THERAPY PROCESS, RIGHTS & RISKS
Please feel free to ask questions about any aspect of the therapy process. If you have been referred by a court or state agency, you should know that during the therapy sessions, you have the right to divulge only what you want to be included in a report. To have effective therapy sessions, you need to be willing to discuss what troubles you and be open to change. During therapy sessions, you may remember unpleasant events, have intense emotions aroused, and/or you may decide to alter close relationships.
All office visits are by appointment only and will be scheduled with me directly. Please arrive on time, as you use your own time when you arrive late for an appointment. The usual length of an appointment is 50-60 minutes.
Individual Psychotherapy $95
Couples Psychotherapy $125
Family Psychotherapy $125
Clinical Hypnosis $150.00
Immigration Evaluations $300
Substance Abuse Evaluations (DOT) $450
Court Testimony $250/hour, includes travel time
Letters/Treatment Reports $25 - $75
I have read, understand and agree to the Terms of Agreement. I have discussed these policies with my therapist (if desired) and all questions have been answered to my satisfaction. I have been offered a copy of these policies to take with me. I hereby authorize the Marriage & Family Wellness Center and my therapist to release to my insurance company, any information acquired in the course of my therapy (if client is a minor, a parent or guardian sign) I understand my insurance coverage is a relationship between the insurance company and myself, and I agree to accept full responsibility for payment of all charges incurred.
you are responsible for payment on your account. The client portion (co-pay) of fees is expected at the time of service. I will bill your insurance company for services provided. If your policy requires pre-authorization to receive services, this is
your responsibility and needs to be handled
prior to your first visit. You may also need to check with your insurance provider whether you have a deductible to meet. Failure to pay your part may jeopardize your benefits. Co-pays are not negotiable.
Clients paying on a cash basis are expected to pay in full at time of service.
Phone calls in excess of (5) minutes will be billed at the usual rate. Insurance does not cover phone consultations, and therefore, the client assumes financial responsibility for such phone consultations.
You should discuss any change in your financial situation directly with David Saavedra, LCSW.
In the event you find it necessary to change mental health providers and require records to be sent to your new provider, your account will need to be up to date and paid in full.
If you fail to cancel a scheduled appointment or you don't keep your appointment, I cannot use this time for another client. Please take into consideration that my psychotherapy practice is very different from a medical doctor who can see numerous patients in an hour.
UNINSURED CLIENTS: Fee $60.00
You will be billed for the entire cost of your missed appointment. A missed appointment with less than a 24 hour notice or no shows will be payable in full, by the client.
INSURED & EAP (Employee Assistance Program) CLIENTS: Fee $90.00
Cancellation or No Shows fees for clients with insurance...it is your responsibility to pay what the insurance would reimburses me had you shown up or not cancelled your appointment. Insurance companies do not cover no-shows or cancellations. This policy also applies to EAP (Employee Assistance Programs) sessions that are a free benefit to employees. You will need to have a credit card or debit card on file with me to cover potential no shows or late cancellations. Thank you for your consideration regarding this important matter.
CONSENT TO TREATMENT FEES
If conjoint (couple or family), all adults need to sign this contract because of confidentiality and individual rights issues even though one person is the identified patient (and paying).
CONSENT TO TREATMENT
You have decided to embark on a powerful journey known as psychotherapy, a decision of strength and courage. Know that we consider the psychotherapeutic relationship to be one of sacred trust. This information serves to inform you about the therapeutic process, give you some information and answer questions about the professional relationship between therapist and clients.
Psychotherapy cannot insure the successful resolution of the issues you bring to it. Human beings are far too complex and life is too uncertain. However, it is our experience as therapists that most people can gain some value from the therapeutic process. Know that as we journey together new, often unforeseen destinations may appear. The therapeutic process may not only affect you, but also relationships, work and other areas of life. There are alternatives and many adjuncts to psychotherapy. These include, but are not limited to, medications, support groups and complimentary modalities. I will be happy to discuss any alternatives you want to consider at any time.
I have a number of client expectations about the professional relationship we embark on with each client. We expect you to keep your appointments. Please remember that someone else may want this time. Please give our other clients, their obligations, relations and your therapist the courtesy of a 24 hour notice if you must cancel an appointment; otherwise, you will be charged for this time. I always consider broken appointments individually and understand that emergencies do arise. Insurance will not pay for broken appointments.
My current fee is $125.00 for the initial session. Individual therapy sessions are $95.00. I do have a sliding scale depending on your household income. Payment for your session is due at the time of service. We accept cash, personal checks, and credit cards. I work with a number of insurance companies via managed care contracts and we are responsible for filing claims for our services; you must pay your copay at the time services are rendered. There are no exceptions. Other insurance plans (out of network) are accepted but you may be required to pay the difference. Payment arrangements are discussed during your initial session.
I also charge for our time when you require written correspondence. This is billed according to the amount of time utilized with a minimum fee of $25. This would include correspondence such as letters to other practitioners, disability applications, etc. Insurance will not pay for correspondence. We do not charge for customary insurance filing. Telephone consults are also billed at regular rates. The first 5 minutes we consider a professional courtesy to our relationship; thereafter, the time is billed at regular rates to the nearest quarter hour. Sessions are 50 minutes in length. I often take a few minutes of an hour between clients to relax, let go of the last session and prepare for the next one.
My appointment times are generally on the hour from 9 AM to 5 PM. I do make earlier and later appointments but these are reserved for long standing clients. I will schedule our next appointment at the end of each session. I am in the office Monday through Saturday. You may reach me via telephone/voicemail during regular office hours. As I am in session most of the day, I do often check voice mail and return messages several times a day. If your call is non-urgent, we will respond as soon as possible. Calls left for me after 5 PM will be returned the following business day at the earliest.
If you are in a life and death emergency situation dial 911 for assistance or go immediately to your local emergency department.
Although the client-therapist sessions will be intimate psychologically, it is important for you to understand that the client-therapist relationship is professional and not social. All contact will be limited to sessions you arrange with your therapist. Sessions are usually held in one of our offices. If you should encounter your therapist outside of the office, the therapist will speak with you only if you initiate the contact; this allows you to maintain the privacy of your psychotherapeutic relationship. Please do not invite your therapist to social gatherings (including, but not limited to, parties, weddings, business meetings, etc.), offer gifts, or ask them to relate to you in any way other than the professional context of our therapy sessions. Although this may seem artificial and/or awkward, it is the best way to promote a good psychotherapeutic relationship.
Your sessions should focus on your concerns exclusively. You will learn a great deal about your therapist the longer you work together; our therapist may occasionally share experiences and struggles with some regularity as models for clients. Nonetheless, you will still be experiencing the therapist in a professional role solely. As your therapist I will keep confidential anything you say with the following exceptions: a) you direct the therapist to speak about you with someone, b) The therapist determines that you are a danger to yourself or others, or c) there is evidence of child or elder abuse. In the event of the latter two exceptions, the therapist will contact family, friends, DFCS and/or law enforcement authorities to attempt to prevent harm from coming to anyone.
As your therapist, I use an eclectic approach to therapy, meaning that they utilize a variety of therapeutic models. I work diligently to use what is most helpful for each individual rather than take any one approach exclusively. I hope this information is helpful to you. If at any time during your relationship with your therapist you have any questions, please feel free to ask.
I do hereby seek and consent to take part in the treatment provided by this provider. I understand that developing a treatment plan with this therapist and regularly reviewing our work toward the treatment goals are in my best interest. I agree to play an active role in this process. I understand that no promises have been made to me as to the results of treatment or of any procedures provided by this therapist.
CLICK HERE TO ACCEPT AND SIGN TERMS OF AGREEMENT