Privacy Policy

Transformation Counseling & Consulting, PLLC

Phone: (919) 283-6083

Email: [email protected]

P.O. Box 627 Wake Forest, NC 27588

PRACTICE POLICIES

Appointments and Cancellations

The standard meeting time for psychotherapy is 55 minutes. We ask that you be prepared to meet for 60 minutes.  The last 5 minutes will be used to address payment and scheduling if necessary.  Cancellations and re-scheduled sessions will be subject to a $75 charge if NOT RECEIVED AT LEAST 24 HOURS IN ADVANCE. This is necessary because a time commitment is made to you and is held exclusively for you. Appointments can be changed online up to 24 hours before the scheduled time. You may also cancel by text, email, phone call, or voice message at the main number (919 -283-6083).  We recommend you email your clinician as soon as you are aware of a possible problem with attending the session.

Please be on time for your sessions to avoid losing treatment time.  Please have your payment ready and/or your credit card information updated to avoid using clinical time to conduct business. Transformation Counseling & Consulting accepts credit cards and cash for payment.  Payment is due on the day of service.

No Show/Late Cancellation

You understand that should you No Show, Late Cancel or reschedule 3 consecutive appointments your clinician has the right to discontinue services or fill your regularly scheduled appointment time.

You understand that should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, Transformation Counseling & Consulting, PLLC must consider the professional relationship discontinued and your profile will be made INACTIVE.

INSURANCE

It is strongly encouraged to call your insurance company to confirm benefits and to be fully aware of deductible, copay, or coinsurance per session.  You may also verify if your therapist is an In-Network or Out-of-Network provider when you contact your insurance company.

By signing this document, you understand it is your responsibility to inform the office of any changes in my insurance, prior to the effective date of the change and accept financial responsibility for any office charges that were incurred prior to this date.

If you have third-party reimbursement, you understand it is only for the services they have agreed to cover. you understand that any additional services you desire are being provided outside this insurance arrangement, and You accept full financial responsibility for these services.

You understand there is a contract between this payer and the office for this provider’s services. You accept responsibility for any deductibles and co-payments specified by this contract. You request that claims be filed with this carrier and authorize the office to provide whatever medical information is required by the carrier for the processing of the claim.

You also assign benefits directly to the office.  You accept financial responsibility for any services you desire that are not covered by your insurer or if insurance does not pay within a 3-month period.  You understand that you are responsible for paying for those services and you can be reimbursed if they follow through at a later date.  You understand that your credit card will be kept on file and processed within 24 hours after the service for the copay and within 48 after the return of the claim for the balance of the account. 

You understand that you are responsible for understanding, tracking, and resolving any coverage and/or payment issues with your insurance carrier.

You understand that if you use insurance you will be given a diagnosis. If you do not want a diagnosis submitted to insurance, you will choose to pay for sessions out of pocket. This office is an in-network provider for some insurance companies and insurance companies are billed as a courtesy to clients. The claim filing process may also require further information about your treatment to be submitted to the insurance company in the future (if there is a medical review for example) Any requests for client information and records will be kept to a minimum.

Financial Responsibility

You hereby unconditionally guarantee payment to Transformation Counseling & Consulting for all costs, charges, and expenses incurred by said client at this office, unless separate arrangements are agreed upon in writing.

Self-Pay/Cash Payment

• Initial Assessment/Consultation – $125 – $215

• Individual 46–60-minute session – $100 – $180

• Family 46–60-minute session- $100 to $180

• Additional 15 minutes- $35

*Session fees may vary according to the individual therapist.  Sliding scale is offered based on need.

• No show/late cancellation 75.00

• Completion of Forms 50.00/hour

• Letter to work or school 25.00

• School Meetings 200.00

Court: If in-person appearance is required by the therapist the rates are as follows:

• Per day $600

• Per hour $100

• Paperwork and court prep time – $100 per hour

Collections/Late Fees

In an attempt to prevent sending overdue accounts to collections,  you agree to keep credit card information on record and authorize Transformation Counseling & Consulting, PLLC to debit your credit card 48 hours after the claim has been processed and the EOB has been received by Transformation Counseling & Consulting, PLLC.

Credit Cards

You understand that providing credit card information is mandatory before the session.  (Credit card information will be stored online through a secure HIPPA-compliant merchant called Stripe. B)

You agree to update any changes in your credit card (lost or stolen) through the patient portal or at your next appointment.

You understand that your card will be used to cover copays, missed appointment fees, and or full rate of service fees within 24 hours for copays and within 48 hours from receipt of processed claims for deductibles and the balance of the account. 

Talkroute

Transformation Counseling & Consulting utilizes the Talkroute phone system to communicate with clients.  This system is HIPAA-compliant. 

Sharing of Personal Information:

We do not share, sell, or disclose your personal information or mobile opt-in data to third parties without your explicit consent, except where required by law. Your information is kept confidential and used solely for the purposes you have agreed to. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with third parties. Text messaging opt-in data is not being shared with third parties. 

Opting Out of Text Messages:

You have the right to opt out of receiving text messages from Transformation Counseling & Consulting at any time. To opt-out, you can reply “STOP” to any text message you receive from us.

Consent and Opt-In:

By providing your phone number and opting in to receive text messages, you consent to the collection and use of your personal information as described in this policy. We ensure that your consent is obtained explicitly and that you are informed about the types of messages you will receive.