APPOINTMENTS
Services are by appointment only. The length of the appointment time varies on
the basis of services provided. Individual therapy is generally scheduled for 45
to 50 minutes, and this is known as the "clinical hour". Because the appointment
is reserved for you, it is necessary to charge $75.00 for appointments which are
not canceled 24 hours in advance, unless in fact they are occasioned by
circumstances which we would both define as an emergency. Failure to provide a
24-hour notice of cancellation generally means that some other person is not
able to use that appointment time.
CONFIDENTIALITY
You should be aware that there are various issues that might affect the limits
of confidentiality in your relationship with our practice and your therapist.
Generally, there are three main areas where confidentiality is limited. First,
if you disclose any information that relates to suspicion of child abuse or
elder abuse, certain State laws may mandate disclosure to authorities. Second,
if you make specific threats against another identifiable person or yourself and
it is believed that this is serious and can be carried out, then limitations may
apply. The third area concerns issues which might threaten national security.
Additionally, you should be aware that current legal cases nationally have
allowed release of records against the patient's wishes in matters having to do
with child custody where the Court has held that the rights of the child to know
such information have outweighed the individual's right to confidentiality. In
addition, a recent law in Kansas may allow under certain circumstances
disclosure of records to the Behavioral Sciences Regulatory Board under subpoena
if there were to be serious misbehavior or illegal activity by anyone in our
group. You should be aware that we will always try to preserve your
confidentiality rights and specific questions can be addressed with your
therapist or Dr. Cappo in this regard. This information is provided to keep you
as fully informed as possible of any potential limitations of confidentiality.
Practitioners in our group will occasionally consult other professionals
regarding your case so as to better serve you. Specific identifying information
is not disclosed and some details may be changed so as to assure
confidentiality. Also, you should be aware that privilege and confidentiality
apply only to the identified patient. If you are seen in an adjunct or
collateral fashion, then you do not have these rights as outlined. An example
would be a patient's spouse who is not an identified patient but who is seen in
session for the benefit and progress of the patient. Our new building uses video
surveillance for security. Some images are viewable by our staff and employees
and are not recorded in any form. Some images are stored electronically on a
hard disk that is then overwritten when full. Only in the case of an incident of
some type are the stored images reviewed. If you have any questions or concerns
in this area please talk to Dr. Cappo.
MESSAGES
During regular office hours, calls are answered by the receptionist in the
office. In the evening, calls are answered by an answering service and if there
is an emergency they will contact your therapist.
Please be aware that if you subscribe to certain telephone features, that
this may affect confidentiality or our ability to contact you. If you have
Caller-ID services and we phone from the office, then our practice name may show
up on your Caller-ID and be available to others in the household. We do not
block the Caller-ID signal in outgoing calls from our office. Also, please be
aware that should your telephone not accept any blocked calls, then it may limit
our ability to contact you at times. There are times when only blocked calls may
be available from specific locations. If we are calling from one of those
locations and your telephone does not accept blocked calls, there will be a
delay in eventually contacting you. If you have concerns along these lines,
please discuss this with your practitioner.
INITIAL CONTACT
Your initial appointment is often called an "initial evaluation." This
appointment is scheduled for you to discuss your concerns and problems from your
point of view. There may be time during this appointment to obtain historical
and other background data or this information may be gathered at subsequent
sessions. In situations of crisis, the usual format of an "initial evaluation"
is not followed in the hope that the time might be used to resolve or relieve
the immediate crisis. As part of the "initial evaluation" new clients are
sometimes requested to complete at least one questionnaire concerning their
beliefs, experiences, thoughts and feelings which will then be scored using
statistical norms. The results of this "psychological test" will allow us to
"measure" your concerns and problems. This booklet contains a copy of our
Policies and Practices to Protect the Privacy of Your Health Information. You
should review this information and ask any questions of your provider or Dr.
Cappo. You should be aware that email is not a secure and confidential
medium and that by emailing us and receiving a reply back through email you
acknowledge this.
TREATMENT
We expect and encourage you to obtain knowledge of the procedures, goals, and
possible side effects of psychotherapy. We expect to make our professional
contact one where you receive the maximum benefit, and we will also keep you
informed about alternatives to psychotherapy. Psychotherapy may be tremendously
beneficial for some individuals while, at the same time, there are some risks.
The risks may include the experience of intense and unwanted feelings,
including: sadness, anger, fear, guilt or anxiety. It is important to remember
that these feelings may be natural and normal and are an important part of the
therapy process. Other risks of therapy might include: recalling unpleasant life
events, facing unpleasant thoughts and beliefs, increased awareness of feelings,
values and experiences, alteration of an individual's ability or desire to deal
effectively and harmoniously with others in relationships, changing employment
settings and changing lifestyles. These decisions are a legitimate outcome of
the therapy experience as a result of an individual's calling into question many
of their beliefs and values. Your therapist will be available to discuss any of
your assumptions, problems, or possible negative side effects of your work
together.
TERMINATION
Termination of psychotherapy may occur at any time and may be initiated by
either the patient or the therapist. We request that if a decision is being made
to terminate, that a final termination session be scheduled to explore the
reasons for termination. Termination itself can be a constructive, useful
process. If any referral is warranted, it will be made at that time.
PATIENT'S RIGHTS
At any time, our patients may question and/or refuse therapeutic or diagnostic
procedures or methods, or gain whatever information they wish to know about the
process and course of therapy. Patients are also assured of confidentiality
which is protected by both ethical practice and by Kansas law. There are,
however, important exceptions to confidentiality that are legally mandated. In
general terms, these exceptions include: (1) Possible notification of relevant
others if we judge that a patient has an intention to harm another individual or
themselves; (2) we are also obliged by the law to report any incidence of
suspected child abuse, neglect, or molestation in order to protect the children
involved; (3) in legal cases, we or our records may be subpoenaed by the court.
Confidentiality will be respected in all cases, except as noted above, and in
those additional cases where in our clinical judgment the maintenance of
confidentiality is, in fact, destructive to the individual. In those situations,
we will inform our patients of our judgment and they will have the final
decision as to whether we maintain confidentiality. Please understand that all
files are kept confidential in their use by the staff of Clinical Associates,
P.A. Your written consent is required for any release of information by Clinical
Associates, P.A. staff to other persons, organizations or agencies except in the
rare cases of court orders, child abuse, life threatening situations and
national security issues. If you provide us a fax number with instructions to
fax information to you, we cannot assure confidentiality or security at the
receiving end. Also be aware that while your provider may be available to you by
e-mail, this also is not a secure or confidential form of communication. If you
receive a response by e-mail, then such information should not be forwarded to
others and should be considered specific to your private use. There may be other
relevant exceptions to confidentiality which are not included here or that arise
following printing of this document. Please ask your therapist or Dr. Cappo any
questions you may have in this area. You have the right to discontinue at any
time, except in cases where the treatment or assessment has been ordered by the
court. Clinical Associates, P.A. may discontinue treatment if it becomes
reasonably clear that you are not benefiting from treatment.
Disclosing information received from other agencies or doctors is subject to
the Drug Abuse Office and Treatment Act of 1972 (21 USC 1175) Comprehensive
Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of
1970 (42 USC 4582) as follows:
Prohibition on Redisclosure: This information has been disclosed to you from
records whose confidentiality is protected by federal law. Federal regulations
(42 CFR Part 2) prohibit you from making any further disclosure of this
information except with the specific written consent of the person to whom it
pertains. A general authorization for the release of medical or other
information if held by another party is not sufficient for this purpose. Federal
regulations state that any person who violates such provision of this law shall
be fined not more than $500 in the case of a first offense, and not more than
$5,000 in the case of each subsequent offense.
PATIENTS WHO ARE DEPENDENTS
If you are requesting our services as the guardian or parent of a child, or the
guardian of a dependent adult, the same general practice as outlined above will
apply. However, as your child's therapist, it is important that your child is
able to completely trust us. As such, we keep confidential what your child says
in the same way that we keep confidential what an adult says. As the parent or
guardian, you have the right and responsibility to question and understand the
nature of our activities and progress with your child, and we must use our
clinical discretion as to what is an appropriate disclosure. In general, we will
not release specific information that the child provides; however, we feel it
appropriate to discuss with you, the parent or guardian, your child's progress
and your participation in their treatment. Children over the age of 13 have
specific rights and should sign pertinent forms in addition to their parent or
guardian.
CHARGES
The fees for our services are based on the usual, customary, and reasonable fee
profiles for this area. Our charges are as follows: An initial diagnostic
interview is $180.00. An individual session (45 to 50 minute clinical hour) is
$150.00 and a 25 to 30 minute individual session is $85.00. Group therapy is
$120.00 for a 90 to 100 minute session. Family conference sessions are $175.00.
The fee includes our time on your behalf for record keeping and preparation. Psychological evaluation is $225.00 per hour.
Court appearances are $180.00 per hour, door to door. We encourage you to discuss fees
at any time, and our patients are expected to pay for services when provided
unless arrangements have been made in advance. With limited exceptions, when our
psychological reports are sent to a third party, payment in full is necessary
prior to release of our findings. For your convenience, we accept Mastercard,
Visa, and Discover. Please feel free to discuss any concerns about fees with
your therapist directly.
Payment is expected at the time services are rendered unless other specific
arrangements have been made. Payment of fees is an important part of our work
together. Please discuss fee issues with your therapist directly should you have
difficulties or concerns. Dr. Cappo is always available to discuss fees with you
personally regarding the practice.
Please understand that failure to pay your bill may result in specific
information being disclosed to a collection agency to facilitate payment. This
information would include demographic information including your name, how you
might be contacted, the amount you owe and for what specific services. Specific
clinical information about your problems will remain confidential.
You will receive written notification that this will happen at the address
supplied to Clinical Associates, P.A. You will be notified of a date by which
you must contact the office to make arrangements for payment or have your
account turned over to collection. It is your responsibility to maintain
accurate phone and mailing contact information with our office.
BILLING AND TRANSCRIPTION
Our office contracts with reputable third parties at times to provide various
support services. Such services could include, but are not limited to
transcription or billing. Any vendor who provides such services to us is
committed to the same levels of confidentiality that we apply here in our
practice.
CONFLICT OF INTEREST
Dr. Cappo has a financial interest in STAT Corporation which provides support
services, including transcription to our practice. Additionally, he is a
consulting psychologist for the Overland Park Police Department and provides
psychological services to Prairie Village Police Department, KU Medical Center
Police Department and Johnson County Community College Security Department. He
performs work on a regular basis for Miami County Mental Health Center in Paola,
Kansas. He also has contracts with the Federal Bureau of Prisons and the Federal
Drug & Alcohol Prevention Services Program to provide both mental health and
substance abuse evaluations and treatment. He provides services to the Drug
Enforcement Agency (DEA) and Transportation Security Agency (TSA) and may
provide services to other governmental entities or agencies which may not allow
affiliation disclosure by name. Dr. Russell is affiliated with Sprint. Mike
Crowley also practices at Miami County Mental Health Center in Paola. Jeff
Cowan, Rennie Shuler-McKinney and Jana Bremenkamp are affiliated with Shawnee
Mission Medical Center. Jana Bremenkamp is also affiliated with Shell. Dr. Chiasson is affiliated with Johnson County Mental Health Center. It may be that
you would qualify for services under these programs at a different rate than you
would be charged through our practice. It may be that you would be eligible for
different rates from our providers at the various other organizations with which
they are involved. If you believe that this may be the case, you should discuss this
with your provider, the front office staff or Dr. Cappo.
INSURANCE
If you have a health insurance plan, your visits may be reimbursed by your
insurance company. Our office will file most insurance claims for you. Your
signature on the appropriate form allows our office to release relevant
information to facilitate reimbursement. At your request, we will be happy to
discuss with you the "diagnosis" that we are releasing to your insurance
carrier. While a patient's diagnosis is very sensitive information and is
generally treated as such by insurance carriers, we cannot guarantee how any
particular insurance carrier or employer respects this information. If you
prefer that we do not release information to your insurance carrier for
reimbursement purposes, or if your insurance carrier fails to reimburse you in a
manner which you expected, you will remain responsible for the fee for services.
Many individuals are members of preferred provider plans or health
maintenance organizations with whom we have contractual obligations. Please
inform us in advance should you be eligible for these contracted services. It is
the patient's responsibility to obtain insurance pre-authorization for all
office visits. Failure to do so may result in out-of-pocket expense.
In situations where there is a court order, mandate or recommendation, it is
often the case that an insurance company or managed health organization will not
find medical necessity. This is explained up front in such cases and we ask that
a form be signed, stating that the individual knows that they are responsible
for all charges incurred whether or not they are covered by insurance.
We again welcome you and anticipate our work together will be beneficial to
you.
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