RB Counseling (RBC)

PRACTICE POLICIES

APPOINTMENTS AND CANCELLATIONS Counseling sessions usually last 45-minutes, and we must end each session promptly. Payment is due at the time of your appointment using cash or credit card. We must charge the full fee even if you are late. If you cannot make your appointment, please let us know at least 24-hours in advance. Sessions cancelled/rescheduled with less than 24-hours notice will be charged an $80 fee. No-show sessions will be charge the full session fee. Late cancellation, rescheduling and no-show fees in most cases are not billable to insurance.

If you have transportation concerns during inclement weather or related to illness, please call us to discuss options for a telephone/video session (which may or may not be covered by insurance) or rescheduling.

There is a $30 fee for any check returned for any reason.

FEE SCHEDULE

Fees for therapy sessions are $175 per 45-minute session for individual, couples and family sessions. If deemed appropriate by the client and therapist, extended session are available at $190 per 55-minute session. Fees will be prorated accordingly for session lengths over 60-minutes.

As previously noted, sessions cancelled/rescheduled with less than 24-hours notice will be charged an $80 fee. No-show sessions will be charge the full session fee. Late cancellation, rescheduling and no-show fees in most cases are not billable to insurance.

RBCounseling does not bill insurance and is considered an Out-Of-Network provider for all insurance companies. Upon your request, a “superbill” will be provided to you if you wish to seek reimbursement from your insurance company. Due to vast differences between insurance companies and individual plans, we are unable to provide information related to possible reimbursement by your insurance company.

The fee schedule is evaluated annually, at a minimum. You will be given a minimum of 30 days’ notice when fees increase.

As part of our policies, we keep a credit card on file for all client in our secure online system. This credit card will be charged the day of your appointment for our agreed upon session fee unless a 24-hour cancellation is provided or if we have other payment options arranged. By signing this informed consent you agree to keep a current credit card on file and agree to be charged for your sessions and any late cancellations or no-show appointments. You may also choose to use this card to cover session fees. If for some reason you find that you are unable to continue paying for your therapy, you should inform your therapist. Your therapist will help you to consider any options that may be available to you at that time.

NON-CLINICAL FEE SCHEDULE

Fees for telephone calls, email consults, preparation of records or summaries, letter writing, attendance at meetings with other professionals you have authorized, or other services you might request which require longer than 10 minutes to perform are prorated will be pro-rated per 10 minute increment of the clinical hour (1/5 hour). These services normally are not covered by health insurance.

COURT-RELATED POLICIES & FEES

At the initiation of treatment, you and collateral parties agree not to solicit the clinician’s written or in-person testimony in legal cases. However, the court may order the clinician to testify. If court-ordered to testify, the clinician will testify as a fact or percipient witness. The clinician requests that subpoenas be personally served during the regular business hours of 9 AM to 4 PM, Monday through Thursday. The clinician’s scheduled meetings or sessions cannot be interrupted or misrepresented in order to personally serve the clinician with a subpoena.

The entity or party initiating the subpoena agrees to compensate the clinician for her/his professional time according to the legal fees stated in this document and all legal expenses the clinician incurs from consultation with her/his attorney in preparation for a legal case. Professional time is defined as any activity the clinician undertakes or support required to provide testimony, which includes but is not limited to, time spent in preparation for testimony, time spent in consultation to prepare for testimony, travel to provide testimony, travel from providing testimony, lodging, and parking fees. The clinician charges a higher rate for her/his professional time in a legal proceeding that requires the clinician’s participation due the complexity and difficulty of legal involvement. The clinician will attend agreed upon and scheduled depositions, court appearances, or legal conferences. The clinician will not participate in on-call court appearances.

Legal fees are as follows: $175 per hour for preparation, review of legal records, or deposition, court appearance, or legal conference; $900 for half day deposition, court appearance, or legal conference (up to 4 hours); $1800 for full day deposition, court appearance, or legal conference (greater than 4 hours and up to 8 hours). Full payment of legal fees must be rendered at least 48 hours prior to the clinician’s scheduled deposition, court appearance, or legal conference. Court-related legal rates may be raised periodically at the clinician’s discretion and without additional notice.

NO SURPRISES ACT

In compliance with the No Surprises Act that went into effect January 1, 2022, you have certain rights and protections against “surprise billing." This Act requires that we inform you of your federally protected right to receive a notification when services are rendered by a therapist who is out-of-network with your insurance provider (i.e. a non-participating provider). In addition, you have the right to receive a Good Faith Estimate explaining the cost of any non-emergency healthcare services, including psychotherapy.

GOOD FAITH ESTIMATE

In compliance with the No Surprises Act that went into effect January 1, 2022, you have certain rights and protections against “surprise billing." This Act requires that we inform you of your federally protected right to receive a notification when services are rendered by a therapist who is out-of-network with your insurance provider (i.e. a non-participating provider). In addition, you have the right to receive a Good Faith Estimate explaining the cost of any non-emergency healthcare services, including psychotherapy.

GOOD FAITH ESTIMATE

Provider Information:

Name: Rachel Baker LICSW, SUDP
Facility: RB Counseling
Location: 222 W. Mission Ave - Ste 232, Spokane, WA 99201
Phone: (509) 402-1569
Email: rachel@rbcounseling.com
TIN: 45-2523580
NPI: 1932428414

Primary Services & Expected Charges

• 90791 Psychiatric Evaluation: $175

• 90834 Psychotherapy 45-min (standard session): $175

• 90837 Psychotherapy 55-min: $190

• Late Cancel/Reschedule (less than 24hrs notice): $80

• No-Show: full session fee, $175

Note: Fees are based upon individual session length. There is NOT a charge difference based upon diagnosis(es).

Additional services may be recommended. This estimate of your costs is only an estimate, and your actual charges may differ. You have the right to initiate the patient–provider dispute resolution process if the charges you are actual billed substantially exceed the expected charges in this estimate. This estimate of costs is not a contract and does not obligate you to obtain clinical services from us. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.

Expected Scope of Recurring Services

Length, frequency and number of sessions is dependent upon your condition and is a collaborative decision made by both you and your provider. Most clients will attend one 45-minute psychotherapy visit per week, but the frequency of psychotherapy visits that are appropriate in your case may be more or less than once per week, depending upon your needs.

As noted above, the fee for a standard 45-minute psychotherapy visit (in-person or virtually) is $175 . Your total estimated fees will be the number of sessions you attend, multiplied by $175 (for standard 45-minute sessions). For example, if you attend one session per week, your estimated charge would be $700 for four visits provided over the course of one month.

Note: Fees are based upon individual session length. There is NOT a charge difference based upon diagnosis(es).

Please note (a.k.a. Disclaimer):

• This is an estimate of costs. It is not a contract and does not obligate you to obtain clinical services from RBCounseling.

• This Good Faith Estimate (GFE) shows the costs of items and services that are reasonable expected for your health care needs for an item or service. The estimate is based on information known at the time of the estimate was created.

• The GFE does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.

• If you are billed for more than this Good Faith Estimate by at least $400, you have the right to dispute the bill. You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the GFE, ask to negotiate the bill, or ask if there is financial assistance available.

• You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

• There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

• For questions or more information about your right to a Good Faith Estimate (GFE) or the dispute process, please visit www.cms.gov/nosurprises.

TELEPHONE ACCESSIBILITY

We are not always available for emergency calls, but you may attempt to contact your therapist at (509) 402-1569. If you need to contact your therapist between sessions; please leave a message on their voice mail. Therapists are often not immediately available; however, we will attempt to return your call within 24 hours during normal business hours (which are based upon the individual therapist’s schedule). Please note that face-to-face or video sessions are highly preferable to phone sessions. Telephone conversations lasting over 10 minutes will be charged at regular session rates. If an emergency situation arises, please call the Regional Crisis Line at (877) 266-1818, 911 or go to any local emergency room. To the extent possible, we will keep you informed about when your therapist is away from the office and when they will return. When your therapist is away from the office for several days, we will arrange to have another counselor available for situations that cannot wait until their return. Your therapist will probably not have discussed your case with that person, but they will make every effort to be helpful to you in your therapists absence.

CONFIDENTIALITY

In addition to the laws pertaining to confidentiality as described in the Notice of Privacy Practices & Informed consent document, if we see each other accidentally outside of the therapy office, we will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to us, and we do not wish to jeopardize your privacy. However, if you acknowledge us first, we will be more than happy to speak briefly with you, but feel it appropriate not to engage in any lengthy discussions in public or outside of the therapy office. Additionally, we occasionally may find it helpful to consult with another professional about our work. In this case, we make every effort to avoid revealing your identity. Those consultants, of course, are also legally bound to keep your information confidential.

RECORD STORAGE

Your records are maintained in an Electronic Health Records (EHR). What this means is your records are stored online in a secure, encrypted, HIPAA compliant system that is backed up to ensure records are not lost due to technical problems. This system may provide certain benefits to clients including online payment, online scheduling, and secure messaging to your therapist. Please ask any questions or report any concerns you have regarding online record keeping. As with any record keeping method, every foreseeable precaution has been taken to protect privacy, but there are no guarantees. Here is an up to date list of all the ways your information remains secure: <https://www.simplepractice.com/security>

SOCIAL MEDIA AND TELECOMMUNICATION Due to the importance of your confidentiality and the importance of minimizing dual relationships, we do not accept friend or contact requests from current or former clients on any social networking site (Instagram, Facebook, LinkedIn, etc). We believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.

You may “like” the RBCounseling Facebook business page or Instagram business account. However, the information on these sites is often also on our website. If you “like” these pages, you are choosing to reveal that you are connected to RBCounseling in some way. Our business pages exists to be a forum for information and inspiration.

You may find our business/profile listing on review sites (i.e. Health Grades, Yahoo, Yelp). If you should find our listing on any of these sites, please know that the listing is NOT a request for a testimonial, rating, or endorsement from you as our client (and is probably not even run by us). Of course, you have the right to express yourself on any site you wish. But, due to confidentiality, we cannot respond to any review on any of these sites whether it is positive or negative. We urge you to take your own privacy as seriously as we take our commitment of confidentiality to you. You should also be aware that if you are using these sites to communicate indirectly with your therapist about your feelings about our work, there is a good possibility that they may never see it. If we are working together, we hope that you will bring your feelings and reactions to our work directly into the therapy process. None of this is meant to keep you from sharing that you are in therapy at RBC wherever and with whomever you like. Confidentiality means that we cannot tell people that you are our client and our Ethics Code prohibits us from requesting testimonials. If you feel we have done something harmful or unethical and you do not feel comfortable discussing it with us, you can always contact the Washington State Department of Health, which oversees licensing, and they will review the services we have provided.

Please do not use messaging on Social Networking sites such as Facebook, Instagram or LinkedIn to contact us. If there were an emergency, we would not be able to respond in a timely manner as we do not check these accounts regularly. The best way to interact with RBC staff is by phone or secure message. If you post on the RBC business social media pages, these exchanges may become a part of your legal medical record and may need to be documented and archived in your chart.

As the therapists in our practice do use social media in their personal lives, it is possible that you may see comments from one of us in a Facebook group or message board. Views expressed on a therapist’s personal account do not represent the views or policies of the practice. However, should you see something online that changes how you feel about your work with your therapist, we strongly encourage you to bring it up to your therapist in session.

ELECTRONIC COMMUNICATION (TEXT and EMAIL)

It is recommended that electronic communications be conducted via your smart phone through the Spruce Health App (located in the app store) using RBCounseling’s contact number of (509) 402-1569. Communications via this method provide an added layer of security and confidentiality not afforded with standard email and SMS texting. If you have any questions about using this platform, please ask us.

We cannot ensure the confidentiality of any form of communication through electronic media, including traditional SMS text messages. If you prefer, we may communicate via email or SMS text messaging for issues regarding scheduling, if you’re running late, or for cancellations. Professional advice will not normally be provided via the internet or text. If you need to talk with your therapist, please call and leave a message, (509) 402-1569. Clients with professional inquiries are urged to contact us by telephone or secure messaging via the Spruce Health App. We will attempt to return your call within 24 hours during normal business hours (which are based upon the individual therapist’s schedule). If you send messages by email or other electronic form of transmission, you acknowledge and agree that you may be compromising confidentiality by using such means of communication. Please be aware that these communications may become part of your permanent client record. We request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.

MINORS If you are a minor, your parents may be legally entitled to some information about your therapy. We will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately kept confidential.

THE THERAPY PROCESS

It is your therapist’s intention to provide services that will assist you in reaching your goals. Based upon the information that you provide to your therapist and the specifics of your situation, your therapist will provide recommendations to you regarding your treatment. We believe that therapists and patients are partners in the therapeutic process. You have the right to agree or disagree with your therapist’s recommendations. Your therapist and you will also periodically exchange feedback regarding your progress. Due to the varying nature and severity of problems and the individuality of each patient, your therapist is unable to predict the length of your therapy or to guarantee a specific outcome or result.

TERMINATION Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. Your therapist may terminate treatment after appropriate discussion with you and a termination process, if we determine that the psychotherapy is not being effectively used or if you are in default on payment. We will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. You have the right to discontinue treatment at any time and to choose a practitioner and treatment methods that best suit your needs. If therapy is terminated for any reason or you request another therapist, we will, at your request, provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source. If you have missed a scheduled visit and you do not contact us within seven days, we will accept that as your notice that you have terminated this agreement and that you wish to discontinue counseling. You may return to therapy in the future if you decide to continue treatment.

UNEXPECTED THERAPIST ABSENCE

In the event of your therapists unplanned absence from practice, whether due to injury, illness, death, or any other reason, we maintain a detailed Professional Will with instructions for an Executor to inform you of your therapist’s status and ensure your continued care in accordance with your needs.  Please let us know if you would like the names of the Executor and Secondary Executor. As part of this agreement, you authorize the Executor and Secondary Executor to access your treatment and financial records only in accordance with the terms of my Professional Will, and only in the event that we experience an event that has caused or is likely to cause a significant unplanned absence from practice.