Therapy Services & Confidentiality

GENERAL INFORMATION The therapeutic relationship is unique in that it is a highly personal and at the same time, a contractual agreement. Given this, it is important for us to reach a clear understanding about how our relationship will work and what each of us can expect. This consent will provide a clear framework for our work together. Feel free to discuss any of this with your therapist. Please read and indicate that you have reviewed this information and agree to it.

THE THERAPEUTIC PROCESS You have taken a very positive step by deciding to seek treatment. The outcome of your treatment depends largely on your willingness to engage in this process, which may, at times, result in considerable discomfort. Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. There are no miracle cures. We cannot promise that your behavior or circumstance will change. We can promise to support you and do our very best to understand you and repeating patterns, as well as to help you clarify what it is that you want for yourself.

CONFIDENTIALITY The session content and all relevant materials to the client’s treatment will be held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons. Limitations of such client held privilege of confidentiality exist and are as follows:

1. If a client threatens or attempts suicide or otherwise conducts themselves in a manner in which there is a substantial risk of incurring serious bodily harm.

2. If a client threatens grave bodily harm or death to another person.

3. If the therapist has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.

4. Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.

5. Suspected neglect of the parties named in items #3 and #4.

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

7. If a client is 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.

8. Occasionally, the therapist may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name.

9. If you and your therapist see each other accidentally outside of the therapy office, the therapist will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance, and Celeste Genevieve Counseling staff do not wish to jeopardize your privacy. However, if you acknowledge your therapist first, they will speak briefly with you, but not engage in any lengthy discussions in public or outside of the therapy office.

Cancellation Policy

Celeste Genevieve Counseling requires a minimum of 24 hours in advance of your scheduled appointment time if you need to cancel or reschedule. You will be responsible for the entire session fee ($180) if cancellation is less than 24 hours. Insurance DOES NOT cover late cancellation fees. To avoid this fee, please be sure to reach out to your therapist directly to cancel, prior to 24 hours from your planned session time.

Appointments & Billing Policies

APPOINTMENTS AND BILLING The standard meeting time for therapy is 53 minutes. It is up to you, however, to determine the length of time of your sessions. Requests to change the 53-minute session will need to be discussed with the therapist in order for time to be scheduled in advance.

Cancellations and re-scheduled sessions will be subject to a full fee charge if NOT RECEIVED AT LEAST 24 HOURS IN ADVANCE. Your credit card will be charged for this full amount. Insurance will not cover late cancel or no show fees. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late for a session, you may lose some of that session time.

Your therapist holds your session slot for the entire hour. Late arrivals that are 15 mins past the start of the session will be considered a self-pay session, as we are unable to bill insurance for the standard 53-min session.

SESSION FEES AND CHARGES

The standard fee for the initial assessment session is $200 and each subsequent session is $180, regardless of the session time. Coaching session fees vary per provider, between $180-$200/session and cannot be billed to insurance. As a courtesy and for the convenience of our clients, we do bill on your behalf to any insurance companies we are in-network with.

For insurance companies we are out of network with, you are required to pay for your services in full at the time of service, and we will issue you a superbill to submit to your insurance company. As an out of network provider, we do not have access to your benefit information, so you will need to contact your insurance company in order to understand the procedure and policy of out of submitting superbills/out of network benefits.

All clients are required to keep a credit card on file, which will be used to cover the costs of self-pay or financial hardship fees, copays, co-insurance, deductibles, late cancel charges or any fees that the insurance company indicates as a cost passed to you. Fees are due after each service. Additionally, you will be charged if any balance is due once insurance has processed your claims, as well as any late cancel/no show charges. We will charge the card on file after receiving explanation of benefits regarding your required portion of a balance submitted to insurance. Due to the untimely payments and information from insurance companies, you understand that charges to your credit card may be made on a date other than the actual date of service and is based on insurance reimbursement. You will be responsible for whatever the insurance company indicates as your responsibility for all appointments held. If there are any any inconsistencies with benefit information, you will be required to contact your insurance company for more information.

OUTSTANDING BALANCES ON YOUR ACCOUNT

Any accounts with balances will be charged to the credit card on file. Any client who: (1.) Has a current balance over 30 days for any reason (ie: expired credit card), AND/OR (2.) Has a balance in excess of $250, AND/OR (3.) Has a late cancel charge from the previous session; then our administrative team will notify you and your therapist of this situation(s), and will pause your sessions until your balance is paid in full. You will have access to pay your balance anytime through your PracticeQ client portal.

OTHER PROFESSIONAL FEES

In addition to weekly appointments, it is our practice to charge for other professional services that you may require, such as report writing, telephone conversations that last longer than 15 minutes, attendance at meetings or consultations which you have requested, or the time required to perform any other service which you may request of me, such as appearing in court. If you anticipate becoming involved in a court case, we recommend discussing this fully with your therapist before you waive your right to confidentiality. If your case requires your therapist’s participation, you will be expected to pay for the professional time required even if another party compels the therapist to testify. These services will be charged on at an hourly rate of $180/hr, prorated as such. Please note, insurance cannot be billed for these services. If you or another provider on your behalf (including attorneys) request your records, an administrative fee in the amount of $25 will be required to release your records.

INSURANCE

In order for us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. Celeste Genevieve Counseling clinicians are currently in-network with BCBSIL PPO, Blue Choice, Blue Options, and BCBS HMO through Edward, Elmhurst, NorthShore, and Swedish Covenant. We also partner with programs such as R3c with Deloitte Staff and DePaul University Athletics. Please be sure that you have confirmed with your insurance company that Celeste Genevieve Counseling is a part of your plan’s network. If you should change insurance at any time while you are a client at Celeste Genevieve Counseling, it is your responsibility to contact our billing staff at 630.519.1242 or hello@celestegenevieve.com to confirm we accept your insurance. If we do not have current insurance information on file for you, then you will be charged the out of pocket rates.

We will collect the required co-pay per session on the day of your session, and we will bill services on your behalf. If you have a required deductible to meet, full payment (please ask for the current negotiated fee with the insurance company, as this is the rate you will need to pay for each session) is required for each session, until the deductible is met. We do not charge co-insurance and/or deductible amounts until we receive this information from your insurance company, called an Electronic Remittance Advice (ERA). The ERA breaks down what is the responsibility of the insurance company and what is the responsibility of the client. We do not charge anything above the negotiated rates that the insurance companies have set for therapeutic services. It is the responsibility of the client to contact the insurance company to inquire about deductibles and copayments/ coinsurance responsibilities that are required for your specific policy. If you are or plan to see your therapist via telehealth, please contact your insurance company directly to inquire about your coverage for telehealth. Some companies or certain plans within the companies began changing their coverage on telehealth sessions beginning in 2023. Some of the potential changes we have heard have/may happen includes: (i) telehealth will no longer be covered, (ii) telehealth sessions will cost you more out of pocket, (iii) no changes occur to telehealth coverage. You will be responsible for contacting your insurance company and knowing your plan’s fee structure after the initial benefits check. You will be responsible for any fees that are incurred from seeing your therapist and are indicated by the insurance company as the client’s responsibility, including deductibles, copays, out of network costs and/or any fees incurred as a result of change or lapse of coverage.

In order to bill your insurance company, we must provide BCBS with your session dates, diagnostic codes and potentially treatment goals/notes, if requested.

Celeste Genevieve Counseling is currently an “Out of Network” provider with all other insurance companies, which means you are responsible for paying the self-pay rate at the time of service. As a convenience to you and at your request, if you are currently a member of another insurance group, our office staff will provide you with a service encounter form, or “superbill,” for you to provide to your insurance provider for reimbursement. It is the client’s responsibility to check into these benefits. Please note that not all insurance companies reimburse for out-of-network providers. If you prefer to see a provider who is network, your therapist will provide referrals to a clinician who is in-network.

THERAPIST ACCESSIBILITY

If you need to contact your therapist between sessions, or if you need to cancel/reschedule your session, you have 3 different options to reach them. Please note-if you attempt to reach out to your therapist and are experiencing a life threatening emergency, please do not rely on voicemail, emails and/or secure messaging as your sole support. Therapists are often not immediately available, so we encourage you to reach out to additional supports, contact 988, 911 and/or visit your nearest behavioral health emergency facility.

1. PracticeQ offers Secure Messaging through the client portal. Again, please allow them up to 48 business hours to respond (refer to their individual office hours). THIS IS THE PREFERRED METHOD OF COMMUNICATION

2. You may call our main number, 630.519.1242, and choose the dial by name directory in order for you to locate your therapist’s extension number. Please leave them a voicemail with your call back info if you do not reach them. They will attempt to return your call within 48 business hours (refer to their individual office hours).

2. Email them using their Celeste Genevieve email address. If you prefer this method of communication, please inquire to your therapist about their email address, if you have not already received this. Please allow them up to 48 business hours to respond (refer to their individual office hours). Please be aware that although we do utilize encrypted email service, communicating via email always includes the risk of security issues.

RISKS TO BE AWARE OF

Face- to-face sessions are highly preferable to Telehealth and phone sessions. However, in the event that you are out of town (you MUST BE located in the state in which your therapist holds a current, valid license to practice), you are sick, or need additional support, phone or telehealth sessions are available. If a true emergency situation arises, please call 911, 988, or visit any local emergency room immediately for support, and request that our office be notified.

In addition, please be aware that sometimes emotions, thoughts and other experiences may feel more intense while going through therapy, especially in the beginning. It is natural for these to increase when you allow yourself to process through challenging experiences.

SOCIAL MEDIA AND TELECOMMUNICATION

Due to the importance of your confidentiality and the importance of minimizing dual relationships, our staff does not accept friend or contact requests from current or former clients on any social networking site (e.g., Facebook, LinkedIn, etc.). We believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of the therapeutic relationship. If you have questions about this, please bring them up with your therapist when you meet and you can discuss it in further detail.

ELECTRONIC COMMUNICATION

You may choose to email your clinician in order to communicate. Please note that unless emails are being exchanged via an encrypted email platform, we are unable to confidently guarantee what happens to your information via transmission of emails. If you choose to email any personal information with your therapist, you acknowledge that this is a risk.

We cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or messaging for issues regarding scheduling or cancellations, your therapist may agree to do so. While they may try to return messages in a timely manner, an immediate response is not guaranteed. Further, these methods of communication should not be used to discuss therapeutic content and/or request assistance for emergencies. The most secure ways of reaching would be to call our office phone number and choose the appropriate extension, or you can send a message through the PracticeQ messaging system. Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail are considered telemedicine. Telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another. If you and your therapist chose to use information technology for some or all of your treatment, you need to understand that: (1) You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled. (2) All existing confidentiality protections are equally applicable. (3) Your access to all medical information transmitted during a telemedicine consultation is guaranteed and copies of this information are available for a reasonable fee. (4) Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent. (5) There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to: improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel costs. Effective therapy is often facilitated when the therapist gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third person consultations, but also from direct visual and olfactory observations, information, and experiences. When using information technology in therapy services, potential risks include, but are not limited to the therapist’s inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: your physical condition including deformities, apparent height and weight, body type, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression. Potential consequences thus include the therapist not being aware of what he or she would consider important information, that you may not recognize as significant to present verbally the therapist.

MINORS If you are a minor, your parent/guardian(s) may be legally entitled to some information about your therapy. Your therapist will discuss with you and your parent/guardian(s) what information is appropriate for them to receive and which issues are more appropriately kept confidential. Clients who are aged 12 and older do have the right to decline or consent to treatment without the consent of their parent/guardian(s).

TERMINATION OF RELATIONSHIP Should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, we must consider the professional relationship discontinued, and your file will automatically be closed. At this point, you will no longer be considered an active client of the practice, and your account will be closed.S HMO through the Network Endeavor Health. This network includes reputable providers such as Illinois Health Partners, Edward, Elmhurst, NorthShore, and Swedish.