Welcome to Healing Powers of Therapy, PLLC! I am so glad you are here. This document contains important information about my professional services and business policies. WAC 246- 809-710 requires the disclosure of the following information in written form by counselors to their clients. When you sign this document, it will represent an agreement between us. If you have any questions, please let me know and I am happy to answer them.

 

I have partnered with Mindful Therapy Group for administrative services. If you have questions about scheduling, billing, or technology issues, please contact: frontdesk@mindfulsupportservices.com | (425) 640-7009 7am-7pm Monday-Friday; 8am-4pm Saturday-Sunday.

 

I am an independently contracted provider participating in the Mindful Therapy Group Organized Health Care Arrangement (OHCA). While I have engaged Mindful Therapy Group, P.C., a Washington Professional Services Corporation (Mindful Therapy Group), to provide business administrative services to my behavioral healthcare business, all services you receive from me reflect my own health care license, independent business, and practice style. Mindful Therapy Group subcontracts with an affiliate company, Mindful Support Services, LLC (Mindful Support Services), to provide a portion of the administrative services.

 

My Licenses, Education and Training

 

I hold licenses in Washington state and in Alaska. My Washington State Department of Health Independent Clinical Social Work (LICSW) license number is LW61498290. My Alaska Board of Social Work Examiners Independent Clinical Social Work (LCSW) license number is 233677. My National Provider Identification is 1306577523. I have a Master of Social Work (MSW) degree from University of Washington (2022), a Doctorate of Philosophy (Ph.D.) in Higher Education Leadership from Old Dominion University (2012), a Master of Arts degree in International Relations from University of Oklahoma (2007), as well as a Bachelor of Arts degree in Military History (with minors in Leadership and Women’s Studies) from Virginia Tech (2004). I am also a member of the National Association of Social Workers and the American Counseling Association.

 

I am a veteran and I have worked with veterans. Post-military, I have worked in academia, social services, mental health, and counseling fields for 15 years. During this time, I have been in administrative, professor, facilitator, case manager, and counselor roles for individuals with post-traumatic stress disorder, traumatic brain injury, military sexual trauma, complex trauma, eating disorders, depression, anxiety, transitional issues, and more. I have worked in community, academic, emergency, and outpatient treatment settings. In addition to this professional experience, I participate in continuing education as part of my ongoing professional development.

 

As a professional social worker, I am committed to upholding the values, principles, and ethical standards outlined in the NASW Code of Ethics. This code guides my professional conduct and decision-making in all situations. My primary responsibility is to promote the well-being of clients, and I am committed to treating everyone with dignity and respect, while maintaining professional boundaries.

 

Additional information about my licensure is available at the WA State DOH Provider Credential Search site.

 

Patient Mix

 

I provide counseling for individuals ages 18-100 with a wide range of emotional and behavioral health issues, including PTSD, TBIs, MST, depression, anxiety, transitional issues, adjustment issues and more. I do not offer case management services, which includes but is not limited to providing paperwork for disability, unemployment, custody, adoption, foster care, car accidents and any type of legal issues. I do not offer therapy for individuals who are court mandated for treatment or seeking treatment in which disclosure of appointments will need to be provided to an outside entity.

 

Treatment Modality and Therapeutic Orientation

 

The way I help you heal from the issues you are facing is through person-centered and integrated evidence-based practices. Along with these therapeutic approaches, I provide a client-centered space for you to share your struggles with empathy and without judgment or agenda. Together, we can start to recognize how other people and events in your environment and culture affect these issues, the way you are coping with these issues, and the way you think about these issues.

 

Person-centered counseling is a treatment approach that emphasizes the importance of empathy, unconditional positive regard for others, and congruence in the therapeutic relationship. Through these therapeutic aspects, a therapeutic relationship can become stronger and more powerful and ultimately help you achieve your goals and effect change. Person- centered therapy comes from the humanistic psychology movement, which places clients at the center of treatment and views clients as experts in their own lives.

 

Benefits and Risks

 

Naturally, therapy might feel uncomfortable. You may choose to discuss issues that are uncomfortable to visit or try new strategies and coping skills that are different from what you have been implementing. New ways of managing your life can feel scary and out of your comfort zone. However, if you are not happy with how your life currently is, then trying new coping skills, gaining insights through therapy, and changing certain aspects of your life and your behavior may have benefits. There are no guarantees that counseling will work for you, but keep in mind that progress often happens slowly and is not linear. With that said, the intention of my therapeutic methods is to improve your well-being. Through counseling, we can develop new coping skills, make behavioral changes, reduce symptoms of behavioral health disorders, improve the quality of your life, learn how to manage difficult emotions, learn to live in the present, and many more benefits. Together, we can maximize those benefits of therapy and apply those benefits to your life. Although, if you are experiencing physical pain or discomfort, I recommend you see a medical provider. Therapy sessions are not a replacement for medical treatment.

 

New Patients

 

You have taken an incredibly positive step by deciding to seek therapy. Therapy can help transform your life and the way you navigate the world. The outcome of therapy often depends on your willingness to engage in this process, despite the discomfort that may occur when strong emotions arise. My goal is for your individual counseling experience to be a rewarding and compassionate experience. It will be an interactive process that improves the quality of your life, helps you attain your counseling goals, and increases your sense of well-being. To maximize the benefits of therapy and achieve your counseling goals, I suggest that clients schedule to see me consistently and weekly, although sometimes sessions will be more or less frequent as needed.

 

Although I wish I could guarantee a quick and easy fix to your problems, I cannot. What I can guarantee is that I will support you, advocate for your needs, and do my best to understand you and your world. I can also help you clarify what you want for yourself as you work toward your desired changes.

 

The goals of therapy are personalized to you. Oftentimes, goals are long-term, such as improving the quality of your life and increasing your sense of well-being. Other times, goals are short-term, such as reducing anxiety and depression symptoms, developing healthy relationships, or changing other behaviors. No matter what your counseling goals are, we can develop them and strategize how to work towards them together. I might make suggestions about how to reach your goals, but you ultimately decide your course of action.

 

Firstly, therapy begins with an intake assessment and evaluation. It is my practice to conduct an assessment that typically lasts for the first 4-5 sessions. Appointments are 53 minutes. This assessment allows me to gain a detailed, thorough understanding of the issues that brought you into therapy, important aspects of your mental health, family and relationships, life history, and other factors that influence you and why you are seeking counseling. The assessment also provides time for you to decide if I am a good fit for you and for me to determine whether I am the best provider to meet your needs. At the end of your assessment, should you decide that you would like to continue working with me, we will collaborate to define your goals for therapy, and I will establish a treatment plan detailing how we will achieve your goals.

 

Secondly, therapy will involve a commitment of time, energy, and money, so it is your right to be thoughtful about the therapist who you select. If you have questions about any of the interventions that I recommend, feel free to discuss these openly with me. Be aware that you have the right to refuse treatment and the right to choose a provider and treatment modality that best suits your needs. I will be happy to help you find another mental health provider should you want this.

 

Thirdly, termination of therapy will ideally occur when both you and I agree that you have met your goals for therapy. Termination may also occur, after appropriate discussion, if either you or I believe that progress is not being made, or if therapy is not being used effectively. Termination and referral to another provider may be made if you or I believe that you need a higher level of care or a more specialized type of treatment than what I can provide. I will not terminate the therapeutic relationship without first attempting to discuss and explore with you the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, I can provide you with a list of qualified therapists to treat you. You may also choose someone on your own or from another referral source.

 

Cancelling Appointments

 

In order to provide you with optimal care, your appointment time is reserved specifically for you. I do not double book clients. In return, I ask that you provide our front office with a minimum of 24 hours notice if you are unable to make it to your appointment. Please call our front office staff for all scheduling needs at (425)-640-7009 to ensure prompt attention.

 

I work with all my clients on a reoccurring, weekly basis. If you cancel several appointments, I will ask that you be removed from your recurring appointment slot and be placed on my on-call list, as repeated cancellations present a barrier to the therapeutic process. If you are on the on-call list, I will reach out to you as appointments become available. If you have repeated no-show appointments, upcoming scheduled appointments may be cancelled.

 

Requests for Consultation

 

If you need a consultation outside of a scheduled appointment, please direct your request to me via the email or phone number listed. Mindful Therapy Group administrative staff are not clinically trained and are unable to respond to requests for consultation.

 

In general, my office hours are Monday, Tuesday, and Wednesday from 3pm to 6pm. I may not be able to respond to requests for consultation outside of these hours.

 

Emergencies

 

If you need to contact me between sessions, please call or text (206) 337-8090, email info@healingpowersoftherapy.com, or message me via your AdvancedMD web portal. I will return calls, texts, and messages within 48 business hours. In general, my office hours are Monday, Tuesday, and Wednesday from 3pm to 6pm. I may not be able to respond to requests for consultation outside of these hours. I may not be able to respond to requests for consultation outside of these hours. Please note, however, that face-to- face sessions are often the most appropriate place for in-depth conversations, and I may encourage that we resume our conversation during our next scheduled session.

 

I am not available on an emergency basis. If you are experiencing an emergency or are concerned you may be a threat to yourself or others, please dial 911, 988 (an emergency line specific to suicide and mental health crises) or go to the nearest hospital emergency room. Because I am not immediately available between sessions, I encourage you to contact the following crisis lines in the event of a mental or behavioral health crisis:

 

King County 24-Hour Crisis Line: 1-866-4CRISIS

National Suicide Prevention Lifeline: 800-273-8255

Crisis Text Line: Text HOME to 741-741

 

Contact for Administrative/Scheduling Questions

 

If you have questions about scheduling, billing or technology, please contact Mindful Therapy Group at:
 

frontdesk.wa@mindfulsupportservices.com
scheduling.wa@mindfulsupportservices.com

425-640-7009

7:00am-7:30pm Monday-Friday
8:00am-4:00pm Saturday-Sunday

 

Rescheduling Appointments

 

Mindful Therapy Group and/or I will make every effort to provide you with adequate notice if I will be unavailable for a scheduled appointment.

 

If you need to reschedule an appointment, the rescheduling request should be made with Mindful Therapy Group, not me. If you need to reschedule an appointment, I ask that you give Mindful Therapy Group at least 24 hours’ notice in advance of the originally scheduled appointment. Rescheduling requests made without 24 hours advance notice will incur late cancellation fees (see Financial Responsibility section below).

 

Confidentiality

 

All information disclosed within appointments is confidential. I keep brief notes of our appointments but such notes and other information related to these appointments will not be disclosed to anyone except as permitted or required by law.

 

Notice of Privacy Practices

 

The Mindful Therapy Group Organized Health Care Arrangement Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. An electronic copy of the Notice of Privacy Practices can be found here.

Session content, medical records, and all relevant materials to your treatment will be held confidential by me, apart from a few exceptions. These exceptions include:

1.If you sign a release of information to have your session content released to a specific named person/people.

2.For the purpose of coordinating care, referrals, and/or crisis response between me and a qualified provider responsible for your care.

3.If the client is under 13 years of age, their parents have a right to their mental health treatment information.

4.If I assess that you pose imminent threat to your own health or safety, such as threatening suicide or behaving in a manner in which there is a substantial risk of incurring serious harm.

5.If you threaten or pose the risk of grave bodily harm or death to another person.

6.If I have reasonable suspicion that you or another named victim is the perpetrator, observer, or actual victim of physical, emotional, or sexual abuse of children under the age of 18 years.

7.Suspicions, as stated above, in the case of a vulnerable adult who may be subject to these abuses.

8.Suspected neglect of children or vulnerable adults.

9.If a court of law issues a legitimate subpoena for information stated on the subpoena.

10.If you are in therapy or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney.

11.If I use clerical assistants or billers who process your information and paperwork (Mindful Therapy Group processes your information for billing).

 

Due to the importance of your confidentiality and the issue of dual relationships, I do not accept friend or contact requests from current or former clients on any social networking site. Although I appreciate therapeutic relationships, adding clients as friends or contacts can compromise our respective privacy and blur the boundaries of our therapeutic relationship. If you have questions or concerns, please feel free to bring them up when we meet.

As we will use electronic communication to exchange information, please know that I use Google Suite, a HIPAA-secure email platform with a Business Associate’s Agreement. I also use a phone.com plan that is HIPAA compliant under a Business Associate's Agreement. I also use AdvancedMD, a HIPAA-compliant electronic health record system, through Mindful Therapy Group. You have a right to request a copy of your medical records at any time, which should be provided within 15 working days of receiving the request (RCW 70.02.080).

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Your Rights

 

You have the right to refuse treatment and the right to choose a practitioner and treatment modality that best suits your needs. At the same time, if I feel your needs will be best met by another provider, I will make the appropriate referrals for you to receive better care elsewhere.

 

You also have a right to direct any complaints or concerns to the Department of Health. Additionally, you have the right to obtain a list or copy of acts of unprofessional conduct listed under RCW 18.130.180. The Department of Health may be contacted at:

 

Health Systems Quality Assurance Complaint Intake

(360) 236-4700

HSQAComplaintIntake@doh.wa.gov

P.O. Box 47857

Olympia, WA 98504-7857

 

You have the following rights:

 

• To refuse treatment;

• To choose a practitioner and treatment modality which best suits your needs;

• To expect that I have met the qualifications of training and experience required by state law;

• To examine public records maintained by the state authority that licenses me and to have such authority confirm my credentials;

• To obtain a copy of the code of ethics to which I am bound;

• To report complaints to the state authorities that license me (Washington State Department of Health - Town Center 2, 111 Israel Rd. S.E., Tumwater, WA 9850)

• To be informed of the cost of my services before receiving the services;

• To be assured of privacy and confidentiality while receiving services from me (note - the law sometimes permits or requires disclosures of private/confidential information); and

• To be free from free from discrimination because of age, color, culture, disability, ethnicity, national origin, gender, race, religion, sexual orientation, marital status, or socioeconomic status.

 

PATIENT/PARENT/GUARDIAN ACKNOWLEDGMENT AND CONSENT TO MENTAL HEALTH TREATMENT

 

I (the patient or the patient’s parent legal guardian) have been provided a copy of my (or my child’s) provider’s disclosure statement. I have read and understand the information provided. I consent (or consent on my child’s behalf) to receive mental health services from the provider named in this Disclosure Statement.

 

TELEHEALTH CONSENT

 

Since my counseling services are telehealth-only, technology will be part of your counseling experience. Telehealth is the practice of delivering clinical health care services via technology-assisted media or other electronic means between a practitioner and a client who are located in two different locations. Telehealth, like counseling, comes with risks and benefits. Due to the nature of telehealth, there is always the possibility that unauthorized people may attempt to obtain your personal information. I will take every precaution to safeguard your information (e.g., HIPAA-compliant electronic communication, encrypted and HIPAA-compliant electronic health record, etc.) but cannot guarantee that unauthorized access to electronic communications will not occur. Please be advised to take precautions regarding authorized and unauthorized access to any technology used in counseling sessions. Be aware of any friends, family members, significant others, or coworkers who may have access to your computer, phone, or other technology used in your counseling sessions. You are responsible for choosing a location that is private for your telehealth counseling appointments, such as an unoccupied office or bedroom, empty parked car, or other unoccupied area. Furthermore, you are responsible for not driving or engaging in unsafe activity during your telehealth appointment. If you are unable to find a private location at the time of your appointment, or unable to refrain from engaging in unsafe activity during your appointment, I may need to cancel your session (resulting in a late-cancel fee).

 

While there are risks, telehealth has many benefits, including improved access to care, convenience of meeting from a location of your choice (within Washington State), and the absence of travel or commute time. We can further discuss the benefits and risks of telehealth which may be personalized to you. By signing this document, you consent to participating in telehealth services. Please feel free to bring up questions or concerns about telehealth.

• In utilizing Telehealth, I agree to participate in technology-based sessions with my Provider, and I authorize information related to my health to be electronically transmitted in the form of images and data through an interactive video connection to and from my Provider and other persons involved in my health care.

• I represent that I am using my own equipment to communicate and not equipment owned by another and am specifically not using my employer’s computer or network. I am aware that any information I enter into an employer’s computer can be considered by the courts to belong to my employer and my privacy may thus be compromised.

• I have read this document carefully and fully understand the benefits and risks. I have had the opportunity to ask any questions I have and have received satisfactory answers. With this knowledge, I voluntarily consent to participate in Telehealth sessions, including, but not limited to, care, treatment, and services deemed necessary and advisable, under the terms described herein.

 

ARTIFICIAL INTELLIGENCE

 

Artificial Intelligence (AI) tools may be integrated into your sessions to complement the therapeutic process. Your privacy and confidentiality while utilizing AI tools are of utmost importance. Any data inputted into AI tools will be securely stored according to HIPAA privacy guidelines.

 

I have read and understood the above information and consent to the utilization of AI to support the therapeutic process. I understand that my consent is voluntary, and I have the right to withdraw my consent at any time.

 

FINANCIAL RESPONSIBILITY

 

Insurance Fees

 

I am in-network with a select number of insurance companies for my services (listed here). Please provide full insurance information and your insurance card upon your initial visit (or before, if possible) so we can determine the benefits for which you are eligible. If you have a change in insurance, please let us know as soon as possible.

 

Your insurance plan may require me to assess you a copayment, coinsurance or deductible (“cost share”). Mental health appointments are assigned billing codes on claims that vary based on factors such as appointment length and complexity. As a result, your cost share may vary from visit to visit.

 

Any cost share is due at the time of service. Mindful Therapy Group staff and I will do our best to estimate your cost share in advance of or at the time of your appointment. However, it is possible that your insurance plan, after reviewing the claim, will determine that your cost share is higher than we estimated. In these situations, Mindful Therapy Group will notify you about any balance due with a monthly statement. In the event we overestimate the cost share, the credit will be applied towards your future visits, unless you specify otherwise.

 

If your insurance plan requires preauthorization for services, it is your responsibility to obtain this authorization prior to our appointment. If you fail to obtain authorization, any and all charges incurred for services rendered by me and not reimbursed to me or Mindful Therapy Group by your health insurance will be your financial responsibility.

 

Private Pay (Self-Pay) Fees

 

• $200 per 55-minute session for individuals

 

Case Management Time Fees

 

Most clinical issues should be shared in our appointment. If calls and case management become excessive, I may need to charge for case management time. I will always inform you prior to providing this service and prior to billing for it.
 

• $150 per hour.

 

Cancellation Fees

 

If you are unable to provide more than 24 hours’ notice, you will incur a missed appointment/late cancellation fee as follows:

 

• $100 for missing session

 

This charge is irrespective of the reason for the cancellation/no show. Insurance does NOT cover this fee and will automatically be charged to the credit card listed on file.

 

While I understand unexpected things sometimes pop up, if there is a pattern noticed of cancelled appointments, I may be unable to continue providing services to you, and I reserve the right to cancel future appointments in order to make room for clients committed to the therapeutic process. I will always communicate about this with you and determine if we’re a good fit prior to making changes to your scheduled appointments.

 

Washington Apple Health (Medicaid) Billing

 

In accordance with WAC 182-502-0160, if you are using Washington Apple Health (Medicaid) to cover services, I may not bill you for the following:

 

• Services covered under your Apple Health plan, even if I have not yet been paid.

• Services denied because of provider error (such as missing prior authorization or required documentation).

• Missed, canceled, or late appointments.

 

You may only be billed for services that Apple Health does not cover if you sign an “Agreement to Pay for Healthcare Services” before receiving those services. If Mindful Therapy Group is not contracted with your Apple Health plan, you may be responsible for fees and any cost-sharing as determined by your plan. For more details, please refer to your Apple Health plan documents or applicable Washington regulations.

 

Collections

 

If you have an unpaid patient balance of $100 for more than 120 days, the balance may be turned over to a third-party collections agency. You will receive a final courtesy phone call and/or letter to remind you of your balance due. If you believe that there is an error in your billing, please let us know as soon as possible so we can research the issue. Unpaid balances without a payment plan or partial payment initiated after 120 days will initiate a phone collections effort for recovery, and some identifying confidential information will be released in this process. This may negatively impact your credit. It is very important that you update your contact information with us to ensure you are aware of your financial responsibility and receive your statements.

 

Assignment of Benefits

 

In exchange for, and in connection with, any and all of the services provided to you or your child, as applicable, by your Provider, you irrevocably assign and transfer to Mindful Therapy Group and your Provider all of the rights, benefits, privileges, protections, claims and any other interests of any kind whatsoever, without limitation, that you or your child, as applicable, had, have or may have in the future pursuant to or in connection with any health insurance policy or plan, health benefit plan, health management agreement, healthcare risk-bearing agreement, healthcare trust, healthcare fund or any other source of payment, healthcare insurance, healthcare indemnity or health or medical coverage of any kind covering you or your child, as applicable to healthcare. This assignment also includes assignment of your or your child’s, as applicable, appeal rights, fiduciary rights, rights to sue, rights to payment, rights to full and fair claims review, rights to penalties or interest, rights to plan documents and plan information, and rights to notices and disclosures from any source.