In order to decide the service that can best meet your needs please read the
Statements of Understanding below going into detail about expectations and the differences
between Counseling and the other services we offer. All Counseling Clients will be asked to initial each
statement before receiving services.

Statement of Understanding for Counseling Service

Emergency Procedure Statement for Counseling

____If you are having a clinical emergency and are not able to contact us or it is after hours or we are not able to get back to you; call 911 or report to the local emergency room.

Confidentiality Statement for Counseling

____Counselors are a mandated reporter which means that services are confidential unless:

  1. Someone's safety is in imminent danger or there is a direct threat of bodily harm to the client or someone else.
  2. There is child abuse.
  3. A judge orders the release of information.
  4. You sign a release of information form.

____These services are covered under the Health Insurance Portability and Accountability Act of 1996 (HIPPA). Your therapist can provide you with detailed HIPPA information at your first session.

____ This service can only be provided by someone with a state license in Counseling, Marriage and Family, Social Work, or Psychology. This service is often contracted through a third party payer such as an insurance company. When third parties are involved it is often required that the service is based on the medical model and requires a diagnosis and that treatment focus on medical conditions such as Depression, Anxiety, Post Traumatic Stress Disorder, or Attention Deficit Disorder, etc.

____Third party payers may require prior authorization, treatment plans, or treatment plan updates. Since you are their client they are more likely to give you the information we need to file your claim correctly. We will file claims and provide factual information but it is your responsibility to let us know what is needed, who needs it, and where to send it. Often behavioral or mental health services have different numbers, rules, addresses, procedures from other medical services.

____We will work in good faith and cooperate to help you receive your full benefits but 60 days after the date of service you will be billed for any remaining balance.

Statement of Understanding for services provided by a
Health and Happiness Partner and for the service we call Soulwork

____This service is not appropriate for treating a mental illness, dealing with suicidal impulses or other emergencies. It is based on educational, spiritual, and philosophical models rather than the medical model and medical procedures or treatment.

____Since no diagnosis is required this service will not count toward your deductable and cannot be paid for through your HRA spending account. It may be eligible through your medical spending account but inform us if you plan to use this as it will require a diagnosis and a counseling receipt rather than soulwork receipt.

____We are advocating that this service become eligible for HRA payment and that using this service should make you eligible for the full or maximum prevention, health coaching, and wellness incentives through your benefit plan but it is not part of any plan at the present time.

____This is an innovative service and there is no license required to provide this service at the present time.

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