Thank you for asking us to participate in your health care. The following are our policies and procedures. Please read them carefully, and ask any questions you may have before signing this agreement. 

 

Payment Types Accepted

Cash, Credit Card 

Payment is due at time of session.

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Phone calls: Calls are returned Tuesday through Friday, we attempt to return calls in a timely manner. Please leave your phone number with your voicemail message each time you call.

 

Emergencies: If you have an emergency need for a therapy session contact your therapist, please call our office to make an appointment. RLSGA does not provide  on-call or crisis services, therefore we ask that you follow the emergency protocol : 

EMERGENCY PROTOCOL***If you are experiencing a life threatening emergency, please call 911, go to your local ER or call

the National Suicide Prevention Lifeline at

1-800-273-8255.

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Billing: The following billing policies apply:

a. Fees for sessions are due at the time of service. We accept insurance, EAP, cash, money order, and credit cards.

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b. In the event we are unable to collect on your account, be advised that uncollected fees may be turned over to the office’s collection agency. Only necessary information will be released to them. Please be assured that we will make every effort to work with you before this happens.

 

c. We ask that you place a debit or credit card on file for fees and/or debts. If late the amount is one session fee for self-pay, or $55.00 if using insurance.

 

d. The credit card on file is the card that will be used to collect on ALL outstanding debts and fees.

 

Insurance Payment

 

All references to insurance are effective once your therapist is on insurance panels.

 

We ask that you call your insurance company to get an over view of your “Outpatient Mental Health Benefits.” This information will notify you if you :

• Have a copay

• Need to meet your deductible first before the insurance will pay for service

• Have 100% coverage

 

Mental health services are different from “ Specialist” services.

Please look on the back of your insurance card for your customer service number. A copy of your ID and Insurance card will be made at  the assessment appointment.  

Please note that you will be responsible for payment if the insurance does not cover your visit.

 

Super Bill

 If you would like to receive a Super Bill for your insurance Out of Network fee, please let us know. You may file for reimbursement but we cannot guarantee that your insurance company will reimburse you being that I am at associate level licensure. 

 

Employee Assistant Programs (EAP)

 

An employee assistance program (EAP) is an employee benefit program that assists employees with personal problems and/or work-related problems that may impact their job performance, health, mental and emotional well-being.

 

The EAP offers help with the resolution of problems that are affecting work. These problems, however, do not have to be caused by workplace issues. Employee Assistance Programs are designed to help people understand or overcome their personal problems.

 

You may call your EAP and request your therapist if your therapist is on the panel.

 

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24 Hour Notice Cancellation Policy

If you fail to cancel a scheduled appointment, we cannot use this time for another client. Therefore, you will be billed for the entire cost of a missed appointment.

 

a. A full session fee is charged for missed appointments or no show cancellations with less than a 24-hour notice. The full session fee will be added to the client’s next session, if a credit card is not available.

 

b. If the client(s) do not show for the next session, a bill will be mailed directly to all clients who do not show up for a following appointment.

 

c. Clients using insurance: A fee of $55 will be charged for missed appointments or no show cancellations with less than a 24 hour notice

 

d. Clients who are self-pay: You will be charged the full amount of your session. 

Appointments can be cancelled or rescheduled up to 24 hours in advance. Cancellations within 24 hours require payment of the full session fee.

 

 

Confidentiality & Privacy Policy

Once you become a client you will have access to gain a copy of our Privacy Policies and how we work to keep your information confidential. Psychotherapy laws protect the relationship between a client and a psychotherapist and information cannot be disclosed without written permission with the exception of : 

 

• Suspected child abuse or dependent adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately. 

• If a client is threatening serious bodily harm another person/s, I must notify the police and inform the intended victim. 

• If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.

• In the case of divorce or separation of parents, the therapist will not share information about one parent with a parent who does not physically participate in the session.  However, the non-custodial or non-accompanying parent has the legal right to be knowledgable of the therapy for their child, including appointments, treatment plan goals, and progress, and to give or deny consent for treatment. 

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Personal Information Collected on Site

Our website is SSL secure, hence the lock next to the link in the search box above.SSL (Secure Sockets Layer) is the standard security technology for establishing an encrypted link between a web server and a browser. This link ensures that all data passed between the web server and browsers remain private and integral. SSL is an industry standard and is used by millions of websites in the protection of their online transactions with their customers.

We collect personal identification information from Users in a variety of ways, including, but not limited to, when Users visit our site, register on the site, contact us from the site , subscribe to the newsletter, and in connection with other activities, services, features or resources we make available on our Site.  When you reach out to us you may be asked to give,  as appropriate, a name, telephone number  and an email address. Other collection of data may occur through collection of website traffic and aggregate usage data. For instance, the date and time a user visits our site, the (IP) address from which your website was accessed, the webpages visited, duration on each page, the type of browser and operating system used to access our site.We will you your information for contact purposes such as replying to an email, send out a newsletter, or inform you of any events we may have. Also, as with any website, apps used to collect the information on our site ,our website and domain host may collect information you give, which is out of our control. The information was collect is not sold or given away by us. Your information is only used by Real Life Solutions GA, LLC and Mission Dorothy™ Female Empowerment Services for informational purposes only. If you ever receive any unwanted information from us please contact us and let us now you prefer not to receive any further information from us. 

Effective January 2018

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Medical Disclaimer

The contents of this website are for informational and educational purposes only. The resources, opinions, tips, and strategies are not a replacement for medical or mental health professional treatment.  Nothing found in our newsletter or website is intended to be a substitute for professional psychological, psychiatric or medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified mental health provider with any questions you may have regarding a medical condition or mental disorder.Never disregard professional medical or mental health advice or delay in seeking it because of something you have hear on our podcast or read on our site. Real Life Solutions GA, LLC, Mission Dorothy ™, Tamekis Williams or any guest writer or advertisement is not liable for any advice or information provided on the website, all of which is provided on an “as-is” basis. No warranties either express or implied are made on the information we provide. Opinions and other statements expressed by third parties (including articles, website posts) are theirs alone, not opinions of Real Life Solutions GA, LLC, Mission Dorothy™, and Tamekis Williams. While Tamekis Williams makes an effort to review certain content. Its accuracy and completeness are not endorsed or guaranteed.

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Right to a Good Faith Estimate

 

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

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• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, therapy and hospital fees.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

• Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.