Maplewood Counseling

Welcome to Our Practice

Maplewood Counseling in New Jersey

Policy Information

Informed Consent for Psychotherapy

Maplewood Counseling
169 Maplewood Ave Suite 4
Maplewood, NJ 07040
973.793-1000

Informed Consent for Psychotherapy
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 me.
The Therapeutic Process You have taken a very positive step by deciding to seek therapy. 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. I cannot promise that your behavior or circumstance will change. We can promise to support you and do my 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 itemized below:
1. If a client threatens or attempts to commit suicide or otherwise conducts him/herself /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.
Occasionally we 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.
If we see each other accidentally outside of the therapy office, I will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to me, and I do not wish to jeopardize your privacy. However, if you acknowledge me first, we will be more than happy to speak briefly with you but feel it appropriate not to engage in any lengthy discussions in public or outside of the therapy office.

 

Right to Receive a Good Faith Estimate

Maplewood Counseling
169 Maplewood Ave Suite 4
Maplewood, NJ 07040
973.793-1000

GOOD FAITH ESTIMATE DISCLAIMER

Disclaimer for Good Faith Estimate for Cash Pay and Out of Network Clients

Effective January 1, 2022, a ruling went into effect called the “No Surprises Act” which requires practitioners to provider a “Good Faith Estimate” about out-of-network care. The Good Faith Estimate works to show the cost of items and services that are reasonably expected for your health care needs for an item or service, a diagnosis, and a reason for therapy. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur and will be provided a new “Good Faith Estimate” should this occur.

You’re getting this notice because this provider or facility isn’t in your health plan’s network and is considered out-of-network. This means the provider or facility doesn’t have an agreement with your plan to provide services. Getting care from this provider or facility might cost you more than utilizing your in-network insurance benefits.
Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” (GFE) of expected charges. The GFE shows the costs of items and services that are reasonably expected for services provided by TTC. The estimate is based on information known at the time the estimate was created. It does not take into account any reimbursement that you may receive as a result of out of network benefits.

The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur.

Surprise Billing Protection Form

This document describes your protections against unexpected medical bills. It also asks if you’d like to give up those protections and pay more for out-of-network care. IMPORTANT: You aren’t required to sign this form and shouldn’t sign it if you would prefer to use services with an in-network provider for your care. You can choose to get care from a provider or facility in your health plan’s network, which may cost you less.
Prior to the onset of service, contact your health insurance plan to discuss your potential out-of-network mental health benefits, including your deductible and co-insurance, if any. You also can ask about what’s covered under your plan and your provider options. You will receive a Good Faith Estimate for the cost of services at Maplewood Counseling. Review your detailed estimate and proceed with services only after reviewing and signing the document.

If you are billed $400 or more than your Good Faith Estimate, you have the right to dispute the bill. You may contact the health care provider or facility listed to let them
know the billed charges are higher than the Good Faith Estimate.

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 800-985-3059. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059.
Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.
For more information about your rights and protections under Federal Law, visit www.cms.gov/nosurprises/consumers.

 

Texting or Over the Internet Communication
There are limits to protecting your confidentiality via text over the internet. While we do our utmost to preserve your confidentiality, we cannot guarantee privacy. Please consider the information you submit over the internet prior to sending.

There are several ways you can communicate with us without having to send information over the Internet: in person, by phone, by regular mail.

HIPAA Notification & Privacy Practices

Maplewood Counseling
169 Maplewood Ave Suite 4
Maplewood, NJ 07040
973.793-1000

HIPAA NOTIFICATION & PRACTICE POLICIES

APPOINTMENTS AND CANCELLATIONS

Our Cancellation Policy – Kindly call 973-793-1000 to give a minimum of 24 hours notice if you need to cancel or change an appointment to avoid the full fee for your visit (except for a true emergency ). This allows us enough time to offer the appointment to someone on the waiting list. I understand I must call 973-793-1000 to cancel or change an appointment or I will be charged the full fee for a missed appointment or an appointment canceled with less than 24 hours notice.

The standard meeting time for psychotherapy is 45 minutes. There are options for a 60 minute session for an additional fee. The first session is billed the day before since our system has triple processing certain cards. This gives us enough time to let you know if there is an issue so we can resolve and your session can take place as planned.

Payment is due in full at each visit and charged the morning of the day of your session using the credit or debit card you entered on file. If there are insufficient funds we will send a link to use a different credit card or sufficient funds must be deposited to cover charges before the session unless arrangements are made in advance. We will attempt to discuss any billing issues and resolve them as soon as possible.

If requested, the appointment length can be changed to an intensive/double 90-minute session for an additional fee.

Credit cards are used for sessions. We also accept debit cards and will supply you with a receipt to submit to your FSA or HSA Flex account for reimbursement upon request. If a check is used and is returned there is a $40.00 service charge will be charged for any checks returned for any reason for special handling.

Cancellations and the re-scheduled sessions will be subject to a full charge if NOT RECEIVED AT LEAST 24 HOURS IN ADVANCE by calling our office (we do not receive messages from the “no-reply” text and email alerts so we will have to charge for the session if we do not receive your message). This is necessary because the appointment time commitment is made for you and is held exclusively for you. If you are late for a session, you may lose some of that session time.

The fee for preparing documents requested by the client is $50 for every 15 minutes of time for documents requested.

Late Fees

Full payment is expected at the time of service unless otherwise agreed upon. A grace period will be allowed with no late fee if payment is received by 6:00 pm the next business day. After 6pm on the next business day, there will be a $20 charge for late payments made within the same week, and a $30 charge the next business week. We do not permit clients to carry a balance of more than two sessions and if you are unable to pay this balance, we will discuss whether it makes sense to pause your care or develop another strategy.  We will attempt to discuss any billing issues and resolve them as soon as possible.

TELEPHONE ACCESSIBILITY If you need to contact us between sessions, please leave a message on our voice mail. We are often not immediately available; however, We will attempt to return your call within 24-48 hours. If a true emergency situation arises, please call 911 or any local emergency room.

SOCIAL MEDIA AND TELECOMMUNICATION Due to the importance of your confidentiality and the importance of minimizing dual relationships, We do not accept friend or contact requests from current or former clients on any social networking site (Facebook, Linked In, 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 our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.

ELECTRONIC COMMUNICATION We 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 only, we will do so. While we 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, video conferencing, and e-mail is considered telemedicine by the State of New Jersey. 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, diagnoses, and interventions based not only on direct verbal or auditory communications, written reports, and third-person consultations, but also on 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 therapist not being aware of what he or she would consider important information, that you may not recognize as significant to present verbally to the therapist.

MINORS If you are a minor, your parents may be legally entitled to some information about your therapy. We will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately kept confidential.

TERMINATION Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. We may terminate treatment after appropriate discussion with you and a termination process if we determine that the psychotherapy is not being effectively used or if you are in default on payment. We will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, we will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.

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.

 

Technology and Social Media Policy

Maplewood Counseling contact@maplewoodcounseling.com

Our Private Practice Social Media Policy

Social Media and Technology Policy:

Privacy in use of social media cannot be guaranteed. Any use of technology carries some risk of breach of confidentiality. Here’s what Meta.com privacy policy disclaimer says:

We at Meta want you to understand what information we collect, and how we use and share it. That’s why we encourage you to read our Privacy Policy. This helps you use in the way that’s right for you.  In the Privacy Policy, we explain how we collect, use, share, retain and transfer information. We also let you know your rights. Each section of the Policy includes helpful examples and simpler language to make our practices easier to understand. We’ve also added links to resources where you can learn more about the privacy topics that interest you.   It’s important to us that you know how to control your privacy, so we also show you where you can manage your information in the settings of the Meta Products you use. You can to shape your experience.

Please be mindful of the needs of your privacy and confidentiality when using social media.

Last Updated December 2023

Our Mission

 

Our mission is to help couples, families, and individuals in our community improve their relationships and personal lives. Our vision is to eliminate the stigma of mental health services by helping people become more aware of and appreciate how mental health counseling can help improve overall wellness. Our down-to-earth, authentic therapists are easy to connect with and will work with you to help you achieve your goals and find better ways to cope with personal, family, and relationship challenges.

Maplewood Counseling is an equal opportunity employer. We embrace a philosophy that values and recognizes diversity. Our goal is to develop and retain a talented, diverse group of clinicians to serve the residents of New Jersey.

Maplewood Counseling is an inclusive, anti-racist, and LGBTQ+ affirming practice.

Our Purpose

Guiding people on their journey to improve their relationships & personal lives.

Our Niche

Providing quality relationship counseling for couples, individuals & families.

Our Core Values

We are authentic and put our humanity first – we are humans before therapists.
We have a passion for helping our clients improve their relationships and personal lives.
We are humble experts in our field and easy to connect with.
We practice integrity in all things.
We put our client’s needs first.
We are Team Maplewood Counseling.

What Makes Us Unique

We offer trusted and quality therapy services in Essex County in Northern New Jersey.
We provide our clients with responsive & personal service.
We are culturally sensitive, inclusive & experienced.
We utilize the most effective research-based counseling roadmap to support long-lasting change.
Professionals who lead with our humanity & compassion.

Our Guarantee |  Pledge | Commitment

We pledge to be neutral and balanced with our couples and families – we pledge to not take sides.
While we can’t guarantee every client’s desired outcome, we are committed to helping you work on reaching your goals.
We understand and respect you are investing your time and money into this process. We honor and offer the value of our experience and training and are committed to being as efficient and effective as possible.
As experienced professionals, we guarantee we will never recommend that you get divorced or break up.

 


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