COUNSELING POLICIES

Please carefully read through the following Counseling Policies. This document contains important information about our professional services and business policies as well as the responsibilities and expectations of you as the client. When you sign the IMPORTANT SIGNATURES page of this document, it represents your understanding of all the rules and responsibilities of both the client and the therapist in addition to understanding the financial terms and agreements.

Welcome to SOUL CARE COUNSELING SOLUTIONS, INC.!

We are a professional mental health counseling group where your therapist maintains his or her private practice. Within this model, your therapist is your primary point of contact for scheduling and account management (payment, statement/receipt requests, and billing questions). Our business office provides administrative support to your therapist. To update your insurance information or to schedule with another therapist within our group, please contact the intake coordinator at 810 368-5065

What is therapy and how does it work?

Therapy is the process of solving emotional problems by talking with a professional trained to help you achieve a more fulfilling individual life, marital/couple relationship, or family relationship. The process of change will, in many ways, be unique to your particular situation. Who you are as a person will help to determine the ways in which you go about changing your life.

The process of change begins by first clearly defining the problem and then discussing your thoughts and feelings, understanding the origin of the difficulty, and developing new skills and healthy attitudes about yourself and others. In some instances, talking about your difficulties may exacerbate your symptoms; however, over time, you should see an improvement. In addition, not all individuals benefit from therapy or working with a particular therapist.

Generally speaking, the relationship between the therapist and the client is the most accurate predictor of success in therapy. As the client, you have the right to ask your therapist questions about his or her qualifications, professional background, and therapeutic orientation. If, at any time during therapy, you have questions about whether or not the treatment is effective, feelings about something your therapist has said or suggested, or need clarification of our goals, do not hesitate to bring this up in your session.

You can end therapy at any point you wish. Usually, therapy pursues specific goals, and you and your therapist will discuss together an appropriate termination process. A final session is strongly recommended for closure.

INTAKE APPOINTMENT

Once you check-in at the window, please take a seat in our waiting area, and your therapist will greet you for your appointment. Please bring these REQUIRED items to your intake appointment:

o Photo ID (of legal guardian if client is a minor)

o Insurance card(s) (also bring MA card if you have one)

o Payment for copay or other financial responsibility (cash, credit/debit card, or HSA card)

All forms MUST be completed prior to your appointment time. If they are not complete, the appointment will be canceled. The time allotted for the appointment cannot be extended due to incomplete forms.

All forms will be reviewed during your intake session, and the remaining time will be spent talking about what brought you in for counseling. Your therapist will focus on hearing your story and asking questions to better understand your particular struggle and/or situation. This is also a time to measure how comfortable this feels and if this is a good “fit” between you and your therapist.

By the end of your first session, you can expect some feedback from the therapist, and both of you will agree on a “game plan” for therapy. If you have any questions, feel free to ask your therapist during your appointment.

UNATTENDED CHILDREN

We are unable to provide supervision for children in the waiting room and cannot accept responsibility for their safety if left unattended. For the safety and welfare of the children, and, out of consideration for others, please make arrangements for childcare during therapy sessions or provide adult supervision for children while waiting in the waiting room.

Parents will be held responsible for any property damage caused by their children.

CONFIDENTIALITY POLICY

The staff and therapists at SOUL CARE COUNSELING SOLUTIONS, INC. have an obligation to respect your right to confidentiality for the information you share within this clinical setting. Confidentiality of client information is governed by federal law (Health Information Portability and Accountability Act) and by state law.

The State of Michigan laws impose some limitations on your rights to confidentiality. The following is a list of situations in which you may lose your right to confidentiality:

We are obligated to report any maltreatment of minors or vulnerable adults. This includes physical abuse, sexual abuse or neglect.

We are obligated to report any prenatal exposure to controlled substances.

We are obligated to report any serious harm you intend to inflict on yourself or another.

We are obligated to share information if directed by Court Order to conform to state or federal law, rules or regulations.

We are obligated to share information with licensing boards, which is pertinent to a disciplinary proceeding involving a provider.

If you are a minor, you have a limited right to privacy in that your parents may have access to your records. Minor clients have the right to complete confidentiality in obtaining counseling for pregnancy and associated conditions, sexually transmitted diseases, and information about drug and alcohol abuse. However, if the therapist believes that sharing this information will be harmful to you, confidentiality will be maintained to the limits of the law.

Group Therapy: The right to confidentiality is addressed in the group setting. However, SOUL CARE COUNSELING SOLUTIONS, INC. and group therapists are not responsible for any breaches of confidentiality by group members.

Master’s-prepared therapy interns are an integral part of our counseling team and are obligated to abide by the relevant code of ethics and HIPAA privacy guidelines regarding confidentiality when participating in individual supervision with a primary clinical supervisor (licensed mental health professional), bi-monthly peer supervision staffed by our licensed clinical team, impromptu individual supervision, and consultation by other licensed staff clinicians, as well as appropriate supervision within their academic community.

There are instances in which administrative individuals associated with SOUL CARE COUNSELING SOLUTIONS, INC. have duties that require access to the information you may share for claim processing, scheduling, reports, consultations, etc.

In keeping with standards of practice, your therapist may consult with other mental health professionals within this group's private practice regarding the care and management of cases. The purpose of this consultation is to ensure the quality of care. Your therapist will maintain confidentiality and protect your identity by not using real names or any identifying information. Therapists seeing members of your family or your significant others will obtain a signed Release of Information (ROI) prior to discussing specific details of your situation.

IN CASE OF EMERGENCY

Your therapist is not available for after-hours crises or emergency situations. In a crisis or an emergency situation, please call 911 or go to the nearest emergency room.

TELEPHONE & EMAIL COMMUNICATION

Voicemail is available between sessions. Messages will be returned as soon as possible during business days. Please do not rely on your therapist’s voicemail in times of crisis or for an emergency.

A prorated charge is applicable to time spent with you on the telephone by your therapist beyond appointment scheduling or similar matters (lasting more than 5 min). Telephone sessions between sessions may be scheduled in advance based on the availability of both parties. Therapy sessions conducted on the telephone are not billable to insurance.

Email should ONLY be used for scheduling purposes and may not be checked on a daily basis. Email correspondence is not considered to be a confidential medium of communication, and your therapist is not responsible for any information transmitted via email.

INSURANCE BILLING

Please call us at 810.368-5065 to update insurance or registration information.

We are in-network providers for Blue Cross Blue Shield, Blue Care Network, McLaren Health Plan, Meridian, Beacon, Molina, Straight Michigan Medicaid, Optum Behavioral Health (United HealthCare), Blue Cross Complete, Cigna, and Military One. As a courtesy to you, we work directly with your insurance company.

You must notify us in advance of your first appointment if you intend to use an Employee Assistance Program (EAP). Once services have been provided under insurance, we will not bill your EAP.

Once your appointment has been scheduled, we will verify your coverage and obtain any necessary authorizations. Verification of coverage is not a guarantee of claim payment. Coverage is subject to the terms and conditions (e.g. authorizations, network requirements) outlined in your member contract with your insurance company.

It remains your responsibility to understand your plan’s limitations, deductibles, and exclusions. For benefit coverage questions, please call the customer/member service number on the back of your insurance card. We have no authority to make specific representations to you regarding coverage of services.

It is your responsibility to provide us with updated information when your insurance policy changes or your coverage terminates. If the insurance information you provide to us is later determined to be inaccurate, resulting in a denial of your claim, then you will be responsible for paying the amount of the denied claim.

If you attend an appointment without verification of your current insurance coverage, you are responsible to pay the private pay fee for services at the time of your visit.

There may be instances in which you will need to communicate directly with your insurance company to ensure a smooth billing process. If your insurance requests information regarding Coordination of Benefits (CoB) or Pre-existing Conditions, please promptly return any forms or call your insurance company directly to follow up. Once they request this information from you, all claims deny and become your full financial responsibility until you provide it. Please call us at 810368-5065 to let us know you have resolved any CoB or Pre-existing Condition requests so we can have your insurance reprocess the denied claims immediately

ACCOUNT RESPONSIBILITY

Because we are a “fee for service” provider, billing statements from SOUL CARE COUNSELING SOLUTIONS, INC.will NOT automatically be sent. Should you need a statement or itemized receipt, please inform your therapist, and we will provide this for you upon request.

Per your agreement with your insurance company, it remains your responsibility to immediately pay any copayments, deductibles, coinsurances, or other amounts your insurance carrier determines as payable by you. This payment is to be collected by your therapist.

We do not have the ability to waive copayments, deductibles, or coinsurance amounts due, as this is a violation of the contract, we have with your insurance company.

Cost estimation tools provided by your insurance company allow the collection of coinsurance and deductible amounts upfront at the time of service rather than waiting until after the claim is processed. This collected payment is based on an estimate of your out-of-pocket costs for services provided. Actual coverage and member liability amounts are determined once the claim is processed and you receive an explanation of benefits (EOB). Any overpayments will be applied to ongoing balances or refunded within 60 days of claim processing. Any underpayments must be paid by mail, online at our website, or at your next scheduled appointment (if the scheduled appointment occurs within 1 week of receiving your EOB).

You are responsible for charges not eligible and/or covered by your medical insurance plan. If you discontinue care for any reason, all balances will become immediately due and payable in full by you regardless of any claim submitted.

Should you default on any payment obligations, we reserve the right to forward your information to collections, and an additional 30% may be assessed to cover the costs of this action.

We are not obligated to provide continuing services in the event that Re-Connect My Life, Inc. is named as a creditor in any bankruptcy filing.

MISSED APPOINTMENTS

We realize that on occasion you will not be able to make a scheduled appointment. However, please remember that your therapist has reserved this time for you alone, so our policy is to charge a minimum of $ 35 for cancellations without AT LEAST 24-hour advance notice or a missed appointment. It is up to your therapist’s discretion to require more than a 24- hour notice or to charge a higher rate for missed appointments.

This charge is NOT covered by insurance and will be billed as your responsibility. Please help us serve you better by keeping scheduled appointments. Clients with more than one missed appointment may be subject to same-day scheduling and/or termination of care.

MAKING PAYMENTS

Please understand that payment of your bill is considered a part of your treatment. If mailing, please remit payment to:

Soul Care Counseling Solutions

2367 South Linden Rd. 48532

Flint Michigan

RELEASE OF RECORDS

Most of the information a clinician collects about you will be classified as confidential. However, when insurance is involved, SOUL CARE COUNSELING SOLUTIONS, INC. does not have control over and cannot assure its clients of confidentiality. That means employees of the insurer and employees of contracted organizations of the insurer have access to your chart. This is provided for in the insurance policy between you and your insurance company. The client record is legally the property of SOUL CARE COUNSELING SOLUTIONS, INC. However, clients may have access to the information contained in the file except in those cases where the release of such information may be deemed harmful to the client’s well-being. Information can be released to others only upon written informed consent of the client. In a few cases, information is unavailable to a client. Certain confidential data may be available only to the clinician and particular government agencies; classified material falling into this category might deal with adoption, civil or criminal investigations, some medical data, and the names of persons who report suspected abuse of children or vulnerable adults.

In the event of a request for transfer of records, the records will be forwarded upon completion of a Release of Information form and a payment fee based on the current MI Dept of Health maximum allowed. Copies of records are available for a $20 processing fee, plus up to $1 per page for copying.

**COURT & LEGAL PROCEEDINGS

SOUL CARE COUNSELING SOLUTIONS, INC. does NOT provide disability determination, custody studies, or handle court issues.

SOUL CARE COUNSELING SOLUTIONS, INC.. providers do not perform court evaluations, nor do they appear in court on behalf of individuals, children or adults.

SOUL CARE COUNSELING SOLUTIONS, INC. services are designed to assist in alleviating problems through individual or relational psychotherapy.

SOUL CARE COUNSELING SOLUTIONS, INC. providers are not trained for, nor do they maintain records with the intended purpose of court involvement.

In addition, the legal process is such that we may be compelled to reveal information about you that could affect you negatively or undermine your relationship with your therapist. Because the client-therapist relationship is built on trust with the foundation of that trust being confidentiality, it is often damaging to the therapeutic relationship for the therapist to be asked to present records to the court, testify whether factual or in an expert nature, in court or deposition.

Should we be called to court by a judge’s court order or our records be court-ordered or subpoenaed, we will charge the full amount applicable under the law for our services. Copies of records are available for a $20 processing fee, plus $1 per page for copying.

In the event that it is necessary by court order or by subpoena for the therapist to testify before any court, arbitrator, or other hearing officer to testify at a deposition - whether the testimony is factual or expert - or to present any or all records pertaining to the counseling relationship to a court official, the client agrees to pay the therapist for his or her services [including but not limited to: travel, necessary expenditures (copies, parking, meals, and the like), time spent speaking with attorneys, reviewing records and preparation of reports] at the rate of $250 per hour rounded to the nearest half-hour.

The client further agrees to pay a retainer fee of $2,000 two weeks prior to the appearance, presentation of records, or testimony requested. Checks will not be considered an acceptable form of payment for these services.

Client Bill of Rights

SOUL CARE COUNSELING SOLUTIONS, INC. does not discriminate on the basis of religion, race, gender, marital status, age, sexual orientation, national origin, previous incarceration, disability or public assistance status.

Every client:

shall be informed prior to or at the time of the intake appointment of services available at SOUL CARE COUNSELING SOLUTIONS, INC.and of any financial charges that are his or her responsibility to pay beyond the coverage of health insurance.

can expect complete and current information concerning his or her diagnosis and individual treatment plan in terms he or she can understand.

shall have the right to know the name and the competencies of the licensed mental health professional responsible for the coordination of his or her treatment.

shall have the freedom to place grievances and recommend changes in policies and services to SOUL CARE COUNSELING SOLUTIONS, INC. staff free from restraint, interference, coercion, discrimination, or reprisal.

In addition to the rights listed above, clients using services offered by practitioners licensed by the State of Michigan have the right to: (a) expect that a practitioner has met the minimal qualifications of training and has the experience required by state law; (b) examine public records which contain the credentials of the practitioner; (c) obtain a copy of the rules of conduct.

Every client:

has the right to be informed of and to refuse to participate in any experimental research.

may expect courteous treatment and to be free from verbal, physical, or sexual abuse bySOUL CARE COUNSELING SOLUTIONS, INC. staff.

has the right to a coordinated transfer of care when there will be a change of providers.

may assert the client’s right(s) without retaliation.

has the right to choose freely among available mental health professionals and practitioners in the community and to change providers after mental health services have begun within contractual limits of the client’s health insurance (if any).

COMMENTS, QUESTIONS, CONCERNS

We value your opinion and strive to provide the best service possible. If you would like to share your comments, questions, or concerns, please contact our Clinical Director, at (810)368-5065 or email: dmabry@soulcarecounselingsolutions.org

NOTICE OF PRIVACY PRACTICES (HIPAA)

This notice describes how your health information may be used and disclosed and how you can access this information. Please review it carefully. Protecting our patients' privacy has always been important to this practice. A new state and federal law, the Health Insurance Portability and Accountability Act (HIPAA), went into effect on April 14, 2003, and requires us to inform you of our policy. At SOUL CARE COUNSELING SOLUTIONS, INC., we are very careful to keep your health information secure and confidential. This law requires us to continue maintaining your privacy, to give you this notice, and to follow the terms of this notice. The law permits us to use or disclose your health information to those involved in your treatment; for example, a review of your file by a specialist doctor whom we may involve in your care. We may use or disclose your health information for payment of your services. For example, we may send a report of your progress to your insurance company. We may use or disclose your health information for our normal healthcare operations. For example, one of our staff will enter your information into our computer. We may share your medical information with our business associates, such as a billing service. We have a written contract with each business associate that requires them to protect your privacy. We may use your information to contact you. For example, we may send newsletters or other information. We may also want to call and remind you about your appointments. If you are not home, we may leave this information on your answering machine or with the person who answers the telephone. In an emergency, we may disclose your health information to a family member or another person responsible for your care. We may release some or all of your health information when required by law. If this practice is sold, your information will become the property of the new owner. Except as described above, this practice will not use or disclose your health information without your prior written authorization. You may request in writing that we not use or disclose your health information as described above. We will let you know if we can fulfill your request. You have the right to know of any uses or disclosures we make with your health information beyond the above normal uses. As we will need to contact you from time to time, we will use whatever address or telephone number you prefer. You have the right to transfer copies of your health information to another practice. You have the right to see or receive a copy of any of your health information. You have the right to request an amendment or change to your health information. Give us your request to make changes in writing. If you wish to include a statement in your file, please give it to us in writing. We may or may not make the changes you request but will be happy to include your statement in your file. If we agree to an amendment or change, we will not remove or alter earlier documents but will add new information.

You have the right to receive a copy of this notice. If we change any of the details of this notice, we will notify you of the changes in writing. You may file a complaint with the Michigan Department of Licensing and Regulatory Affairs Bureau of Professional Licensing Legal Affairs Division, Allegations Section, P.O. Box 30670 Lansing, MI 48909 (517) 373-9196. However, before filing a complaint, or for more information or assistance regarding your health information privacy, please contact our Clinical Director,

If you choose to file a complaint, we will not retaliate in any way.