Practice Policies
Assignment of Benefits & Billing Authorization
I, the undersigned, authorize my insurance benefits to be paid directly to Malaer Mental Health Services, PLLC / Kristin Malaer, LCSW-S for services rendered. I understand that I am financially responsible for any amount not covered by insurance, including copayments, deductibles, and non-covered services. I agree to provide any additional documentation required by my insurance carrier to process claims.
I further authorize the release of any information necessary to process my claims, including but not limited to diagnoses, treatment plans, and session details. I understand that my therapist may be required to release specific information to my insurance provider to obtain authorization or payment.
Consent for Treatment & Practice Policies
Therapeutic Process
Therapy aims to address identified concerns and improve overall mental health. While therapy can lead to personal growth and symptom reduction, no guarantees can be made regarding specific outcomes.
Client Responsibilities
Clients are expected to:
Attend scheduled sessions, complete assigned therapeutic activities, and openly communicate regarding their progress.
Engage in therapy with a willingness to participate in personal growth and change.
Ensure a private space during sessions to maintain confidentiality and minimize distractions.
Not engage in driving or operating machinery during telehealth sessions. Doing so is strictly prohibited and may result in immediate termination of the session. The client assumes full liability for any risks associated with unsafe engagement in telehealth sessions.
Refrain from recording or filming therapy sessions. Any attempt to record, share, or post any portion of a therapy session online or via other mediums is strictly prohibited and may result in termination of services. Clients are expected to attend scheduled sessions, complete assigned therapeutic activities, and openly communicate regarding their progress. Therapy requires active participation and a willingness to engage in change.
Confidentiality
All client information is confidential except in cases where disclosure is required by law, including suspected child/elder abuse, imminent harm to self or others, or a court subpoena.
Telehealth Services
Client Location Requirements: Clients must be physically located in a state where the provider is licensed at the time of each telehealth session. If the client travels out of state, they must inform the provider in advance.
Technology Requirements: Clients are responsible for ensuring a stable internet connection and using a secure, private location for sessions. If technical difficulties occur, clients should have an alternative communication plan in place, such as phone backup.
Data Security & HIPAA Compliance: Telehealth sessions are conducted using HIPAA-compliant platforms. Clients should be aware that despite best security practices, there is always a risk of unauthorized access or data breaches. Clients are advised to use secure networks and avoid public Wi-Fi when attending sessions.
Telehealth sessions are provided via HIPAA-compliant platforms. Clients must ensure a private setting for sessions. By agreeing to telehealth, clients acknowledge potential risks, including technical issues and unauthorized access.
Cancellations & No-Shows
Appointments must be canceled with at least 24 hours’ notice to avoid a $75 late cancellation/no-show fee. This fee is not billable to insurance and remains the client's responsibility.
Clients who miss three consecutive sessions without proper cancellation will be considered non-compliant with their treatment plan, and services may be terminated.
Termination of services is encouraged to include a final session as part of the therapeutic process to review progress and discuss next steps for continued care. Appointments must be canceled with at least 24 hours’ notice to avoid a $75 late cancellation/no-show fee. This fee is not billable to insurance and remains the client's responsibility.
Fees & Payment
Session Fees: The standard session rate is $120 per 50-minute session (unless otherwise contracted with insurance). Payment is due at the time of service via credit card or Health Savings Account (HSA). A valid credit card must be kept on file.
Administrative Fees:
Letter Writing Fee: $50 per letter.
FMLA or Short-Term Disability Paperwork: $100 per set of forms.
Other Documentation Requests: Fees may vary depending on the complexity and time required for completion.
Insurance Reimbursement: Clients using out-of-network benefits are responsible for submitting their own claims for reimbursement unless otherwise arranged with the provider. It is the client’s responsibility to confirm out-of-network coverage with their insurance provider.
Late Payment Policy: Payments must be made at the time of service. If payment is not received within seven (7) days, a $25 late fee will be applied. If the balance remains unpaid for 30 days, services may be suspended until payment is made or a payment plan is established.
Missed Payment & Collections: Accounts delinquent for 60 days or more may be referred to a collections agency, which may impact the client’s credit score.
Session Fees: The standard session rate is $120 per 50-minute session (unless otherwise contracted with insurance). Payment is due at the time of service via credit card or Health Savings Account (HSA). A valid credit card must be kept on file.
Insurance Reimbursement: Clients using out-of-network benefits are responsible for submitting their own claims for reimbursement unless otherwise arranged with the provider. It is the client’s responsibility to confirm out-of-network coverage with their insurance provider.
Late Payment Policy: Payments must be made at the time of service. If payment is not received within seven (7) days, a $25 late fee will be applied. If the balance remains unpaid for 30 days, services may be suspended until payment is made or a payment plan is established.
Missed Payment & Collections: Accounts delinquent for 60 days or more may be referred to a collections agency, which may impact the client’s credit score. The standard session rate is $120 per 50-minute session (unless otherwise contracted with insurance). Payment is due at the time of service via credit card or Health Savings Account (HSA). A valid credit card must be kept on file.
Legal & Court Fees
Therapists do not provide forensic evaluations or testimony. Should a client require legal testimony, the fee is $2,000 per day for preparation and court appearances.
Telehealth allows remote access to therapy services via secure video conferencing. By consenting to telehealth services, I acknowledge:
I have the right to withdraw consent at any time without affecting my right to future treatment.
Telehealth involves potential risks, including internet instability or unauthorized access despite reasonable security measures.
Emergency situations are inappropriate for telehealth; in such cases, I will contact 911 or crisis resources.
I will not record sessions without written permission.
HIPAA & Client Rights Notice
Data Breach Policy
In the event of a data breach involving client information, Malaer Mental Health Services, PLLC will notify affected clients in accordance with federal and state regulations. Clients will be informed of the nature of the breach, what information was compromised, and what steps can be taken to protect their information. If necessary, additional security measures will be implemented to prevent future incidents.
This practice follows HIPAA guidelines to protect your private health information (PHI). You have the right to:
Access and request copies of your medical records.
Request restrictions on the disclosure of your PHI.
File a complaint if you believe your privacy rights have been violated.
Notice of Privacy Practices
Malaer Mental Health Services, PLLC is committed to protecting your privacy and ensuring the confidentiality of your health information in accordance with the Health Insurance Portability and Accountability Act (HIPAA).
Use and Disclosure of Protected Health Information (PHI):
For Treatment: Your health information may be shared internally to coordinate and provide effective care.
For Payment: Your health information may be used to obtain payment for services provided.
For Healthcare Operations: Information may be used for quality assessment, compliance, and administrative purposes.
Your Rights Under HIPAA:
Right to Access Records: You have the right to inspect or obtain a copy of your records.
Right to Request Restrictions: You may request limits on how your information is disclosed.
Right to Confidential Communication: You can request that we communicate with you in a specific way (e.g., phone, email).
Right to Amend Records: You can request corrections to your medical record.
Right to File Complaints: If you believe your privacy rights have been violated, you may file a complaint with our office or the U.S. Department of Health and Human Services.
For further details or to obtain a copy of our full Notice of Privacy Practices, please contact our office.
Social Media & Online Reviews Policy
No Friend Requests: We do not accept friend or contact requests from current or former clients on any social media platform (e.g., Facebook, Instagram, LinkedIn, Twitter) to maintain professional boundaries.
No Direct Messaging: We do not engage in private messaging on social media. Any inquiries should be directed via phone or secure email.
Public Comments: If you comment on our social media posts, you do so at your own discretion and risk breaching your confidentiality. Therapists will not engage in therapeutic discussions on public forums.
Online Reviews: While clients are free to leave reviews on third-party sites, therapists cannot solicit or encourage reviews due to ethical considerations.
By posting a review online, you waive your right to full confidentiality and grant permission for the therapist to respond if necessary.
While we will not disclose private health information, we may address any misleading or inaccurate statements to provide clarification.
If a review includes information that suggests an immediate risk to the client or others, we reserve the right to take appropriate safety measures.
We strongly encourage clients to bring concerns directly to our practice rather than posting online to preserve confidentiality and resolve any issues professionally.
Termination of Services
Clients may terminate services at any time and are encouraged to participate in a final termination session to review progress and discuss aftercare options.
Three consecutive no-shows or ongoing non-compliance with treatment recommendations may result in termination of services.
The therapist reserves the right to terminate services if:
The client engages in behavior that is disruptive, threatening, or inappropriate.
The client is non-compliant with payment agreements.
The therapist determines that the client requires a higher level of care.
The provider waives the right to terminate services without due process, meaning termination will be discussed in advance whenever possible, and referrals will be provided as needed.