Policies and Consent for Treatment
Welcome to Pieces of Me, LLC! We look forward to working together with you to achieve your goals. There are a few ground rules we need to establish before we get started. Here are some of the policies we follow that may affect you:
Appointment Expectations:
Psychotherapy appointments are provided by therapists. Appointments range in length from 30 to 55 minutes, depending on the type of session, cost, and coverage.
Medication management service provided by psychiatrists (MD or DO), nurse practitioners (APRN), or psychiatric physician assistants to determine diagnosis and/or to determine the benefits of medication therapy. Assessments for medications will last 30-60 minutes, depending on need. If medication intervention is determined to be a course of treatment agreed upon by you and your provider, it will be prescribed and monitored by your provider on a regular basis. Most ongoing medication management appointments will last 10-45 minutes, depending on need. During your appointment, your provider will discuss potential side effects or adverse reactions, benefits, and interactions that may occur from use of other medications, substances, and medical conditions. Please note, if you are prescribed a controlled substance you will be asked to sign a separate Controlled Substance Agreement.
Regular attendance for follow-ups are essential to ensure continuity of care, track progress, and address emerging challenges in a timely manner: this reduces the risk of feeling worse or experiencing a crisis.
Cancellations:
Cancellations/rescheduling must be arranged at least 24 hours before the session. If an appointment is missed or cancelled/rescheduled within 24 hours of the session, you will be charged a $40 cancellation fee. If you are 15 minutes late or more to an appointment, it will be cancelled/rescheduled. An EAP or insurance company will not pay for the late cancel or missed appointment. In case of inclement weather, a challenge with transportation, or any reason you are unable to reach our office for an in-person appointment, you can opt to attend the session via video telehealth appointments. Otherwise, the appointment will be cancelled. If you come to your appointment under the influence of drugs or alcohol, the provider may end the appointment early, and you will be liable for the full payment of the appointment.
Payments:
Payments are due at the time of service for in-person appointments. Payment for video telehealth appointments must be arranged prior to the appointment via credit card, cash or check. We reserve the right to release your information to a collection agency to collect unpaid fees or cancel scheduled appointments due to an outstanding balance, if necessary. You are permitted to have a maximum of two outstanding appointment fees at a time in order to schedule another appointment. You may be refused service for non-payment of fees. Outstanding fees denied or not otherwise covered by an insurance company or EAP will be the responsibility of the client, regardless of prior quote of coverage. It should be noted it is the client’s responsibility to ensure their insurance coverage is active and up to date.
Pieces of Me, LLC will store debit or credit card information online in a secure and HIPAA compliant database (SimplePractice) to more conveniently bill for session fees, copays, deductibles, and cancellation fees. If you would prefer not to have your payment information stored, please coordinate with your provider or the practice office manager to arrange payment that is in compliance with payment policies.
Record Keeping:
We will keep brief records of our appointments. Under the provision of the Health Care Information Act of 1992, you have the right to a copy of your file at any time. You have the right to request that we correct any errors in your file. You have the right to request that we make a copy of your file available to other health care provider(s) at your written request. We typically maintain records for 10 years following termination of therapy, and destroy records in a manner that preserves your confidentiality.
Limitations of Services:
If you need to contact your provider between sessions, please leave a message on your provider’s voice mail or other indicated form of communication that is your provider’s preference. Your provider is often not immediately available; however, they will attempt to return your call within 24 business hours. We do not offer 24-hour-care. If you need after-hours care, we will assist you in finding the proper resources.
Our office correspondence is not monitored at night or on weekends or holidays. It is not intended for emergency correspondence. If this is an emergency, please call your doctor, dial 9-1-1, or go to the nearest emergency department. For psychiatric emergencies, you may contact the Boystown National Hotline by calling 800-448-3000 or Text VOICE to 20121. CommonSpirit (formerly known as CHI) by calling (402) 717-HOPE (4673), National Suicide Prevention Lifeline, 1 (800) 273-TALK, or texting 988 24 hours a day for assistance.
Purposes & Goals:
Psychotherapy and medication management can have many purposes, such as to improve mental health and wellbeing, improve communication skills, build healthier relationships, heal from trauma, create healthier habits, and more. Your provider will work with you to outline your unique goals in a treatment plan, and will discuss with you our working understanding of the problems/diagnosis, results and implications of any assessment tools or tests used, therapeutic objectives, and possible outcomes of treatment. We aim to help you create measurable and achievable goals, and will review progress with you periodically during the course of treatment. You can refuse services or recommendations at any time, and we will discuss alternatives for you. If you have questions or concerns about your treatment plan, please discuss them with your provider.
Potential Risks & Benefits:
Psychotherapy and medication management services are a process in which we will discuss a myriad of issues, events, experiences, and memories for the purpose of creating positive change. It provides an opportunity to more deeply understand oneself, as well as any problems or difficulties you may be experiencing. Psychotherapy and medication management treatment is a joint effort between client and provider. Progress and success may vary depending on many factors. Participating in your treatment may result in a number of benefits including, but not limited to reduced stress/anxiety, decreased negative thoughts, decreased self-sabotaging behaviors, improved interpersonal relationships, increased comfort in social, work and family settings, increased capacity for intimacy, and increased self-confidence. Such benefits may also require substantial effort on your part, including active participation in the therapeutic process, honesty with your provider and yourself, and willingness to change feelings, thoughts and behaviors. There is no guarantee that treatment will yield all or any of the benefits listed above. Benefits are more likely to occur if clients make a good faith effort in treatment.
Participating in treatment may also involve some discomfort, including remembering and discussing unpleasant and traumatic events, feelings and experiences. The process may evoke strong feelings of sadness, anger, fear, anxiety, etc. There may be times in which we will challenge your perceptions and assumptions and offer different perspectives. The issues presented by you may result in unintended outcomes, including changes in personal relationships. Sometimes, a decision that is positive for one family member, is viewed quite differently by another. You should be aware that any decision on the status of your personal relationships or regarding your personal life is solely your responsibility. During the treatment process, many people find that they feel worse before they feel better. This is generally a normal course of events.
Personal growth and change may be easy and swift at times, but may also be slow and frustrating. You should discuss your concerns about progress with your provider. Due to the varying nature and severity of problems and individuality of each client, we are unable to predict the length of treatment or guarantee a specific outcome.
Together you and your provider will work to achieve the best possible results for you. Pieces of Me, LLC will not knowingly utilize any treatment or procedure that is experimental, controversial, or carries intrinsic risk. The goal of the provider is to follow the path of truth, however uncomfortable or painful that may be at times. However, the benefits of assessment and treatment can far outweigh the risks. It is our desire to work with you to attain your personal goals, which may include obtaining the right help for a client who may be resistant to the treatment process.
Medication Refill Requests:
Typically, refills are addressed during scheduled medication management appointments: patients and prescribers will determine the amount to refill to coincide with the next follow-up appointment.
Certain refill requests may not be authorized for refill without first seeing the prescriber: this is usually due to the need to schedule follow-up appointments. However, it is sometimes the case that refills are not neatly lined up with follow-up appointments.
Patients are asked to understand the following for refill requests:
Please review your prescription bottle and review the number of refills: if it says “0” then please call Pieces of Me for a new prescription. If there is a number “1/2/3” next to the word refills, this indicates there are still refills on the current prescription that you can pick up at your pharmacy.
If you run out of medication and require a refill before your next appointment, please call (402) 237-8621 and follow the prompts to leave a message for medication refill requests. Or you may email medrequests@piecesofmeomaha.com stating NAME; PHARMACY; MEDICATION when requesting refills. Your request will be tended to within 24-48 business hours and we ask that you allow 1-5 business days to process from initiating your request to obtaining your refill from the pharmacy.
*Some medications may require PRIOR AUTHORIZATIONS: this can further delay the refill/pick-up process. Please know these cases can take up to 5 business days to process. Please: Be mindful that it is patient responsibility to request refills in a timely manner. Late requests may result in a few days without medication due to processing requests from office-to-pharmacy. Every effort is made to process requests in a timely manner; however, immediate responses cannot be guaranteed for requests submitted with insufficient advance notice.
Patient Code of Conduct:
All Pieces of Me staff, at all locations, will provide professional, ethical, & compassionate care. Please be advised of our patient expectations:
- Patients will comply with environmental safety: No Weapons are allowed on Pieces of Me premises (guns, knives, etc.).
- Patients will communicate respectfully, whether this is in-person, over-the-phone, or via email. Verbal intimidation – yelling, swearing, threats, or physical intimidation- aggressive gestures, standing close, throwing objects, will not be tolerated.
- Patients will report accurate information about their health history: misrepresentations may be a breach in the treatment relationship and will be addressed.
- Patients will pay bills in a timely manner, and address billing matters with the billing department/office manager: accounts in default may result in collections.
- Patients will adhere to appointment scheduling and attendance standards: lack of treatment engagement may affect ongoing care.
Patients who are in violation of the Patient Code of Conduct are subject to dismissal from the practice.
How Family Members Can Help:
If a friend or family member is able to offer healthy support, it can help you in the therapeutic process. They could potentially attend an appointment with you, listen to you, help with tasks, or hold you accountable for changes you are making. Feel free to discuss this with your provider for more information. Each individual that attends an appointment for support will need to have a signed release of information form in order to participate. However, there may be times when a provider may respectfully request others not be part of the treatment session, if there is concern that other participation seems to interfere with the treatment process. Your provider will offer an explanation in these circumstances.
If you participate in couples or family therapy, we adhere to a “no secrets” policy. This means that we do not keep information gathered in individual conversations (including phone or email) secret if the revealed information violates the integrity of the therapy.
Minor Child Treatment Policy:
We believe that privacy is important in developing trust and the overall success of treatment. It is our policy to share general information about treatment status with parents/guardians of minors under the age of 18 years old. We will not share what your child has disclosed to us without your child’s consent. At age 18 or older, minors are allowed to consent to treatment without a parent’s consent in the State of Nebraska. Minors 18 years and older can sign a release of information form for their provider to provide certain information to the parent. If we ever believe that your child is at serious risk of harming him/herself or anyone else, we will inform you. We will not testify in court or give opinions about custody or parenting plans.
There are exceptions related to substance abuse treatment for minors. The law provides parents of children under the age of 18 years with the right to examine their children’s treatment records though there are a few exceptions. One of them being substance abuse information, which is highly protected by law. Pieces of Me, LLC will need a written release for substance abuse information to be disclosed. Another exception is in the event of child abuse or neglect or if there is reasonable belief that sharing the information with the parent will otherwise endanger the individual. Please keep in mind that it is necessary for Pieces of Me, LLC staff to share information with parents if we feel a patient is in danger of seriously harming themselves or someone else.
Ending Treatment:
You normally will be the one who decides when treatment will end, with a few exceptions:
If we are not, in our judgement, able to help you because of the kind of problem you have or because our training and skills are not appropriate, will inform you of this fact and refer you to another provider who may meet your needs.
If you are violent or threatening toward your provider, our office, or our family members, we reserve the right to terminate you unilaterally and immediately from treatment.
If you miss 2 or more sessions without at least 24 hours notice, we reserve the right to terminate treatment with you.
In the unlikely event of your provider’s incapacitation or death, you will receive notice from other providers or owners of the practice for coordination of care and resources.
If we end treatment with you, we will offer you referrals to other sources of care, but cannot guarantee that they will accept you for treatment.
You may discontinue treatment at any time. We recommend developing a plan for discontinuation with your provider prior to termination of care.
Technology:
Distance counseling includes phone sessions, email counseling and online video sessions. Emails involve requests for advice, guidance, to be listened to, or any other therapeutic reasons are considered email counseling. If you are interested, we will discuss with you if distance counseling is an appropriate treatment option. It is not recommended in all cases. Distance counseling is a different experience compared to in-person sessions. There can be a lack of face-to-face interactions; lack of non-verbal communication including visual and audio cues that are often relied on in personal communication; and issues regarding technology failure.
If distance counseling is deemed appropriate and necessary, comprehensive benefits, limitations, and boundaries surrounding distance counseling will be discussed. Fees for phone or online video sessions are the same as in-person sessions. Email counseling fees are standard at $20 per page of communication, and evaluated individually.
Emails can be used for asking simple questions, asking about rescheduling a time, a quick update, etc. Email may also be used for appointment reminders and self-help information. A HIPAA-compliant program called Simple Practice will be used to schedule sessions and communicate reminders. If you would prefer not to use email/app communication, please let us know.
Complaints:
We encourage you to discuss any concerns or complaints directly with your provider. You also have the option to contact your provider’s licensing board for complaints; we can provide those specific phone numbers upon request.
Professional Consultation:
Professional consultation is an important component of a healthy psychiatric practice. As such, we regularly participate in clinical, ethical and legal consultation with appropriate professionals. If such consultations are with other Pieces of Me, LLC employees, we may use your name and other personally identifying information. Pieces of Me, LLC staff has limited access to your records. If such consultations are with individuals outside of the agency, we will not reveal any personally identifying information regarding you or your situation, unless you have signed a release of information for that individual.
Supervision of Children:
Children under 12 must be supervised outside of the appointment room by an adult during sessions.
Cell Phones:
Please refrain from using cell phones during appointments. Please note that audio or video recording of appointments is not permitted.
Social Media and Telecommunication:
Due to the importance of your confidentiality and the importance of minimizing dual relationships, your provider does not accept friend or contact requests from current or former clients on any social networking site (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 your therapeutic relationship. If you have questions about this, please bring them up with your provider to discuss further.
Electronic Communication:
Your provider cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, your provider will do so. While your provider may try to return messages in a timely manner, we cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.
Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail is considered telemedicine by the State of Nebraska. Under the California Telemedicine Act of 1996, 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 provider 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 provider 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, attractiveness relative to social and cultural norms or standards, 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 provider not being aware of what he
or she would consider important information that you may not recognize as significant to present verbally to the provider.