OFFICE POLICY STATEMENT
Welcome to TMS Psychological Services, P.C., the office of Dr. Theresa M. Schultz & Associates.
This document contains important information about our office’s professional services and business policies. Please read it carefully and write down any questions have. Our Office Staff will be happy to address any of your questions via phone or at your next appointment. When you sign this document, it will represent an agreement between you and TMS Psychological Services, P.C.
THERAPY:
Participation in therapy has the potential to yield many benefits including, but not limited to, gaining insight about oneself, learning effective management and coping strategies, improving interpersonal relationships and resolving the specific concerns that led you to seek therapy. In general terms, therapy is a relationship in which one person enlists the professional assistance of another for the purpose of bringing about changes in her or his own feelings, thoughts, attitudes, and/or behavior. The task of the Therapist, therefore, is to help their client bring about the changes s/he wishes to make.
Attempting to resolve the concerns that led you to therapy in the first place may also yield results that were not originally expected. This is so because the therapeutic process is also a learning process. That is, in addition to helping clients address self-identified concerns, the therapist also helps the client gain insight about emotions and behaviors, and aids with the development of specific adaptive skills and abilities. The achievement of treatment goals will sometimes be easy and swift, but more often it will require perseverance and patience, for it may take a significant amount of time before results are evident.
When entering therapy, it is important to know that the client’s effort is imperative to the success of the therapeutic process. Therapy requires the client’s active involvement, honesty, and openness. In cases where the client is a minor, parental/family participation is encouraged. Parental/ familial involvement can often enhance the therapeutic process by offering a shared understanding of the client’s needs and providing a network of support. Since therapy is a relationship, your/your child’s Therapist will welcome your feedback about treatment at all times.
It is also important to acknowledge that during the initial consultation and ongoing therapeutic work, remembering or talking about unpleasant events, feelings, or thoughts can result in the client experiencing distress, including feelings of anger, sadness, worry, fear, or regret (e.g., through questions, comments, or direct confrontation in therapy sessions). This is because the therapist may challenge some of the client’s assumptions or perceptions and/or propose different ways of looking at, thinking about, or handling situations. Misunderstandings and frustrations are not uncommon; in fact, they are often a sign of change and growth via the therapeutic process. Thus, those who have had successful therapeutic experiences often report that the benefits of therapy in the long run far outweigh the challenges of the process.
Therapy sessions may vary in length, but typically last 30-45 minutes for children and 50 minutes for adolescents or adults. Out of regard for each client, a short break (5-10 minutes) is scheduled between sessions to permit a comfortable transition to/from the therapeutic work. We make every effort to start and end sessions promptly in order to fully use the time, so it is important that clients arrive on time as well.
Discussion of Intervention Plan:
As therapy begins, the therapist will develop a working understanding of the concern(s) at hand and, with the client, will develop an intervention (treatment) plan that includes specific objectives and anticipated outcomes. The therapist will answer any questions the client may have regarding the procedures used in the course of therapy or the therapist’s expertise in employing them. The client also has the right to ask about other interventions and their potential risks and benefits. If the client could benefit from any intervention that the therapist does not provide, the therapist has an ethical obligation to assist the client in obtaining those services.
Termination may occur for a variety of reasons. One reason is that therapeutic work has been successfully completed. Termination may also occur because of a therapist-client mismatch. For instance, a particular therapist may recommend termination when s/he believes s/he is not the best professional suited to address a client’s needs. Likewise, a point in therapy may be reached where the therapist believes that s/he is not effective in helping the client reach therapeutic goals. The client also has the right to seek other professional assistance (i.e., to terminate therapy) at any time. Under any of these circumstances, several things typically occur. First, a termination session is scheduled so that the client and therapist have the opportunity to review their work together, and to discuss the anticipated transition to follow. Second, the therapist will offer to provide names of other qualified professionals whose services might be preferred. Finally, at the client’s request and with written authorization, the therapist will communicate with these professionals to assist in the client’s transition to another therapist.
CONFIDENTIALITY:
It is our office policy to go to great lengths to protect the privacy of our clients. In general, all communications between a client and therapist are protected by law. A client’s information can only be released as the result of a written request or signed Consent to Release Information form. When the client is a minor, a parent or legal guardian must permit the release of information. Children 12 years of age and older must also provide written consent to release information. Please note that there are some conditions, by which the Therapist is required by Illinois law, to disclose information with or without permission. Some of those conditions are as follows:
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Suspicion that you are a danger to yourself or others.
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Suspected abuse of a child, elderly person, or disabled person.
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You are under age 16 and are the victim of a crime.
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You have filed suit against someone and have claimed mental/emotional damages as part of the suit.
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You waive your rights to privilege or give consent to limited disclosure by your therapist.
Please also be aware that your health insurance carrier, if they are paying for your services, has the right to access information about your/your child’s treatment. Sometimes, insurance companies request information related to treatment goals and progress, as a condition of certifying office visits and paying for psychological services. In such cases, the request for information is typically minimal and our office will comply with the insurance company’s request. If we perceive an insurance company’s request for information to be beyond what is typical, we will notify you of their request before releasing the information. (Please refer to the Illinois Notice of HIPAA Privacy Practices for further information).
Our offices administrative practices also reflect our strong respect for your privacy and confidentiality of your records.
Protective measures we employ include:
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Password protected voice-mail
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Password protected computer
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Up-to-date security software on our office computer
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All client records stored under lock and key
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Files securely kept in locked storage rooms
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Faxes and e-mails sent with confidentiality statement
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Faxes received are not accessible to anyone outside our office’s staff
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All disposable documents containing any personal information are shredded
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HIPAA compliant record keeping
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HIPAA approved billing procedures
Note: TMS Psychological Services, P.C., is located in Oak Park, Illinois, and serves a fairly wide geographic area in Chicago and the suburbs. Yet, it is not unusual for some of our clients to know one another and/or to know or come into contact with the professionals of our practice in the community. Consequently, you may see someone you know in our waiting room or you may encounter our Staff or one of the therapists outside the office. Please know that all our staff—administrative and clinical alike—honor your privacy, and will not acknowledge our professional relationship with anyone, without your express permission.
FEES:
We make every effort to keep our fees reasonable to ensure that our services are accessible to clients. Therefore, our current fees reflect the mid-range of fees typically charged within the profession for diagnostic, therapeutic, consultative, and related services. Please refer to the Attachment, Current Fees for Services for detailed information about fees.
CANCELLATION POLICY:
Since scheduling of an appointment involves the reservation of time specifically for you/your child, a minimum of 24 hours notice is required for rescheduling or canceling an appointment. If proper notice is not given for the rescheduling or cancellation of the first appointment (diagnostic session) the full fee will be charged. For other missed or cancelled appointments without 24 hours notice, a cancellation fee will be charged. Please be aware that insurance companies do not reimburse charges for missed or cancelled appointments. (See Current Fees for Services for further information).
PAYMENTS & BILLING:
We appreciate payment in full (of your co-payment or designated session fee) at the time of each visit. Please note that any amount due that is not paid by insurance is your financial responsibility. Your payment may be made by cash, check, VISA, MasterCard, or Discover. Credit card payments require a signed authorization and can be made in person or via phone. Cash and personal check payments are accepted in the office or by mail. For your convenience, a monthly billing statement reflecting receipt of payments and the current balance of your account will be mailed to you. If there is a financial agreement between parents and/or if you are involved in financial negotiations as the result of a separation or divorce, that is your private business. We are not responsible for maintaining financial arrangements made between parents, under any circumstances. In these and in all cases, we require that the responsible party or parties provide written authorization indicating full responsibility for payment. All billing will be sent to the person(s) authorized as responsible for this account. All account inquiries should be directed to the Office Manager.
Special Circumstances:
Please remember that is your responsibility to notify us if any problem arises regarding your ability to make timely payments. A payment plan will be considered at times of financial hardship. To inquire about arranging a payment plan, contact the Office Manager.
INSURANCE COVERAGE:
Our practice is part of the Blue Cross/Blue Shield (BC/BS) PPO Network. Our contract with BC/BS PPO usually ensures some payment for services rendered. However, as with all insurance coverage, payments are made by BC/BS with consideration of your contract deductible and co-payment responsibilities. As part of our contract with BC/BS PPO, we agree to accept payments based on the fees BC/BS determines as “allowable,” (this rate is sometimes referred to as “usual and customary”). The terms of our contract often reduce the financial responsibility of our clients. However, our agreement with BC/BS PPO rarely eliminates the client’s financial responsibility altogether. Due to the differences in coverage from plan to plan, we recommend that you call your insurance carrier to verify your deductible and co-payment responsibilities as well as the portion /percentage of our fees covered by your specific plan.
If you have a health insurance plan other than BC/BS, it is possible that our services will be covered at “out of network” rates or may not be covered at all. Once again, insurance benefits payable will depend on the terms of your insurance contract. Please call your insurance carrier to verify your deductible and co-payment responsibilities as well as the portion/percentage of our fees covered by your specific plan.
Further, some insurance companies require you to call them for “preauthorization/precertification”of services before your first visit. Neglecting this responsibility, when required, may result in a loss or reduction of benefits. Thus, we strongly advise you to contact a representative of your insurance carrier before your first appointment. Please call our office if, after your call to your insurance company, you need additional help understanding your coverage. We are happy to assist you in any way we can.
After you have verified your Mental Health/Behavioral Health benefits with your insurance provider, as a professional courtesy, we will submit your service claims directly to them. The client’s designated responsible party(ies) will be billed for and is obligated to pay any amount that insurance does not cover. Please note that is your responsibility to notify the Office Staff of any change with your insurance including but not limited to: change of insurance company, change in benefits and/or termination of an insurance plan. Finally, it is strongly recommended that, no matter what your insurance coverage, you keep written records of all contacts with your insurance company.
OFFICE HOURS & CONTACTING US:
Our office’s operating hours vary by season and the needs of our clients. We make every effort to accommodate our clients’ scheduling preferences.
Contacting Dr. Theresa M. Schultz, Licensed Clinical and Developmental Psychologist: Dr. Schultz can be reached at the office telephone number, extension #12. Dr. Schultz is often not immediately available by telephone, because she is working with clients. At such times, her calls may be answered by one of our Office Staff or by her confidential voice mail. If you do not reach Dr. Schultz directly, please leave a message and your call will be returned as soon as possible. It is helpful if you leave more than one contact phone number. For urgent matters, Dr. Schultz can be paged at: (708) 521-0816. When Dr. Schultz is out of the office for an extended period of time, one of her colleagues will be designated to accept her urgent calls. In such cases, the name and phone number of the colleague will be available by phone as part of Schultz’s voicemail greeting. See below for information regarding emergencies.
Contacting Erin Marek-Krawczyk, Psy.D., Therapist: Dr. Marek can be reached at the office telephone number, extension #13. If you do not reach Dr. Marek directly, please leave a message and your call will be returned as soon as possible. It is helpful if you leave more than one contact phone number. For urgent matters, Dr. Marek can be paged at: (708) 521-0864. When Dr. Marek is out of the office for an extended period of time, one of her colleagues will be designated to accept her urgent calls. In such cases, the name and phone number of the colleague will be available by phone as part of Dr. Marek’s voicemail greeting. See below for information regarding emergencies.
Contacting Daniel Kelly, Psy.D., Therapist: Dr. Kelly can be reached at the office telephone number, extension #11. If you do not reach Dr. Kelly directly, please leave a message and your call will be returned as soon as possible. When you leave a message, it is helpful if you leave more than one contact phone number. For urgent matters, Dr. Kelly can be paged at: (708) 521-0859. When Dr. Kelly is out of the office for an extended period of time, one of his colleagues will be designated to accept his urgent calls. In such cases, the name and phone number of the colleague will be available by phone as part of Dr. Kelly’s voicemail greeting. See below for information regarding emergencies.
Contacting Erica Drzonek, Office Manager & Clinical Intake Coordinator: Erica can be reached at the office telephone number, extension #10. Erica is generally in the office 2-3 days a week. At times that she is unavailable to answer your call, simply leave a detailed voice message and your call will be returned in a timely manner. Again, it is helpful if you indicate more than one phone where you can be reached as well as times that are good for you to accept the callback.
Contacting Jennifer Katele, and Helen Jonas, M.A., and Lucia Giuffre: Jennifer Katele is our office’s Administrative Assistant. Helen Jonas is our office’s Clinical Assistant. Lucia Giuffre is our office’s Project Manager. Calls and messages for Ms. Katele, Ms. Jonas, and Mrs. Giuffre can be directed to extension #10.
Emergencies: In cases of emergency when you are in need of immediate assistance, call 911, and/or go to your nearest hospital Emergency Room.
A Note about E-mail Communication: Due to the unsound security of the Internet, e-mail communication is discouraged. Email communication is initiated only if you request it, and is strictly limited to infrequent, general, informational contacts.
PROFESSIONAL RECORDS:
The state of Illinois law permits clients’ access to their treatment records, unless a case can be made indicate that allowing access would cause emotional damage or upset. When such a request is granted at TMS Psychological Services, P.C., the treating therapist will typically advise that the review of records take place in his/her presence. The therapist’s presence during the review of records is advantageous because s/he is immediately available to assist with interpretation, to answer questions, and to address concerns. As an alternative to a full record review, a summary can be provided. Likewise, with an authorized person’s written request and a client’s written permission, our office will forward treatment records or treatment summary information to another professional. All record requests should be submitted with sufficient notice (i.e., a minimum of two weeks) to ensure that the request is fulfilled within a reasonable time frame. In some cases, there will be a charge for time spent in preparing information requests.
Regarding the Professional Records of Minors: It is often pertinent that parents be involved in the process and informed about the progress of their minor children’s treatment. It is important for any minor client to acknowledge that the law may provide their parents the right to review their treatment records. If such a request is made, if possible, it will be discussed with the client first and the client’s concerns and/or objections will be considered. (Please refer to the Illinois Notice of HIPAA Privacy Practices for more information about client rights).
DUAL RELATIONSHIPS:
Dual relationships are generally discouraged, per the ethical guidelines for clinical practice, but in some cases are unavoidable, especially in a small community. One example of a potentially feasible dual relationship is the case in which the client and therapist have limited contact with each other via their roles as members of a community organization (e.g., school or church setting). Yet, even in such cases, it is critical to determine if a therapeutic relationship would in any way be compromised by this pre-existing relationship within the broader community. Therefore, the therapist and client are obligated to discuss the complexities that may be involved in such relationships, in order to determine if a therapeutic relationship would be of potential benefit to the client. The client’s welfare is always the primary consideration.
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