RESOURCES

NEW CLIENT PAPERWORK

Before we can have our first appointment, we need some paperwork from you.

Please note that a failure to return your paperwork within 24 hours of your appointment will result in the need to reschedule. We cannot hold your first appointment without it.

Some of this paperwork is available for download on the website below. If the paperwork you need to fill out is not located here, please contact our office at acrs@advanced-counseling.com or 717-394-3994 to obtain another copy.

GENERAL PRACTICE POLICIES

HIPAA Information

These counseling services maintain compliance to HIPAA regulations that have established procedures for transmitting medical health information electronically. There is a separate document that describes policies relevant to HIPAA standards for privacy.

  • You have the right to request where we contact you:
    • Home
    • Work
    • Cellphone
    • Email
  • You have the right to release your medical records, with some exceptions:
    • Must be written authorization to release records/brief conversations.
    • Continuation of care applies if hospitalization occurs.
    • The revocation is not valid to the extent that the counselor has acted in reliance on such previous authorization.
  • You have the right to inspect and copy your medical/mental billing records:
    • You have the right to inspect a copy your records.
    • The counselor may deny the request to certain parts of your records if there is concern that the information may cause harm to the client.
    • A nominal fee of $2.00 PER PAGE PLUS ANY MAILING CHARGES WILL APPLIED
    • You have the right to add information or amend information in your medical record as an appendage.
    • You may request to amend your medical record. Such a request must be in writing and include the rationale for such action.
    • The request to amend your medical record must be made within 14 days from the time that you first become aware of the disputed information.
    • The request for amendment could be denied by the counselor. Such a denial must include a rationale for the denial.
    • If the request to amend your medical records is denied, you have the right to file a disagreement statement that will be placed in the record.
  • You have the right to be informed of any disclosures from your medical records:
    • You have the right to be notified of any disclosures from your medical record for a period of six (6) years after your discharge
    • EXCEPTIONS to this notification
      • Disclosures for treatment, payment or healthcare options.
      • Disclosures pursuant to a signed release.
      • Disclosures made to you, the client.
      • Disclosure for national security or law enforcement.
      • Disclosures made per law, mandated reporters, or duty to warn.
      • Disclosures made to emergency personnel in the event of your loss of consciousness within session.
  • You have the right to request restrictions on uses and disclosures of your healthcare:
    • Such requests must be in writing.
    • The counselor is not obligated to agree with such a request.
  • You have the right to complain about the handling of privacy regarding your medical record.
    • Such complains should first be made to the counselor.
    • If not satisfied, you have the right to complain to the US Department of Health and Human Services (USD of HHS).
    • There shall be no retaliation by the counselor for complaints issued by the client.
  • You have the right to receive any changes in policy:
    • You may request in writing to be notified of any changes in policy that effect your medical record.
    • This request should be addressed to the counselor who acts as the privacy officer (Cheryl Wilson-Smith, M.A., LPC, NCC, CCMHC, CT, and sent certified with signature.

Fees / Cancellation Policy

This counseling practice operates on a fee-for-service basis. The cost of professional services is evaluated annually and posted no later than January 1.

Fee Structure for 2022
Psychiatric Evaluation without medication (Biopsychosocial assessment) / 90791 $225
Psychotherapy 53-60 minutes / 90837 $190
Psychotherapy 45 minutes / 90834 $150
Psychotherapy 30 minutes / 90832 $130
Psychotherapy Family session with/out client / 90847/90846 $200
Group session (Closed group format - minimum of 6 participants) $50
Educational Support Services $30 (open group format)
Documentation to any officer of the court $200
Testimony $350 per hour
Disability Documentation/Evaluation $200
Concierge Counseling Price per contract requirements

Licensed Professional Counselors and Professional Counselors are billed at separate rates.

Professional Counselors are billed as follows
90791 $95.00
90834/90837/90847 $80.00

The majority of sessions are billed to insurances at the 90837 Therapeutic hour, which approximates to 53 minutes face to face time with the therapist.

Efforts are made to help clients access their health insurance benefits for reimbursement for out-of-pocket expenses. Insurance reimbursement for clinical services offered by Licensed Professional Counselors varies from state to state and from carrier to carrier. Payment for services is required when those services are rendered unless alternate provisions have been made in advance. Payment for services by credit/debit card is available. These services appear as “ACRS” on your statement. Scheduled sessions must be cancelled by telephone at least 24 hours in advance or a $150.00 session fee will be assessed. This does not apply to situations deemed to be emergency in nature. Clinical services can be terminated as a result of nonpayment of fees under certain conditions (ACA Code of Ethics, 2005. A.10.d). For individuals with insurance coverage, all co-payments must be paid when services are rendered. A $25 fee will be charged for each returned check along with any prior balance owed.

Responsibility for Payment

Clients are responsible for payment of services when services are rendered except in situations where third-party benefits are approved and forthcoming. As an approved provider for some insurance plans, the therapist has entered into agreements for rate levels that may be different from the posted fee-for-services. In situations such as these, the client is responsible for only the co-payment determined by the insurance plan. Reasonable efforts will be made to accommodate the financial situation of individual clients. Contractual payment plans are considered on a case-by-case basis.

Accounts will become delinquent after 30 days of non-payment unless payments are being made through an approved third-party. A 2.5% late fee will be assessed on the principle for every 30 days the payment remains delinquent. When the payment delinquency extends beyond 120 days, the account will be forwarded to a local collection agency for resolution. Any legal fees or collection fees associated with this action will become the responsibility of the client. Delinquent accounts beyond 120 days will also be reported to local and national credit bureaus.

FAQ

What is Mental Health?

Mental Health is comprised of our perception of our beliefs, feelings, and our behaviors. These perceptions, thoughts, feelings, and behaviors are usually a combination of psychological or emotional cues, inherited traits and/or genes, and any exposure to environmental cues before, and/or after birth.

Mental Health and Symptomology: How are they common and connected are they?

According to the National Alliance on Mental Illness (NAMI) 1 in 5 adults in America experience mental illness in a year and 1 in 5 children between the ages of 13 and 18. Common types of symptoms include but are not exclusive are: Depression Anxiety Suicidal ideations Insomnia Feeling hopeless/ helpless Anger, irritability, agitation, Homicidal ideations Isolation, withdrawal from friends, family, peers. Inability to manage grief, loss, or profound sadness Aggression Tearful, sobbing or excessive crying. Loss of appetite Flashbacks Nightmares Imminent dangers to self or others Confusion, loss of concentration Crisis or acting out behavior.

Can an individual recover from mental illness?

The long of the short of it is ...Yes, while there might not be a way to prevent all mental illness from occurring, there are ways to mitigate long term effects of mental illness. Speaking with a counselor, having an evaluation, and psychoeducation.