Treating the whole person, mind, soul, and family
What happens during therapy?
Therapy may be different depending on the goals for therapy and the needs of the person. Typically speaking, we will discuss the things that are currently happening in your life, things that happened in the past that are relevant to your issue, and review the gains we’ve had from the previous session. Ultimately, I want to help you bring what you’ve discovered or learnt during therapy back into your daily life.
Do I need therapy?
Everyone goes through difficult challenges in life. While you may have been able to cope with the challenges you’ve encountered, it’s always a good idea to seek extra support when you need it. In fact, when you realize you need a helping hand, you’re taking responsibility admirably by facing the challenges you encounter in life. Therapy will give you long - term benefits and the tools you need to overcome whatever difficulties you encounter.
Will our conversations remain confidential?
Confidentiality is a key component of therapy. What you discuss in a session will not be shared with anyone else. By law, your therapist can’t release this information without your written consent, except in the following situations:
-The therapist suspects there is past or present abuse or neglect of children, adults or elders.
-The therapist suspects the client is in danger of harming themselves or has threated to harm another person.
How can therapy help me?
There are many benefits in participating in therapy. Therapists can provide support and help you find relief for issues such as trauma, depression, anxiety, grief, stress, and relationship problems. Counseling is extremely valuable in managing personal growth, relationships, and the many challenges faced in daily life. By applying therapy techniques, therapists can provide different perspectives on complicated problems or even guide you to a solution.
Medication v. Therapy
Medication cannot solve your mental and emotional problems alone. Therapy is needed in order to address the source of your distress and behavior patterns. Check with your medical doctor and see what’s the best treatment for you.
Can I contact you outside of normal business hours? What if there is an emergency?
We are available 24 hours a day for emergency through our answering service and by pager. However, please speak with your provider regarding their personal policies and preferences regarding direct availability and scheduling. Appointments are available as soon as all necessary intake procedures are completed. Please note that there may be a waiting list.
DISCLAIMER: In case of any emergency, please dial 911 and/or go to the nearest emergency room.***
What if I know someone in a crisis?
If you are thinking about harming yourself, or know someone who is, tell someone who can help immediately.
1. Call your doctor.
2. Call 911 or go to a hospital emergency room.
3. Ask a friend or family member for assistance.
4. Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1.800.273.TALK (1.800.273.8255); TTY: 1.800.799.4TTY (4889) to talk to a trained counselor.
5. Make sure you or the suicidal person is not left alone.
How can I get my prescription refilled?
Please call the office or contact your pharmacy to send us a prescription fax. All prescriptions are handled within 24 hours except on weekends.
For stimulants and controlled substances:
These cannot be called in or faxed. please call the office to pick up a prescription. In special circumstances, a prescription may be mailed to special patients under specific circumstances.
Prescriptions can be picked up during business hours and must be original scripts.
What is your cancellation policy?
A 48 hour notice of cancellation is required, except in cases of extreme emergency to be determined by our staff. Cancellations without sufficient notice (24 hour) will be subject to a cancellation fee, which may be equal to your fee of service. All fees must be paid in full prior to your next appointment and co-payments are due at the time of service.
If you are running late or anticipate a delay of more than 15 minutes, please contact our office immediately. Delays of more than 30 minutes are considered a ‘no-show’ and will be accommodated or rescheduled based on availability.
Office Policies and Billing Information
Scheduling and Cancellations — Please note that psychotherapy sessions are typically 45-50 minutes long, and psychiatric medication management visits are typically 15-30 minutes long. New patient appointments/evaluations for both psychiatric/psychotherapy services are 1 hour. While our office does make every effort to assist patients with scheduling and appointment reminders, please keep in mind that the patient is ultimately responsible. Appointments not cancelled within 24 hour notice in non-emergency circumstances will be subject to a $150 no show fee, which cannot be billed to the patient’s insurance company and will be the patient’s sole responsibility.
Payments – Payments for all services are required at the time of service. This includes insurance co-pays, debuctibles, no show fees, and any additional patient balance responsibility not covered by your insurance policy.
Emergencies — In the event of a clinical emergency, patients may contact their provider via phone. If a provider is not available in case of emergency, please call your local crisis line, contact your primary care physician, your local health department, or proceed to your local emergency room. Call 911 in immediate matters of personal safety. We do have an answering service available when the office is closed. Non-emergency patient requests/communication are typically handled via email or our office staff; please speak to your provider regarding communication preferences.
Prescriptions – If your treatment plan includes psychotropic medication, we request that all patients speak to their psychiatrist regarding their upcoming prescription needs in person during your appointment, and be sure that they have the necessary prescriptions to last them until their next scheduled appointment. In the event that you need an additional copy of your script or a refill prescription in between appointments, there is a $15 refill charge, as your request requires office personnel to process. To avoid this charge, make sure you receive enough refills when you see your doctor. The $15 fee also applies to controlled substance prescriptions that have to be re-written. Also, if the patient has not been seen by an Elemental Center provider within the past three months, we will be unable to process your prescription refill request until the patient is seen in office for an appointment.
Confidentiality – We are committed to making this a safe place for you to get help. To that end, we adhere to all legal protections of your confidentiality. Limitations include staff consultation, life-threatening behavior, child abuse, elder abuse, and judge’s orders to release information.
Authorizations – Patients seeking services at the Elemental Center authorize the following:
1.I authorize the release of information to my insurance company(s).
2. I authorize direct payment to my service provider.
3. I understand that it is my responsibility to pay any deductible, co-insurance amount or any other balance not paid by my insurance, for services provided. This payment is expected no later than 30 days after receipt of billing information from this office.
4. I understand that it is my responsibility to pay any co-pay the day and time services are provided.
5. I understand that there will be a service charge on all returned checks.
6. I understand that if my account is sent to collection a collection fee of 33% will be added to thetotal owed when sent to collection. All attorney fees and court costs incurred by the creditor will be the responsibility of the debtor.
Electronic and Social Media Policies and Consent
We the staff of the Elemental Center acknowledge the importance and value of the use of social and electronic media to supplement and enhance mental health treatment. For our patients’ benefit, we have developed the Elemental Center website (found at www.elementalcenter.com) to provide helpful information regarding our office, providers, intake and payment procedures, as well as psychoeducational articles and videos regarding common mental health conditions and questions. Additionally, the Elemental Center is now on both Facebook and Twitter, where patients can get up to date information regarding office closings, new services and providers, and basic mental health information as requested. However, please note that providers and office staff of the Elemental Center are not able to interact with patient via their personal webpages, blogs, Facebook, or Twitter accounts due to confidentiality clauses and professional boundaries.
Additionally, social and electronic media is a useful tool to communicate with your provider regarding treatment questions, emotional/behavioral updates, and medication concerns. In some cases, when appropriate, face to face treatment can now be conducted through telepsychiatry electronic mediums such as Skype, allowing face to face interaction between patient and provider when circumstances make an office visit difficult.
We here at the Elemental Center hold your privacy and confidentiality in highest regards, and thus hold true to all legal and ethical principles of confidentiality while utilizing social and electronic media. However, we do recognize that the nature of internet based communications may carry some degree of risk in terms of third party interception of communication, and ask that our patients remain aware of this potential when making the decision to communicate electronically. Also, please note that all communications via social and electronic media are subject to become part of the patient’s clinical record, at the discretion of the provider
Disclosure of Medical Information
Effective April 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
Your health record contains personal information about you and your health. This information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how I may use and disclose your PHI in accordance with applicable law and Code of Ethics. It also describes your rights regarding how you may gain access to and control your PHI.
Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), I am required to maintain the privacy of PHI and to provide you with notice of my legal duties and privacy practices with respect to PHI. I am required to abide by the terms of this Notice of Privacy Practices. I reserve the right to change the terms of this Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that I maintain at that time. I will provide you with a copy of the revised Notice of Privacy Practices by sending a copy to you in the mail upon request or providing one to you at your next appointment.
HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
For Treatment: Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with clinical supervisors or other treatment team members. I may disclose PHI to any other consultant only with your authorization.
For Payment: I may use and disclose PHI so that I can receive payment for the treatment services provided to you. This will only be done with your authorization. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processingclaims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services, will only disclose the minimum amount of PHI necessary for purposes of collection.
For Health Care Operations: I may use or disclose, as needed, your PHI in order to support my business activities including, but not limited to, quality assessment activities, licensing and conducting or arranging for other business activities. For example, I may share your PHI with third parties that perform various business activities (e.g., billing or typing services) provided I have a written contract with the business that requires it to safeguard, the privacy of your PHI. For training or teaching purposes PHI will be disclosed only with your authorization. I may use PHI to contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services.
Required by Law: Under the law, I must make disclosures of your PHI to you upon your request. In addition, I must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining my compliance with the requirements of the Privacy Rule. Without Authorization. Applicable law and ethical standards permit me to disclose information about you without your authorization only in a limited number of other situations. The types of uses and disclosures that may be made without your authorization are those that are:
• Required by Law, such as the mandatory reporting of child abuse or neglect or elder abuse, or mandatory government agency audits or investigations (such as the social work licensing board or the health department)
• Required by Court Order
• Necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
With Authorization: Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked.
YOUR RIGHTS REGARDING YOUR PHI
You have the following rights regarding PHI I maintain about you. To exercise any of these rights, please submityour request in writing to me at 15010 S Ravinia, Suite 15, Orland Park, IL 60462.
• Right of Access to Inspect and Copy. You have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that may be used to make decisions about your care. Your right toinspect and copy PHI will be restricted only in those situations where there is compelling evidence that
access would cause serious harm to you. I may charge a reasonable, cost-based fee for copies.
• Right to Amend. If you feel that the PHI I have about you is incorrect or incomplete, you may ask me to
amend the information although I am not required to agree to the amendment.
• Right to an Accounting of Disclosures. You have the right to request an accounting of certain of the
disclosures that I make of your PHI. I may charge you a reasonable fee if you request more than one
accounting in any 12-month period.
• Right to Request Restrictions. You have the right to request a restriction or limitation on the use or
disclosure of your PHI for treatment, payment, or health care operations. I am not required to agree to
• Right to Request Confidential Communication. You have the right to request that I communicate with
you about medical matters in a certain way or at a certain location.
• Right to a Copy of this Notice. You have the right to a copy of this notice.
If you believe I have violated your privacy rights, you have the right to file a complaint in writing with me at 15010 S Ravinia, Suite 15, Orland Park, IL 60462
Who should I call regarding questions about my bill?
Please call the number on your bill or call the office during normal business hours (Monday thru Friday, 11am to 7pm). We will respond to all messages.