origin, sex, age, mental or physical disability, creed, religion, or political belief when applying for employment or receiving benefits or services from Capstone Behavioral Health.

By signing this agreement I agree that I understand the materials included in this document.