Welcome to my practice! I appreciate you giving me the opportunity to help. This document outlines important information we must agree to before we begin working together. Our work is most helpful when we share a mutual understanding of the rules I must comply with due to various laws and ethical codes. If you are concerned to the point of not agreeing with anything here, please stop and call me so we can discuss. 

Introduction to My Practice 
I am a counselor who specializes in working with adults on issues of anxiety and work/career. I am trained as a general mental health counselor but my postgraduate training has focused mostly on anxiety disorders, organizational mental health, and career issues. I primarily use a research-based approach called Acceptance and Commitment Therapy. ACT is a behavioral therapy, meaning that it requires behavior change from you to create psychological and emotional change. We work together on new behaviors to try out and then see if they're successful outside of the therapy room (and yes, that means homework). 

In our first meeting, I will go over some administrative things (like confidentiality, etc.) and then ask you to talk about what brought you to my office. I will do my best, by the end of that first meeting, to explain my take on what you've told me and try to give you a rough outline of what treatment would look like. After the initial meeting, I meet with most clients once every one to three weeks, with sessions tapering in frequency after 10 or so appointments. You may need more frequent meetings, especially if your symptoms are intense or if they've been going on a very long time. We will talk about what frequency I think is most likely to help and what frequency you feel comfortable with. Most clients benefit from 45 minute sessions, which are considered "industry standard" by most insurance companies. Some clients need longer meetings and we can talk about why, if I recommend those for you. 

The Benefits and Risks of Therapy
First, the risks. Therapy can be very uncomfortable and hard work. You may experience sadness, guilt, anxiety, anger, frustration, loneliness, helplessness, or other negative feelings. It is possible that despite the increasingly common nature of therapy, some people in your life have misconceptions about therapy or about people who seek therapy and may think differently of you for seeking help. Our work may uncover relationships that aren't working for you or may cause you to change your behavior in a way that your associates do not appreciate, even if the change was welcomed by you. It is also possible that your problems may temporarily worsen before they improve. Most of these risks are to be expected when people are making important changes in their lives. Finally, even with our best efforts, there is a risk that therapy may not work for you.

Benefits of therapy have been shown by scientists in hundreds of well-designed research studies. People who are depressed may find their mood lifting. Others may no longer feel afraid, angry, or anxious. In therapy, people have a chance to talk things out fully and try new behaviors until their feelings are relieved or the problems are solved. Your relationships and coping skills may improve greatly. You may get more satisfaction out of social and family relationships. Your personal goals and values may become clearer. I do not take on clients I do not think I can help. Therefore, I will enter our relationship with optimism about our progress.

Relationship Between Counselor and Clients 

Laws and ethical codes put limits on the relationship between a therapist and a client, and I will abide by these. Let me explain these limits, so you will not think they are personal responses to you.

First, I am trained to practice counseling-not law, medicine, finance, or any other profession. I am not able to give you good advice from these other professional viewpoints. I will recommend that you consult with these professionals when issues come up that are better addressed by folks with specialized training. 

Second, state laws and the rules of the ACA require me to keep what you tell me confidential (that is, just between us). You can trust me not to tell anyone else what you tell me, except in certain limited situations. I explain what those are in the"About Confidentiality"section of this brochure and in my Professional Disclosure Statement (PDS). 

If we meet on the street or socially, I may not say hello or talk to you very much. My behavior will not be a personal reaction to you, but a way to maintain the confidentiality of our relationship. If you choose to approach me outside of my office, please consider how you will explain to anyone who accompanies you or me, how we know each other, as I will be unable to acknowledge you until you acknowledge me, first.

Third, in your best interests, and following the ACA's standards, I can only be your therapist. I cannot have any other role in your life. I cannot, now or ever, be a close friend to or socialize with any of my clients. I cannot be a therapist to someone who is already a friend. I can never have a sexual or romantic relationship with any client during or after the course of therapy. I cannot have a business relationship with any of my clients, other than the therapy relationship. I also may not accept gifts nor attend social events clients invite me to and hope that my refusal will not offend you. These standards are in place to protect you, my client, from potential harm. Likewise, I cannot connect with my clients via social networking sites such as Facebook. Standards around how clients and counselors connect on professional sites, such as psychology blogs, are constantly evolving and we should maintain an open and frank conversation about whether such connections are permitted and/or appropriate. 

Confidentiality - Expectations and Limitations
I will treat with great care all the information you share with me. It is your legal right that our sessions and my records about you be kept private. That is why I ask you to sign a "release-of-records" form before I can talk about you or send my records about you to anyone else. In general, I will tell no one what you tell me. I will not even reveal that you are receiving treatment from me. In all but a few rare situations, your   confidentiality (that is, our privacy) is protected by federal and state laws and by the rules of my profession. Here are the most common cases in which confidentiality is not protected:

1. If you were sent to me by a court or an employer for evaluation or treatment, the court or employer expects a report from me. If this is your situation, please talk with me before you tell me anything you do not want the court or your employer to know. You have a right to tell me only what you are comfortable with telling.

2. Are you suing someone or being sued? Are you being charged with a crime? If so, and you tell the court that you are seeing me, I may then be ordered to show the court my records. Please consult your lawyer about these issues.

3. If you make a serious threat to harm yourself or another person, the law requires me to try to protect you or that other person. This usually means telling others about the threat. I cannot promise never to tell others about threats you make.

4. If I believe a child, disabled person, or animal has been or will be abused or neglected, I am legally required to report this to the authorities. Please note that in the State of Oregon, it is considered child abuse when a child witnesses domestic violence.

Please, don't bring me or your records into court!

If you ever become involved in a legal dispute, I want you to understand and agree that I will not provide evaluations or expert testimony in court. You should hire a different mental health professional for any evaluations or testimony you require. This position is based on three reasons: (1) My statements will be seen as biased in your favor because we have a therapy relationship; (2) the testimony might affect our therapy relationship, and I must put this relationship first; and (3) I am not a trained forensic professional (I am not trained to participate in the legal system) and I could inadvertently do something to damage your case due to lack of training in that area. My records are written to document what care I gave you and to prove to your insurance company that I provided appropriate treatment. They are often in "clinicalease" and are not written to support any particular court case. 

Consultations

There are some situations where I need to consult with another professional about your care, who is not a part of your care team. I ask that you authorize me to do so in the following situations:

1. When I am away from the office for a few days, I have a trusted fellow therapist "cover" for me. This therapist will be available to you in emergencies. Therefore, he or she needs to know about you. Of course, this therapist is bound by the same laws and rules as I am to protect your confidentiality. I also have other licensed healthcare professionals assigned to manage my practice should I become suddenly disabled or deceased. 

2. I sometimes consult other therapists or other professionals about my clients. This helps me provide high-quality treatment. These people are also required to keep your information private. Your name will never be given to them, some information will be changed or omitted, and they will be told only as much as they need to know to understand your situation.

3. It may be beneficial for me to confer with your primary care physician with regard to your psychological treatment or to discuss any medical problems for which you are receiving treatment. While I require a written release to participate in non-urgent consultations, I will consult with your medical professionals without a release when you are experiencing a medical or psychiatric emergency. 

Except for situations like those I have described above, my office staff and I will always maintain your privacy. I also ask you not to disclose the name or identity of any other client being seen in this office. If your records need to be seen by another professional, or anyone else, I will discuss it with you. If you agree to share these records, you will need to sign an authorization form. This form states exactly what information is to be shared, with whom, and why, and it also sets time limits. You may read this form at any time. 

Records

It is my office policy to destroy clients' records 15 years after the end of our therapy. Until then, I will keep your case records in a safe place. At this time, I use an Electronic Medical Records (EMR) system that is considered compliant with current laws on medical privacy, to store your record. I am happy to discuss the advantages EMRs provide. My EMR system includes a portal through which you can contact me in a confidential manner and through which I can provide you billing statements and other information. 

Record Status

Active clients are those who are working with me on a regular treatment plan and we meet together no less than once a month. Any client listed as "active" in my EHR, I will follow up with on a pretty regular basis to check on progress and welfare. If we have not met for over a month, I will move your file to INACTIVE status. 

Inactive clients are those who I am not seeing regularly (less than once a month) or with whom treatment is "on hold" for some definable reason. Inactive clients may still receive periodic emails from me about the practice, via this EHR portal. I will not directly follow up on the progress or welfare of inactive clients and instead have a policy of "you call me," when you need an appointment or any other support. Clients who are on inactive status will have their  files closed after three months of no appointments. If I have not met with you in over a month or if you do not respond to my emails (and I don't have any concerns about your safety), I will move your file to inactive status. 

Closed clients are those who have been discharged from my care completely and whose files are now archived and scheduled for destruction in the number of years specified by applicable law. If I have not met with you for three or more months, I will close your file. OR if we met only once or twice and you do not schedule a follow-up appointment and I cannot get a hold of you, I will move your file to closed. After that, you can call or write me anytime for referrals or to discuss coming back to therapy. If I have ever had any concern about your safety, I will do my best to offer you referrals before closing your file. 

My Background

Please see my Professional Disclosure Statement for training and degree information. 

About Our Appointments
The very first time I meet with you, we will need to give each other much basic information. For this reason, I usually provide a free 20-minute introductory phone consultation so that you can learn about my basic office policies and decide whether you would like to proceed with an intake session. Following this, we will usually meet for 45 or 60 minute sessions every week or two, depending on our mutual availability and your clinical needs. As your symptoms get better, we will meet less frequently. 

Sometimes, clients benefit from appointments that begin in the office but include some out-of-office time. For example, some clients process thoughts or emotions better when on a walk outside while others may benefit from confronting their anxiety in real-life situations (in-vivo exposure therapy). I am trained to practice "in-vivo" (in real life) techniques but taking therapy out of the office has implications we should discuss before choosing to do so. If we choose to conduct therapy outside of the office setting, we will discuss risks and benefits ahead of time and if we choose to engage in that type of work, I will document your verbal consent in a progress note. 

Scheduling and Canceling Appointments
An appointment is a commitment to our work. We agree to meet here and to be on time. If I am ever unable to start on time, I ask for your understanding. I also assure you that you will receive the full time agreed to or I will charge you a prorated fee for the actual time of our meeting. If you are late, we will probably be unable to meet for the full time, because it is likely that I will have another appointment after yours. I greatly appreciate it when you can give me one week of notice prior to missing a regular appointment time. I reserve the right to charge you for any appointment cancelled or missed with fewer than 48 hours notice, given via phone, email, or text. Insurance companies do not reimburse for missed appointment fees but EAPs often do (like Lyra Health and Modern Health). I do encourage you to discuss extenuating circumstances with me and when I am financially able, I often forgive missed appointment fees in those cases. Please note that forgiving a missed appointment fee on one occasion is not a promise to do so in the future. 

I will always do my best to let you know of my planned absences and schedule changes as far in advance as possible. As the parent of young children, my practice does generally follow the Portland Public Schools (PPS) holiday schedule from September through June and my schedule my change slightly in the summer to account for scarcity of childcare at that time. Additionally, my practice follows PPS's inclement weather policy. I also disclose my parenting status so that you know sometimes either I or one of my children is sick and I have to cancel due to illness. I try to minimize this by having backup childcare available but even the best plans sometimes fail. I ask for your patience during those times and I try to offer as much flexibility to my clients as I ask of them for these circumstances.

Your care team - Comprehensive mental health care extends beyond counseling
If you could benefit from a treatment I cannot provide, I will help you to get it. You have a right to ask me about such other treatments, their risks, and their benefits. Based on what I learn about your problems, I may recommend a medical exam or use of medication. If I do this, I will fully discuss my reasons with you, so that you can decide what is best. If you are treated by another professional, I will coordinate my services with them and with your own medical doctor.

Sometimes we need skills on your care team that I don't have. I might suggest you see another therapist or another professional for an evaluation. As a responsible person and ethical therapist, I cannot continue to treat you if my treatment is not working for you. If you want another professional's opinion at any time, or wish to talk with another therapist, I will help you find a qualified person and will provide him or her with the information needed.

Fees, Payments, and Billing

**As of September, 2019, Rates are broken out into a separate practice policy in this EHR**

I ask that clients pay their "patient/client portion" of any appointment at the end of their session. I accept cash, credit cards, and check for patient portions of balances due. Fees will be due for all appointments performed or missed with less than 48 hours of notice to the counselor by email, phone, or text. 

Unpaid Balances Policy

I ask most clients to keep a credit card on file for patient/client responsibility amounts.This policy does not apply to most Lyra and Modern Health clients. My credit card processing through this site is both secure AND HIPAA compliant (using Counsol and Stripe platforms). I reserve the right to bill your insurance (if applicable) and then, your credit card for patient-responsibility balances that go unpaid 24 hours after your appointment occurs UNLESS we have an explicit agreement to delay billing until a later date. If you are using your insurance, I will charge only for your copay, anticipated co-insurance amount, or deductible amount. If you are a cash-paying client, I will charge you the full session fee.

If you think you may have trouble paying your bills on time, please discuss this with me. I will also raise the matter with you so we can arrive at a solution. If there is any problem with my charges, my billing, or any other money-related point, please bring it to my attention. I will do the same with you. Such problems can interfere with our work. They must be worked out openly and quickly.

Insurance and Third-Party Payers
Please see my separate policy on using your insurance for more information.

If You Need to Contact Me
I am a private practice counselor and do not have the bandwidth to provide 24/7 services. I am usually in the office Monday through Friday. Since I cannot answer the phone when I am meeting with a client, I encourage clients to leave email messages (here on the secure system for security). I make best efforts to return messages within 24 business hours and usually am much faster than that. Generally, I will return messages daily except on Saturdays and holidays. 

Direct email (to katie@playfairconsulting.com) or text messaging (to 510-910-2033 or to 503-610-6162), and voicemails can be a convenient way to communicate with me but they are NOT HIPAA COMPLIANT and I can make no guarantee as to the confidentiality of direct communication outside of this portal. Unsecure email messages are stored on servers and transmitted over internet connections over which I have no control. Therefore, I suggest you email me directly only for administrative and scheduling issues and not for communication about the issues we may be addressing in therapy. All emails sent to katie@playfairconsulting.com should be assumed to be non-confidential due to issues mentioned previously. You may email me through this online system called Counsol as it meets HIPPA guidelines for protecting your health information. 

If you have an emergency or crisis, I want to know and greatly appreciate your voicemail or email notification. I also ask that you dial 911, go to your nearest hospital emergency room, or dial your local crisis line. The Multnomah County Crisis Line can be reached at 503-988-4888. The Clackamas County Crisis line can be reached at 503.655.8401.

If there is an emergency during our work together, or I become concerned about your personal safety, I am required by law and by the rules of my profession to contact someone close to you-perhaps a relative, spouse, or close friend. I am also required to contact this person, or the authorities, if I become concerned about your harming someone else. Please provide this contact information in the enrollment forms, provided within the website.


Statement of Principles and Complaint Procedures
It is my intention to fully abide by all the rules of the American Counseling Association (ACA) and by those of my state licensing boards. Problems can arise in our relationship, just as in any other relationship. If you are not satisfied with any area of our work, please raise your concerns with me at once. Our work together will be slower and harder if your concerns with me are not worked out. I will make every effort to hear any complaints you have and to seek solutions to them. If you feel that I (or any other therapist) have treated you unfairly or have even broken a professional rule, please tell me. You can also contact the state or local counselor association and speak to the chairperson of the ethics committee. He or she can help clarify your concerns or tell you how to file a complaint. 

You may also contact the state board, below:
Oregon Board of Licensed Professional Counselors and Therapists at 3218 Pringle Rd SE #250, Salem, OR 97302-6312. Telephone: (503) 378-5499 Email: lpct.board@state.or.us Website: www.oregon.gov/OBLPCT

In my practice as a therapist, I do not discriminate against clients because of any of these factors: age, sex, marital/family status, race, color, religious beliefs, ethnic origin, place of residence, veteran status, physical disability, health status, sexual orientation, or criminal record unrelated to present dangerousness. This is a personal commitment, as well as being required by federal, state, and local laws and regulations. I will always take steps to advance and support the values of equal opportunity, human dignity, and racial/ethnic/ cultural diversity. If you believe you have been discriminated against, please bring this matter to my attention immediately.

Our Agreement
I, the client (or his or her parent or guardian), understand I have the right not to sign this form. My signature below indicates that I have read and discussed this agreement; it does not indicate that I am waiving any of my rights. I understand that any of the points mentioned above can be discussed and may be open to change. If at any time during the treatment I have questions about any of the subjects discussed in this brochure, I can talk with you about them, and you will do your best to answer them. I understand that after therapy begins I have the right to withdraw my consent to therapy at any time, for any reason. However, I will make every effort to discuss my concerns about my progress with you before ending therapy with you.

I understand that no specific promises have been made to me by this therapist about the results of treatment, the effectiveness of the procedures used by this therapist, or the number of sessions necessary for therapy to be effective.

I have read, or have had read to me, the issues and points in this brochure. I have discussed those points I did not understand, and have had my questions, if any, fully answered. I agree to act according to the points covered in this brochure. I hereby agree to enter into therapy with this therapist (or to have the client enter therapy), and to cooperate fully and to the best of my ability, as shown by my acceptance of the terms, below.

As the healthcare industry changes, many new organizations and products have emerged to help clients pay for therapy. Often, employers pay a company to provide a wider scope of mental health services than are covered by traditional health insurance. I will call these companies alternative third-party payers (ATPP). ATPPs include companies like Lyra Health, various Employee Assistance Programs (EAPs), and sometimes employers paying directly for their employee's therapy. 

When your therapy/counseling is paid by an ATPP, the ATPP generally requires some information about the treatment you receive including dates of service, minutes of service, a diagnosis code, and perhaps some outcome data. They often do NOT ask for progress notes, as insurance companies sometimes do. In summary, they usually know less about your treatment than a health insurance company would, but more than anyone would know if you were paying directly for care. 

These companies often hold providers, like me, to a higher standard of performance than a traditional health insurance company does. They expect results for their clients and want to measure those results by periodically sending their clients surveys about how therapy is helping. Please expect that if you are using an ATPP, that you will receive surveys from them about our work together. By signing below, you agree that I can provide your specified ATTP billing data and your email address to set up their outcome monitoring surveys. 

ATTPs agree to hold your medical data in confidence, just as a health insurance company would but just as with insurance companies, I cannot directly control your data once it leaves my infrastructure. Both ATPPs and Playfair Consulting are "covered entities" under HIPAA and must abide by privacy rules under the law. 

If you provide me with ATPP information as the entity I am billing your incurred fees to, please know that I will need to release the minimum data necessary to comply with your request to bill your services to them. 

By signing below, you acknowledge that you have received the notice on ATPPs and agree to abide by its terms, should you provide me with billing information for an ATPP. 

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. Our privacy officer is Katie Playfair and she can be reached via katieplayfair.securepatientarea.com, Katie@playfairconsulting.com (not secure), or at 510-910-2033.

Your Rights
You have the right to:
Get a copy of your paper or electronic medical record
Correct your paper or electronic medical record
Request confidential communication
Ask us to limit the information we share
Get a list of those with whom we've shared your information
Get a copy of this privacy notice
Choose someone to act for you
File a complaint if you believe your privacy rights have been violated

Your Choices
You have some choices in the way that we use and share information as we:
Tell family and friends about your condition
Provide disaster relief
Include you in a hospital directory
Provide mental health care
Market our services and sell your information
Raise funds

Our Uses and Disclosures
We may use and share your information as we:
Treat you
Run our organization
Bill for your services
Help with public health and safety issues
Do research
Comply with the law
Work with a medical examiner or funeral director
Address workers' compensation, law enforcement, and other government requests
Respond to lawsuits and legal actions

Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
We may say "no" to your request, but we'll tell you why in writing within 60 days.

Request confidential communications
You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
We will say "yes" to all reasonable requests.

Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say "no" if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say "yes" unless a law requires us to share that information.

Get a list of those with whom we've shared information
You can ask for a list (accounting) of the times we've shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We'll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated
You can complain if you feel we have violated your rights by contacting us using the information on page 1.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
You can complain to the Oregon Board of Licensed Professional Counselors and Therapists.
We will not retaliate against you for filing a complaint.


Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:
Share information with your family, close friends, or others involved in your care
Share information in a disaster relief situation
Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:
Marketing purposes
Sale of your information
Most sharing of psychotherapy notes

In the case of fundraising:
We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures
We typically use or share your health information to:

Treat you
We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.

Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?
We are allowed or required to share your information in other ways - usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues
We can share health information about you for certain situations such as:
Preventing disease
Helping with product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, or domestic violence
Preventing or reducing a serious threat to anyone's health or safety

Do research
We can use or share your information for health research.

Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we're complying with federal privacy law.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers' compensation, law enforcement, and other government requests

We can use or share health information about you:
For workers' compensation claims
For law enforcement purposes or with a law enforcement official
With health oversight agencies for activities authorized by law
For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.


Our Responsibilities
We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

By accepting these terms, I agree that I understand this Notice of Privacy Practices and that I am giving my consent for Katie Playfair & Playfair Consulting. to use and disclose my private health information, only as described above. The version of this notice is February 24, 2017.

As a veteran of the tech industry, I welcome electronic connections with my clients. That said, we should discuss the pros and cons of electronic connections and choose together, what types of connections are appropriate, given each of our values, goals, and challenges. I also must comply with generally accepted standards within the counseling profession. Below you will find a summary of my thoughts on various types of connections common today and together, we can determine what, if any connections, we can make in an ethical, professional way to help facilitate your therapy.

Video Therapy

Increasingly, secure video portals, such as the one contained within this site, are used to deliver various therapy services. These services are often reimbursable by insurance companies, just as in-person services are (but you must check with your insurer to confirm coverage). Over the course of our work together, we may find video therapy to be a good substitute for or adjunct to in-person therapy sessions. Video sessions should mimic, to the greatest extent possible, in-person sessions in terms of a quiet setting, confidentiality, and procedures. If we schedule video-enabled sessions together, you agree to the following terms:

- Prior to beginning video therapy, you will complete intake paperwork, emergency contact paperwork, and informed-consent paperwork, just as you would for in-person therapy.

- Video therapy may be different and less effective than in-person therapy, since we will not be in the same room together. 

- I may only deliver therapy to clients located in Oregon and Washington, where I am licensed, and in particular international locations. If you are not in a state in which I am licensed, you should cancel your appointment and reschedule for when you are in a licensed location or ask me for referrals to someone local to you. 

- I will only conduct video therapy sessions in my clinical offices, which are private. I rely on you to ensure that your surroundings are confidential and appropriate for therapy when we conduct video sessions. I strongly recommend wearing a headset for both audio quality and privacy. 

- The technology I use to conduct video sessions is HIPAA compliant but no technology is completely fool-proof. I cannot guarantee absolute confidentiality of our conversation since I do not own all of the hardware and software infrastructure upon which our communication occurs. 

- I ask that you take some time before video sessions to set up your hardware, software, and internet connection Also, neither of us can guarantee that the internet is running smoothly on any given day. We both accept inherent challenges of conducting therapy online, when we schedule these sessions. 

- You or I may find that video therapy does not meet your clinical needs. This may occur at any time during our work together and if that does occur, we will discuss changing to in-person sessions or referring you to another provider who can better meet your needs. 

- In the event risks to yourself or others become present during the course of our work together, you agree to confirm your location and participate in safety-planning with me so that I may provide adequate clinical care via video. 

Video sessions can be great tools when you don't have time to come into the office or if you live in Oregon and Washington, but outside of Portland. Please remember that if you are not in Oregon or Washington, we cannot provide therapy services to you! By scheduling a video or phone session, you agree that you will be located in Oregon or Washington at the time we meet.

Logging into this system's video therapy rooms

Log into this secure site and navigate to your appointment on the calendar. On that appointment, you should see a button that says "Join Video Session." Click it and you will join a secure conference room. 

If we have technical difficulties with the video room in this portal, we will send you a Google Meet calendar invitation. Meet is Google's HIPAA compliant video conference platform. Click "Join Hangouts Meet" and you will enter the conference room!

Use the volume and microphone sensitivity dials to adjust sound settings as needed.  When the session is finished, close the window to end the connection.

Final Note About Relationships Online

Almost universally, clients rate initial video therapy appointments lower than in-person appointments. It takes a bit longer, in our experience, to build relationship over video chat. We should talk about this and be open about how hard it is to get to know a new clinician online. It almost always gets better after a few visits but if you don't feel like we're settling in after a few appointments, we can discuss other options. 

Other electronic policies

Involuntary Connections

If you use the internet in any way, you've probably experienced one of those creepy moments where you're suddenly receiving advertisements for a product or service you were researching on your browser. Many common services we use online track data from our computers and phones including the fact that you looked up my practice online or perhaps Googled me to learn more about me or my practice. As a very small practice, I do my best to keep up on internet privacy trends and techniques in order to safeguard my clients' privacy. I use this Electronic Health Record System (EHR) and their staff of developers along with some other services, such as Mentegram, to safeguard your health records in HIPAA-compliant software. I absolutely CANNOT erase all electronic trace of you and I being connected, however because that lives in your email, your browser history, and perhaps elsewhere that I have no control over. The things we do have control over are listed below:

Correspondence
Email can be a wonderful way of scheduling visits, collaborating on homework, and staying in touch between therapy appointments. I use an electronic medical record site called Counsol.com to help facilitate secure email communication with my clients. I ask that anytime you need to communicate protected health information (PHI), you use only the Counsol system and not my katie@playfairconsulting.com email address. If we are working on career-specific goals and you wish to send me a professional document, such as a resume, via katie@playfairconsulting.com, that is perfectly ok with me. It is also ok to set appointments using regular email. If you send me a document or email to katie@playfairconsulting.com, I cannot guarantee the confidentiality of the correspondence.

Facebook
I have both personal and professional Facebook pages. I do not accept friend requests from current or former clients because doing so would compromise your confidentiality and the professional nature of our relationship. I do allow current or former clients to "like" my Playfair Consulting page but request that you think carefully before doing so. I also suggest strongly that you not write reviews on our work together or "check in" saying that you were at my office, as both can compromise the confidential nature of our relationship.

If we discover, during the course of our work together, that we have mutual friends or acquaintances, (perhaps identified by Facebook), we should discuss those directly in therapy and arrive at a mutually comfortable and ethically-sound way of navigating those relationships.

Blog
I write a blog on my website so that clients, potential clients, other counselors, and anyone interested in therapy issues, can hear my views on issues in counseling. I do not stop anyone from commenting on my page but note that if you have an easily recognizable screen name, you may be compromising your confidentiality by posting comments on my blog. If I feel that you posting comments to my blog might be counter productive to your therapy goals, I may choose to take down your comment. It is probably best for us to discuss your reactions to anything I write in my blog, during session.

LinkedIn
I maintain a LinkedIn profile to connect with other professionals and to maintain my "resume" online. This information is public and I welcome my clients to review my LinkedIn profile at any time. If we are working together on career counseling issues, I may also review your LinkedIn profile to see what prospective employers might see if they look for you on social media. I will ask your permission before I do that because I must ask your permission before I look up ANYTHING about you online. In general, I cannot accept LinkedIn invitations from clients but am open to discussing the issue if you feel that such a connection would be highly beneficial to your therapy. LinkedIn is one grey area in terms of counselor-client electronic connections.

Google, Google+, Angie's List, other review sites, etc.
Social media sites like those listed above can be really helpful to others looking for professionals of different types and you may very well feel like writing a review of our work together on one of those. In general, I like to discourage clients (and anybody really) from writing reviews about therapy experiences because although you may feel open about having sought therapy today, you may change your mind at a later date. Anything you say on the internet is permanent.

If you feel motivated to say something positive about your experience working with me, thank you and we should talk about it in session! If you feel very negative about our work together, I would very much like to get your feedback so I can improve my practice. Of course, if you are very concerned about something that happened in therapy, I also invite you to tell the Oregon Board of Licensed Professional Counselors and Therapists as they are my licensing agency and have the power to discipline me if I am not meeting the standards of my profession.

Remember that counseling is about helping you and you should always feel comfortable asking me about connections you would like to have with me. Even if I cannot accept your electronic connection, talking about it can be a very powerful tool in therapy!

By signing this form, I certify: ● That I have read or had this form read and/or had this form explained to me. ● That I fully understand its contents including the risks and benefits of the procedure(s). ● That I have been given opportunity to ask questions and that any questions have been answered to my satisfaction.

Katie Playfair, MA, LPC

Professional Disclosures

The purpose of this document is to provide you with summary information about my qualifications, practice, and the rights you have, as the client of a Professional Counselor under Oregon Law (ORS 675.755 and OAR 833-050-0020). All clients in my practice will be provided with an extensive orientation packet ahead of a first in-person appointment that expands upon each of the points, below.

Philosophy and Approach

My general approach to counseling draws from Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT). I work collaboratively with my clients to understand their symptoms and goals and then we approach changing thoughts and actions through techniques that are supported by current scientific evidence.

Formal Education and Training

I hold a Masters Degree in counseling psychology from the Pacific University School of Professional Psychology and a Bachelors Degree in psychology from the University of California at Berkeley.  My coursework and clinical training have focused on counseling adults, older adolescents, and couples, using behavioral approaches, in individual and group settings.

Licensing, Ethics and Supervision

I am a Licensed Professional Counselor with the Oregon Board of Licensed Professional Counselors and Therapists and I abide by its Code of Ethics and that of the American Counseling Association. I regularly participate in training, consultation and supervision with other counseling professionals to maintain and improve my clinical skills (and as required to maintain my license). I do not share identifying information of my clients during my supervision and consultation sessions.

Fees and Payment Policies

I offer one free 20-minute consultation session via phone for new clients, so that we can explore whether my skills match the challenges the client faces. Thereafter my fees are governed by the attached fee schedule. Appointments cancelled with less than 24 hours of notice will result in the client being charged the full session fee.

As the client of an Oregon Licensed Professional Counselor, you have the following rights:

1.      To expect that a Licensee/Intern has met the minimum qualifications of training and experience required by state law;

2.      To examine public records maintained by the Oregon Board of Professional Counselors and Therapists and to have the Board confirm credentials of a Licensee;

3.      To obtain a copy of the Code of Ethics for Professional Counselors;

4.      To report complaints to the Oregon Board of Professional Counselors and Therapists;

5.      To be informed of the cost of professional services before receiving the services;      

6.      Freedom from discrimination on the basis of race, religion, gender, or other unlawful category while receiving services.

7.      To be assured of privacy and confidentiality while receiving services as defined by rule and law, excluding the following exceptions:

  Reporting suspected child abuse;

  Reporting imminent danger to client or others;

  Reporting information required in court proceedings or by client's insurance company, or other relevant agencies;

  Providing information concerning licensee case consultation or supervision;

  Defending claims brought by client against licensee;

You may contact the Board of Licensed Professional Counselors and Therapists at 3218 Pringle Rd SE #120, Salem, OR 97302-6312. Telephone: (503) 378-5499 Email: lpct.board@state.or.us Website: www.oregon.gov/OBLPCT

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Understanding Medical Insurance

We have prepared this letter to help you better understand the complexities of using medical insurance for counseling. Technically, counseling should be covered like any other medical service you would get from your doctor but as you might have experienced, insurance billing is very complicated. We hope this helps clarify some common questions.

Who defines what gets paid?
All levels of payment by insurance companies, including allowed fees, the definition of "usual, customary, and reasonable" (UCR) are dictated by insurance companies. It's what they're willing to pay for. Playfair Consulting fees are based upon a combination of our costs, our time, and our dedication to high-quality care. Thus, there is often a discrepancy between the amount covered under your policy's UCR schedule, and the actual cost of the treatment.

If Playfair Consulting is contracted with your insurance company, then we've agreed to accept their allowed fees for their customers only. However, sometimes we have to draw a line in order to stand up for proper treatment. Some insurance companies have recently started restricting treatment to 45 minute visits. For some clients, this is ok but for others, we have to insist on 60 or 90 minute visits. First, we ask your insurance company to pay. If the insurance company won't pay, we will have to have a difficult conversation with you about paying for longer treatment out of pocket and the risks and benefits of using shorter treatments when longer ones are indicated.

The insurance company also gets to dictate what codes they consider "office visits" which may be charged by "copay" and what they consider "procedures" which may be subject to your deductible. You can find out for sure by calling to ask them questions outlined below.


How will my claim be processed?
1. Preferred/Contracted Provider - If Playfair Consulting, LLC or Katie Playfair, LPC are contracted with your insurance company, the insurance company will receive the claim, pay Playfair Consulting according to the "agreed amount," and you will pay Playfair Consulting for your copayment or coinsurance. If you have a deductible, you may have to pay Playfair Consulting 100% of the fee until you've reached your deductible.
a. Example (Using a round fee number of $100 for the example. Please check actual fees pages for current rates): Playfair Consulting is contracted with Acme Insurance and we send Acme a claim for a 60 minute session for $100. You have a $20/visit copayment. Let's say, for example, that Acme Insurance defined an "allowed amount" of $90/visit for their customers. In that case, Playfair Consulting bills Acme for $100 and writes off $10. Acme pays Playfair Consulting $70 and you owe $20 in copayment.


2. Out of Network Billing - If Playfair Consulting, LLC or Katie Playfair, LPC are NOT contracted with your insurance company, we will provide you with a coded bill called a "superbill" that will give you with all information you need to file a claim with your insurer. We ask that you pay us for your office visit at the time of your appointment or that we mutually agree to a different payment schedule. Your superbill should be ready 24 hours after your appointment. Some clients choose to submit claims to their insurer after each visit while others "batch" them each month. 

Your insurer will receive your claim and process it according to your out of network benefits. We are happy to do our best to interpret your out of network benefits so you know what to expect, but if you want to be certain about how much out of pocket expense you will incur, please call your insurance company ahead of the first visit.

Your Mental Health and Physical Health Insurance Might Be Different!
It used to be if you had health coverage through say, PacificSource, you also had mental health care coverage through the same company. For most insurance plans originating in Oregon, that's still the case. HOWEVER, nationally, many employers are splitting off behavioral health care from medical insurance. You may have an Aetna medical plan and a Optum behavioral health plan. Most of us don't pay attention to these details after open enrollment season until we actually go to use the benefit.

If we have access to your insurance company's system, we are happy to do a quick online benefits check to give you an idea of how your visits will be covered ahead of initiating counseling. However, information available to us through online portals is often incomplete and sometimes inaccurate, especially for plans originating outside Oregon, Washington, or California (the west coast states have pretty similar insurance laws). If you want to be certain about how your visits with Playfair Consulting will be covered, please call your insurance company ahead of your first visit and write down the name of the representative who gave you the estimate.

When you call your insurer, ask them the questions below.
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Is Katie Playfair or Playfair Consulting, LLC in your network? (Tax ID 46-3014896)
If so, how will my in network benefits be paid? If not, how are out of network benefits paid?
Do you cover code 90791 for a first visit and code 90837 (60 minute visit) for visits thereafter? If not, do you cover 45 minute visits (90834?)
Are there limits to how many visits I can have per year?
Do you have any limits on diagnoses not covered?
What are my out of pocket costs per visit?
If Katie is not a preferred provider, what is the "allowed amount," that you are basing your claims processing on for code 90837? How about 90834? (This is what they're willing to consider a reasonable amount for the visit which is often less than practitioners in the community charge)
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Once you know this information, please bring it to your first counseling session and we can help you estimate out of pocket costs.

IF YOU FILL OUT OUR INSURANCE FORMS WITH POLICY INFORMATION, YOU AGREE TO THE FOLLOWING:
By completing the insurance forms on this site, which will be available to you after you've registered, you are authorizing Playfair Consulting, LLC and/or Katie Playfair, LPC to invoice your health insurance company or other third-party payer for services you receive from us. If we are an in-network provider this includes us electronically submitting claims for you and answering your insurance company's questions, should they have any, about your treatment. If you fill out the insurance form and we are an out of network provider, you will submit claims using the superbill method, described above and you are authorizing us to answer your insurance company's questions, should they contact us about your treatment. If you do not fill out the insurance form, we will refuse any contact with your insurance company to protect your privacy. 

Please review the following caveats and acknowledge your understanding and agreement to the terms below.

1. Insurance companies/third party payers don't usually cover fees for missed appointments, telephone consultations, career counseling that is not secondary to a mental health issue, and certain other types of services. It is very likely that if we provide those types of services to you, they will not be reimbursed by your insurance.
2. Insurance companies don't always cover services we recommend. Usually they do, but our recommendation is not a guarantee of reimbursement. We bill code 90791 for a first visit, 90837 for a 60 minute session or code 90834 for a 45 minute session. Please ask your insurance company if they reimburse for 90837 or if their default is 90834. If they only reimburse for 90834 (45 minutes) and if you have medical necessity, we need to discuss how we can appeal that decision as most of our treatment takes at least 60 minutes per meeting.
3. Insurance companies require that we provide them some information about your treatment before reimbursing claims. It is likely we will need to include your name, date of birth, other identifying information, a diagnosis or some justification for why we are working with you, and general reports of what we did in therapy (for example, a 60-minute session). Insurance is a highly regulated industry and so they ought to be keeping all of this information confidential but we do not have direct control over what they do with claim information once we submit it.

4. If you do not meet your insurance company's definition of "medical necessity," they may not pay claims. Some carriers do not cover certain diagnoses. We cannot assign you a diagnosis you do not meet the criteria for, as that is insurance fraud. If you no longer meet criteria for your diagnosis, your insurance company may not cover ongoing therapy. We will make every reasonable effort to notify you if we suspect a change in your diagnosis may result in less reimbursement but we cannot guarantee that any insurer will cover any particular condition. 

If you choose to complete the insurance forms contained in this site, you agree to allow Playfair Consulting, LLC or Katie Playfair, LPC to release all necessary information about services we provide you, to your insurance company for the purpose of reimbursement. You authorize direct payment to Playfair Consulting LLC or Katie Playfair LPC, for these services. If your insurance company pays you rather than us, you agree to pay your invoice in full.

It is your responsibility as the client to obtain authorization from any third party payer, prior to the first appointment you have with us and it will be your responsibility to pay for all services rendered and charges incurred that are not covered by a third party payer.

Finally, plan provisions change from year to year. It is ultimately your responsibility to know how your plan changed from one year to the next.

By signing below, you acknowledge that you have read this information and understand that Playfair Consulting will invoice you for costs not covered by your insurance policy (except as prohibited by Preferred Provider contracts we have with some insurance companies).

We offer a range of counseling and consulting support to individuals and organizations. Below are descriptions of our most commonly used services. If your visits are paid directly to Playfair Consulting because we are a contracted provider with your insurance (PacificSource & Lyra at of the time of publication), these rates do not apply directly to you for covered services but may apply for your coinsurance amounts. We know that information on billing for health/medical services can feel like a foreign language so please let us know if you have questions about rates and billing practices. 

The big thing to know here is that if you plan to submit claims out of network for to you health insurance company, it's important to select sessions with a CPT code - 90791, 90837, 90834, etc. as that will prompt us to maintain your file in such a way where we believe our documentation will pass your insurance company's audit for medically necessary counseling. 

Mental health psychotherapy 

Psychotherapy services are medically-necessary sessions that are often considered reimbursable by insurance. They must be delivered by licensed mental health providers in our offices or via secure video conference and only to clients in Oregon and Washington. Following each session, clients will be provided with a coded bill that contains all information necessary for to submit a claim to health insurance companies.

Counseling and Consulting - Not "medically necessary"

Counseling's scope extends well beyond treating diagnosable psychological conditions. Some clients simply need someone to talk to who is not part of their daily life to provide additional support and perspective. We perform supportive counseling, small business coaching, career counseling, and other counseling services that do not meet the definition of "medically necessary" under this category. Most of these services must be delivered only to clients in Oregon and Washington by licensed mental health professionals in our offices.

All services here can be delivered completely flexibly upon mutual agreement of counselor and client including via phone, text, email, video conference, or in-person. Please note that invoices for these services will not include CPT and ICD-10 codes necessary to seek insurance reimbursement.

*Typically delivered via email, text, or phone

Out-of-session services

Many of our clients find it helpful to have our consulting staff provide perspective and insight on a variety of issues outside of scheduled meetings. Naturally, we can provide advice only from the perspectives of counselors or consultants and these services are not a substitute for appropriate legal, accounting, or other professional advice.

Common things we help with include:

-       Completion of leave paperwork for FMLA, disability, ADA accommodations, etc.

-       Assistance with resumes, cover letters, CVs, and LinkedIn profiles

-       Reviewing job offers, providing advice on negotiation, and assisting with wording

-       Coaching on non-medical counseling/consulting homework between sessions

-       Modeling introductions to colleagues or help with networking

-       Referrals to other professionals to help with work-related issues that may be beyond the scope of our team

-       Consultation with client medical team members for non-medical counseling/consulting services (these are included with medically necessary psychotherapy services)

All out of session services are billed at the rate of $100 per hour and will be prorated to the nearest 15 minutes.

It is typical for clients to set a budget for out-of-session support. For example: "Please spend no more than 30 minutes reviewing my resume and cover letter for this job application." By setting budgets and clear expectations for these services, clients remain in control of what they spend. 

By signing this policy, you acknowledge receipt of these rates.