Policies and Services Agreement

Policies and Services Agreement

Therapy sessions at the Karen Horney Clinic are available in person and via telehealth. Telehealth encompasses any method other than in person sessions. If telehealth is suitable for your therapy needs, you may opt for counselling solely through one medium or in combination. In person sessions take place at 329 E. 62nd Street, New York, NY 10065.

Patient Participation & Expectations

Refrain from using mind-altering substances prior to sessions.
Dress appropriately during web-based sessions as if attending an in-office session with the provider.
Ensure they are located in a safe and private area conducive to the session, such as a home office.
Refrain from having anyone else in the room during sessions without prior discussion with the provider.
Avoid engaging in other activities, such as driving, during sessions.
Prohibit the presence of any weapons during sessions.
Obtain the provider’s approval before recording any session.
Ensure minors have a parent or guardian present at the location/building during telehealth sessions, unless otherwise agreed upon with the provider.

In Person Sessions

In person sessions require proof of a recent Covid vaccination. You may request a change in service delivery mode at any time. You may be placed on a waitlist for in person sessions based on Clinic availability.

Telehealth

Telehealth sessions will be held via Doxy.me, (https://doxy.me ), an encrypted platform compliant with federal standards. Please log into your Doxy.me account at least 5 minutes before your session. You’re responsible for initiating the connection with your provider at the scheduled time. Once you enter, you’ll be in a waiting room until your provider admits you at the appointed time.

Benefits and Drawbacks:

The advantages and disadvantages of attending sessions either in person with your provider or via telehealth will vary based on your individual circumstances and preferences. It is recommended that you discuss your options with your provider. Telehealth should not be seen as a replacement for on-site therapy or medication provided by a healthcare professional, but rather as an alternative counseling method with potential benefits and limitations.

By signing this document, you confirm your understanding of the following regarding telehealth:

It may lack visual and/or audio cues, potentially leading to misunderstandings.
Service disruptions and variations in technology quality may occur.
It may not be suitable for crises, acute psychosis, or when experiencing suicidal or homicidal thoughts.
There might be delays or messages may not be received when using secure chat or texting.

When in doubt about your provider’s statements, clarify with positivity to minimize misunderstandings. Contact your provider by phone if lacking internet for telehealth. Risks include data interception and device compromise; while efforts are made to safeguard electronic communication, complete protection isn’t guaranteed. Use secure devices and avoid alternative communication methods. Be cautious of others accessing your devices; review privacy settings. Avoid social media messaging for contacting your provider and refrain from posting online reviews. Text communication may be documented. Your therapist will provide the After Hours Availability form in your initial session.

Privacy Protocol during Telehealth Sessions:

Sessions should always be conducted in a secure environment. If someone enters, acknowledge them, and your provider will pause or disconnect to protect privacy. You can request a different protocol. For phone sessions, identity verification is required via brief interaction or video conference matching your ID. In case of technology failure, use a phone as backup. Ensure your provider has your number. If disconnected during a video session, promptly restart; if unable to reconnect, contact your provider within five minutes. If no communication within ten minutes, your provider may call. For phone session disconnections, promptly call back; if unable to reconnect, provider will send a message via agreed-upon method.

Emergency Management for Telehealth:

By signing this document, you acknowledge and agree to the following safety measures:

You will inform your provider of your consistent session location and any changes.
You will designate an emergency contact on your application.
Your provider may assess your emergency contact’s ability to reach you.
Depending on risk assessment, we may verify your emergency contact’s ability and willingness to reach you in an emergency. If necessary, your provider may call 911 or arrange hospital transportation. We may also assess and require you to maintain a safe environment during your treatment.

No Shows

Failure to start the meeting at your scheduled time or contact your provider within five minutes of your session start time will be considered a no-show. Please notify your provider if you want them to contact you if you do not initiate your session within the first five minutes of the scheduled start time.

Cancellation and Missed Session Policy

At the Karen Horney Clinic, we require a 24-hour notice for appointment cancellations. No charge applies if you cancel with at least 24-hour notice, but late cancellations or no-shows (missed appointments) may incur a $35 fee. You are responsible for this charge, as insurance cannot cover missed appointments. Three consecutive missed appointments may result in a discharge review. For self-pay patients, fees are determined by the Monthly Budget Form, and missed appointments fees must be paid before further appointments. It’s essential to attend all scheduled sessions, as each appointment is reserved for you weekly. Full policy can be found on our website under “Forms”.

Financial Responsibility

You are financially responsible for all services if your insurance coverage is inactive, terminated, or does not cover our services for any reason. Please inform us of any changes in your coverage otherwise you will be held responsible for any non-covered services. Some carriers may require notification of your visit with us; please contact them to avoid additional financial responsibility. For out-of-network insurances, payment is due before each appointment, and you are responsible for 100% of the fee. All co-pays are your responsibility and due on the day services are rendered.

Attention all service agreement stakeholders:

In accordance with OIG guidelines, it is imperative to ensure compliance within our service agreement. This includes adherence to regulations set forth by the Office of Inspector General (OIG) to maintain ethical and legal standards.

If you suspect that a provider or recipient has committed Medicaid fraud, you can help by reporting to:

Phone: 1-877-87-FRAUD (1-877-873-7283)
Online: Complete an online form at www.omig.ny.gov/fraud/file-an-allegation
Mail: Complete and print a hard copy form and send it to: NYS OMIG Bureau of Fraud Allegations

For any questions or clarifications regarding compliance matters, please contact our Compliance Officer, Manjulika Chatterjee, at 212-838-4333 ext. 125.

Your cooperation in upholding these requirements is essential for the integrity and success of our operations.

Policies and Services Agreement Acknowledgment

If you have any questions about this policy, please discuss them with your therapist. Thank you for your cooperation.

By signing below, you acknowledge that you have received and read the Policies and Services Agreement, agreeing to its terms, which encompass the Telehealth Procedure, and Cancellation and Missed Session Policy.