After experiencing my medical information being accessed without my consent, I am adamant about protecting your confidentiality as much as possible. There are some limits to confidentiality, such as being required to keep you safe if you are actively suicidal, or homicidal, reports of abuse of a child, an elderly, or a disabled person, and complying with court orders. I will ALWAYS inform you if I am required to make a mandated report. I will also work to avoid involuntary hospitalization as much as I can.

Some of the things I do to protect your confidentiality include: keeping notes very minimal and in generalities, to minimize any risk to you should any company require your records (with your signed release), or any 3rd party somehow gets access to your notes (such as is the case with court proceedings). When I am writing notes, I do consider the current political state of our country and laws that make some folx illegal, or receive certain healthcare services. I will never include names of individuals you talk about, or specifics of any challenges you endure. An example of what I mean by generalities is: “Session themes included: interpersonal dynamics, exploration of values.” See what I mean about keeping it very general?

My Electronic Health Record (Sessions Health) is HIPAA compliant. In addition, for email, I use Hushmail for end-to-end encryption.

I do not have any smart devices, such as Alexa, in my home, or enabled on any of my devices. I do not allow recording of sessions. I meet for all of my sessions in my private residence, and ensure that no one can overhear your sessions.

I do not use AI recording software for notes.

Devices used to communicate with clients (such as my tablet or my phone) are encrypted and strongly protected. My internet connection is also heavily protected.

I always welcome referrals, as they are the best compliment to my work that I could possibly receive. However, I will not work with any person you live with, your immediate family members, folx you work with, or any person you are in a close relationship with, especially if the relationship is a topic of discussion for you. I strive to be aware of any conflicts of interest, especially around working with individuals who know each other, and will never talk about you, or contents of your session with another person without your express written and verbal consent. In some cases, I may have to refer you or the other person to a different provider in order to maintain an unbiased stance and prevent harm to you or the other person. I am always happy to recommend various providers that I trust for you to give to your friends and family as necessary, if you are concerned.

You are also allowed to revoke any release of information at any time, for any reason.

I am not able to assist in any court related matters, which include, but are not limited to, testifying as to my opinion about your prognosis, recommendations for care, or doing any assessments required for custody evaluations, etc. I will have to refer you to a provider who does work with legally mandated clients, as I am not an expert witness, or trained to provide any formal assessments or recommendations the court might require. If you are court ordered to participate in treatment following a DUI, for example, it is highly likely that the court system and the State will have specific providers for you to work with, and you will only be allowed to work with them.

If I am required to participate in any court proceedings, to testify about your treatment status, for example, I will have to charge you a significant fee (paid up front, with no refunds) for time spent preparing, and participating in court. Court appearances require a significant time investment, and I will need to cancel a full day of clients. Should your hearing be rescheduled after my client sessions have been canceled, and I have to cancel another day, you will have another fee to pay. I encourage any clients to coordinate with their attorney to ask if my appearance will be necessary, or if a treatment summary, or progress notes will suffice, in order to avoid court related fees. Again, the notes I keep are minimal and generalized, and I will only read from notes in court, and will not be able to offer any interpretation, so your confidentiality is protected.

If I am required to travel more than 20 miles from my home, to appear in person, you will also be required to pay an additional fee to cover travel expenses.

If you are court ordered for therapy, for any reason, at any time during our relationship, I will absolutely work with you to coordinate any care needed, including collaborating with your court ordered provider on an ongoing basis, and providing your progress notes, or treatment summary, with your express written and verbal consent. I will NOT abandon you. I will be transparent about any limitations I have to support you.

Most insurance companies DO NOT require pre-authorization or referral for mental health counseling. Because of this you can reach out to me directly and do not need a referral from a physician. If a pre-authorization is required, we will figure it out!

This answer depends on whether you are utilizing your insurance provider or self-pay for your therapy sessions.

Self Pay: Sessions can be conducted via Video, Phone, or Live Chat (with video on; you are not required to have audio on). Live Chat is conducted on a case-by-case basis as needed to ensure accessibility to engage in therapy.

Insurance: Sessions are required to be conducted via Video only. This is not my rule, but one mandated by health insurance requirements.

Most sessions are 45 to 53 minutes in duration. However, sessions can be shortened or extended based on my availability and your needs. Not everyone needs weekly sessions, and many of my clients actually start therapy by coming every other week.

Before your first session, you will have received an invite to your client portal to complete your consent paperwork and intake questionnaire. During our first session, I will go over what you’ve written (or checked off) in the questionnaire and ask you questions to make sure I’m understanding you correctly. From there, we start working on building your treatment plan, based on what you want to focus on.

I partner with Hello Alma in order to accept insurance, and I am considered in network with most Optum (United Healthcare), Aetna, Cigna, and Harvard Pilgrim plans. Every insurance plan is different, so Alma will verify your benefits and let you (and I) know what your anticipated copay will be. Sometimes this number comes back wildly inaccurate, and you will be required to call your insurance company to verify what your actual copays are, after which I can ask Alma to complete a manual verification.

Every health care provider is at the mercy of health insurance database systems, and inaccuracies do occur as a result. In addition, many health insurance companies have restrictions on telehealth and which platform you are allowed to use for services, which may mean you have a higher copay to access a “non-preferred” provider. Unfortunately, this is not easily found out until you call.

You are responsible for knowing your insurance benefits and your costs. As a solo practitioner, I focus on giving my clients the best care possible, which means I cannot spend hours on the phone each week to handle insurance myself (which would be unpaid labor). I strongly encourage every client to contact their insurance company to get a clear understanding of their benefits, and to keep a copy of their benefits guide on hand to reference.

Your insurance company is allowed to deny any claims if they disagree with the medical necessity of your unique therapy experience.

Insurance companies are also allowed to take their time in processing claims, so if the initial benefits verification is incorrect (or the claim is processed by insurance incorrectly), sometimes that can result in a surprise bill to you several months later. I, and Hello Alma, will work with you to figure out a payment plan in most cases, if necessary.

I am NOT in network with any plans not listed above. If you have out of network insurance benefits, I am happy to provide a superbill that you can submit directly to your insurance company for reimbursement. This means that you would pay me directly on the day of the session, and your insurance company would pay you back.

I am not able to work with any individuals covered by Medicaid or Medicare. If you have Medicaid, you do risk losing your benefits if you self-pay for services, so I am unable to work with you.

If you are covered by any secondary insurance, I may not be able to bill your primary insurance, even if they are in network, as Hello Alma is unable to coordinate between primary and secondary insurances at this time.

My philosophy around diagnosing is to do the minimum necessary. If you are self-pay, meaning you are not utilizing any health insurance benefits, I am not required to diagnose you, nor are you required to meet arbitrary “medical necessity” guidelines. With self-pay, you get to fully dictate your course of treatment. There are no insurance companies deciding what is and is not therapeutic for you. Truly, only you can decide if you are benefiting from therapy.

If you are using health insurance benefits, either in network or seeking out of network reimbursement, I must give you a diagnosis. If I cannot diagnose you to meet “medical necessity” requirements, or your primary diagnosis is Autism, or ADHD, or a Personality Disorder, for instance, therapy claims can be denied, as only certain treatment modalities might be approved (like ABA, which I am vehemently against).

Insurance companies can and do dictate treatment. They require a formal treatment plan that in no way can fully encompass what treatment will look like. They are about numbers, so they can pay the least amount of money possible for your care. Progress in therapy is subjective, often not measurable according to the standards dictated by the healthcare system. Trauma work, especially, where progress can be slow, can be so hard to measure according to insurance standards because sometimes we don’t even recognize how we’ve grown until we encounter a specific trigger. This isn’t medical treatment like surgery, where there is a clear outcome, and progress takes time. How do we quantify progress that can only truly be determined by you alone?

On a regular basis, insurance companies will audit documentation and if they disagree with your diagnosis or the medical necessity of your treatment, they are legally allowed to “claw back” any money paid on previously approved claims, and in some cases, for treatment going back over a year or more. If this occurs, you will be liable to pay your insurance contracted rate to me directly, potentially thousands, as I do deserve to be paid for the services provided.

Well, that’s a great question, and it’s one that I can’t answer. It will take the time that it takes, and no therapist can guarantee any specific outcome. It is always my goal to help you, and I cannot guarantee beyond any doubt that I will be helpful to you specifically. Sometimes we get some relief early on in work. Sometimes, it takes a year of gossip days and gentle presence for us to get to the deeper work to heal the trauma. Every person is different. Ask yourself why you attend your appointments and what you are getting out of them. If you don’t feel like you are making progress, please tell me! I am always open to your feedback and will not get mad. Therapy is about you, not me, and I’m very good at putting my ego aside and adjusting as needed.

If we are unable to make progress with adjustments on my side, ethically, I will need to work with you to get you connected with a provider that might be a better fit for you. Who you see for treatment is up to you. It is my ethical duty to acknowledge when my skills are not aligned with what you need, and I will talk to you about this if I notice anything. I will check in with you and ask you how you feel therapy is going for you, and any decisions regarding frequency of care and/or discharge or referral out, are made with your full knowledge, consent, and collaboration in most cases.

If you are abusive toward me, and we are unable to resolve this, for my own safety as a human, I will discharge you with referrals to other providers. As humans, we are NEVER required to tolerate or accept abuse from anyone, even at our jobs.