Telepsychology Expectations

Christian Heart Counseling

Telepsychology Expectations

What to Expect Patient Insurance Coverage Approval and Responsibility

What are Telebehavioral Services? Telebehavioral services are provided by your therapist, using a specialized online communication program. Is Telebehavioral Services Safe? Yes, all telebehavioral sessions are safe, secure, encrypted, and follow the same privacy (i.e., HIPAA) guidelines as traditional, in-person medical appointments. Your telebehavioral appointments will always be kept confidential. In addition, they are NEVER audio or video recorded. Can I Choose Not to Participate? Of course, with this program you have been offered the option of seeing your therapist via secure and interactive video equipment within your home or other secure setting. It is your choice to accept or decline to participate in telebehavioral services. How Telebehavioral Appointments Work

You must confirm that your medical insurance covers telebehavioral (commonly called Telehealth or Telemedicine) services.
If your insurance does not cover telebehavioral services, your therapist will discuss whether you are willing to pay out-of-pocket for these services. If so, you will be asked to sign a form documenting your understanding that you will pay out-of-pocket, and what the fee will be for each service.
Your therapist will send you, with your permission, an email invitation to a telebehavioral appointment using the video system.
Prior to starting telebehavoral services you will need to complete your therapists’s Telebehavioral Consent Form. This form may be found online at christianheartcounseling.com.
Telebehavioral appointments will have the same start and stop policies as in-person appointments.
If you are experiencing a crisis or your therapist identifies significant risk factors, such as danger to self or danger to others, the therapist will take appropriate steps to ensure your safety. If the therapist becomes aware that you are in crisis or have significant risk factors prior to the start of the telebehavioral appointment the therapist may, at their clinical discretion, cancel the appointment and arrange for alternate treatment, either at his/her office or at an appropriate crisis center.
On the day of your appointment you will receive a link to the video platform. Please be ready a few minutes prior to the start time of your appointment.
After the appointment your therapist will submit either a claim to your insurance company, which is similar to a claim for in-person services except with a different billing code, or charge the session fees to your credit card on file.

If you have any questions or concerns after reading this form please contact your therapist by phone or email.

Approvals

Insurance Coverage Inquiry*

I have contacted my insurance and asked them to confirm tele-psychology coverage. I have given them my therapist’s name and license letters.

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Insurance Coverage*

I have tele-psychology coverage
I do not have tele-psychology coverage

My insurance company has confirmed sessions are covered by my policy. I understand I will be personally responsible for these fees if my insurance does not pay. Write your name as your electronic signature:*

My insurance will not cover tele sessions. I will pay the standard session fee myself.Write your name as your electronic signature:*

Cancellation Policy:*

We have a 48 business hour cancellation policy. We hold times in our schedules just for you. If you need to cancel for any reason with less than 48 business hours there will be a charge of $100. We will gladly waive the fee if the opening created by your cancellation is filled. You authorize your credit card to be charged for any late cancellation fee, returned checks or unpaid insurance.

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Christian Heart Counseling

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