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Terms and Policy

Initial Online Information & Consent
The information below contains information about the practice of Kurt LaRose MSW LCSW (and LICSW in the District of Columbia) for the Secure Client Area @ TalkifUwant.com.  It is necessary for all users to read, review, and accept these terms to begin services with the practice.  Please know that you are providing the practice with certain consents regarding billing, private health information, and obligations that are contractual and or required by certain standards of care and various mandates that govern mental health, behavioral health, clinical supervision, hypnosis and consultation services - between you and the practice of LaRose.


If you are seeking services with the practice as a NEW PATIENT, CLIENT, INTERN, or PEER, the practice is currently ACCEPTING NEW PATIENTS in OFFICE and DIGITAL SESSIONS (Chat, Video, Phone) and who are SELF PAY.  Nearly all office face to face sessions occur in Washington DC at the office of LaRose, with some Florida based onsite face to face services offered monthly. Hypnosis sessions are offered in both DC and FL and are arranged for office sessions based on a case by case scenario and based upon limited availability.  All parties seeking services with LaRose are served using multiple formats: face to face sessions by appointment, video/chat/telephone/shared journal and narrative  digital formats using this secure server.


New persons/clients will be asked to identify if they are a Florida Resident or a DC Resident upon logging in (you may be seen in the office of LaRose if you are from another state, and to identify what services are being sought.  At that time the calendar will be available for you  to schedule once you identify what services you are seeking, provide billing information and reasons for seeking services.  Only self pay clients are being seen by the practice of LaRose, whether digital or face to face options are chosen.  Supervision candidates (those seeking licensure supervision will be directed to alternative scheduling platforms after the initial consultation) where both face to face and online supervision hours can/will occur.


THE NAMED CLIENT/PERSON WHO IS BEING TREATED/SUPPORTED BY THIS OFFICE, WHEN THE CLIENT IS 18 YEARS OF AGE OR OLDER, IS THE ONLY PERSON WHO CAN LEGALLY AGREE TO THESE TERMS AND COMPLETE THE DIGITAL APPLICATION PROCESS. MINOR CLIENTS ARE NOT BEING ACCEPTED BY THE PRACTICE AT THIS TIME UNLESS GUARDIANS HAVE A SPECIALTY REFERRAL DUE TO THE COMPLEXITY OF THE CASE (PARENTS SHOULD NOT SCHEDULE A MINOR CLIENT WITHOUT THE REFERRAL AND PRE-APPROVAL OF ACCEPTANCE OF THE MINOR CASE WHERE A HIGHER LEVEL OF MINOR EXPERTISE AND CASE COMPLEXITY NECESSITATE CARE).  OTHERWISE MINORS ARE NOT SERVED IN THE OFFICE AT THIS TIME.

By giving your consent below, you are stating that you are the client and by digitally signing below, you as the legally named party (the client or the medical guardian on behalf of another adult client), agree that you have read this information and that you are providing your legal consent related to each of the following sections:

===> CONSULTATIONS

===> REGISTRATION, SECURITY & CONFIDENTIALITY.

===> RECORDS STORAGE, CLIENT UPLOADS & REQUIRED CONSENT TO RELEASE.

===> AUTOMATIC ELECTRONIC INVOICES & TERMS OF VALIDITY.

===> USPS PAPER INVOICES AND DISPUTES.

===> FEES, PAYMENTS, REFUNDS, COLLECTIONS, CREDIT BUREAUS and BILLING AGENT.

===> NEWS

===> FACE TO FACE and ONLINE INCLUSIONS and EXCLUSIONS DUE TO REGULATIONS.

===> NON-24 HOUR CANCELLATION POLICY.

===> ACCOUNT ADJUSTMENTS.

===> MENTAL HEALTH ONLINE, SAFETY, CONFIDENTIALITY AND RELEASE OF RECORDS, LICENSING, and MALICIOUS BREACH.

===> ONLINE AND SOCIAL MEDIA PRESENCE, CLIENT REVIEWS AND DIGITAL ETHICS DISCLOSURES.

===> ANNUAL RENEWAL FOR BILLING PRACTICES, HIPAA, AND POLICY UPDATES AUTHORIZED BY USERS

===> ONSITE SERVICES, ON LOCATION SERVICES, SUPERVISION, PROVIDER DEVELOPMENT, CONCIERGE AND ANNUAL RETREAT SERVICES


REGISTRATION, SECURITY & CONFIDENTIALITY. All client records are stored and maintained via the secure digital profile, thus your site registration is necessary to facilitate and manage electronic health records. Confidentiality, Federal HIPPA and State Privacy Standards, as well as encrypted and password client/therapist communications all make the 2 - 3 minutes to sign up - well worth it.

CONSULTATIONS. Initial sessions are billed to the card on file (unless a special arrangement with LaRose is made or offered/chosen); these can occur by video, by chat, by telephone and in the office (where office services are available; limited to hypnosis office sessions in FL and offered effective 2/1/18 in DC).  For initial consults both face to face and online clients will need to show their photo ID's and show their credit card (for verification purposes of the name and the last 4 digits of the credit card and to establish residency where LaRose is licensed to treat) during the consultation.  All appointments can be scheduled for the office, phone, web conference, or chat here in the server, 24 hours a day!  Text reminders of the sessions are sent 24 hours in advance, along with email reminders.  Clients may cancel their sessions in the server PRIOR TO A 24 HOUR WINDOW. 

RECORDS STORAGE, CLIENT UPLOADS & REQUIRED CONSENT TO RELEASE. Most people know that mental health professionals gather information related to personal experiences and histories. Private journals, uploading of diagrams, photos, or scanned drawings, and secure emails make the client portal an ideal platform. Encrypted case notes, client notes, insurance information, intake forms and billing records are available for online updates 24 hours a day. Except in specific legal scenarios (safety, court order, regulatory investigations, and in some third party contract terms) your private health information is protected unless/until you give written consent for release. In certain scenarios "privilege" is exercised with your records even with written consent, meaning the information may not be released without properly served subpoena and/or court order to the office of LaRose.

AUTOMATIC ELECTRONIC INVOICES & TERMS OF VALIDITY. Electronic invoices email 24 hours before your date of service (or at the starting time of the session). Appointments booked UNDER 24 hours will likely receive an INSTANT electronic invoice. INSTANT invoices may reflect a $0.00 balance and this amount is subject to change, depending on whether you are accessing a free consultation or if the service you are requesting requires a fee (emergency session requests will incur fees, whether new or existing and professional consultations will incur a fee, whether new or existing). In all scenarios where a balance due is realized (subsequent to any and all electronic invoicing) the electronic billing will be adjusted at the time of the session (or at the time a non 24 hour cancellation has occurred). All balances due are due at the time of service and/or at the time the fee is realized; balances are billed to the credit card clients provide in the server (the card must be in the name of the client).  Any payments that must be billed by traditional (USPS mail) are considered late and these are processed when a credit card is declined. Any USPS mailed invoice not paid within a 30 period are referred to the billing agency for the practice of LaRose who will mail an additional paper invoice and begin traditional collections procedures and credit bureau reporting.  All amounts due at the time of your first session, are billed at the current practice rate (see FEES... below for additional information).  

USPS PAPER INVOICES AND DISPUTES. Subsequent to any applicable adjustments, if a payment cannot be processed with the credit card on file, a secure email notice will be sent requesting the client update the card to a working card; also a text will be sent requesting an updated card to the cell/texting number your provide (personal email addresses and personal cell phone numbers are required to ensure your privacy).  When paper invoices must be mailed through the United Postal Service, they are mailed to the clients address as it is/was provided by the client at the time of scheduling. Any USPS mailed invoice is due upon receipt. Disputes must be mailed to the office of LaRose within 14 days of the original USPS postmark. Late payments, unless a financial arrangement is agreed upon and recorded by joint signatures, are reported to credit bureaus (see FEES, THIRD PARTY PAYOR, PAYMENTS, REFUNDS.... for more information).

FEES, PAYMENTS, REFUNDS, COLLECTIONS, CREDIT BUREAUS and BILLING AGENT. Payments may be made online, or in the office; cash, check and credit cards are accepted. All fees and payment terms are discussed here and all questions involving these practices should be discussed during your initial consultation; clients are encouraged to ask and to discuss any concern they have in this regard as the terms of this agreement are the final word on how such matters are handled and resolved. Fees for the initial consultation (unless it is an eligible free consult) will be charged to the card on file at the start of the session (after card is visually verified). The amount you agree to pay or that you are responsible to pay out of pocket, is collected at the time of service. The full hourly rate is currently $175 per hour as of 2/1/18, unless a group package or specialty service is/has been requested. Additional service options, special rates, concierge services, and non-specialty services such as hypnosis, with each related fee structure is available at http://www.TalkifUwant.com/prices_fees.htm.      

When billing agents, collection agencies, credit bureaus and in extreme cases legal counsel are involved to resolve balances, please be aware that the name of the client/person working with LaRose is identified as a client and when necessary it will include the release of the social security number, date of birth, mailing address, and phone numbers, as needed to effect collection and to record delinquencies.  Because the practice includes an automated billing and credit card processing platform collections are seldom necessary, particularly as and when clients/persons working with LaRose keep the credit card profile up to date.

NEWS. All patients and clients who are new to the practice and/or who are considering services with the practice have been notified to read the NEWS tab (click the question mark icon above) regarding actual and anticipated changes involving expanded services, professional biography information, client reviews and various videos related to the practice service and services availability.  Links to these and other relative topics are listed in the NEWS section of the server, and these can be reviewed PRIOR to or AFTER this registration is completed. 

The practice of LaRose is currently accepting new patients/clients who are SELF PAY, and who wish to be seen via office, face to face, onsite, remote services, and digital services, including video, chat, and telephone (via this HIPAA compliant secure server).  Face to Face sessions are almost always open to DC and surrounding state clients who are seen at the MetroCenter Office in downtown DC.  Both FL and DC patients/clients/supervisees can access online services 24 hours a day, with digi-mental health services (video/chat/telephone/Shared Journals and Narrative approaches) scheduled based upon calendar availability.  All face to face scheduling options are available as well in this server - which will be selected upon completed registration.  Special appointment requests are handled when clients send secure emails (in this server) requesting such (as certain communications cannot occur in a public domain email process).  In certain scenarios LaRose will schedule an office session for a new patient, however this option is not always available as the practice transitions to an increasing digital platform and expands services to a two state area  (where LaRose is licensed in both DC and FL).   


FACE TO FACE and ONLINE INCLUSIONS and EXCLUSIONS DUE TO REGULATIONS. LaRose is licensed to provide traditional talk therapy, clinical hypnosis and clinical supervision services in accordance with the licensing board standards in both jurisdictions, DC and FL.  Digital services, as an emerging area of practice, in both therapy to client and supervisor to supervisee (in licensure scenarios), has benefits and limitations and current regulatory bodies are significantly behind client demands; that is to say that while you may want to access digital services with the practice, you can only access such services if you are an actual resident of the same states where LaRose is licensed to practice in his areas of expertise FOR ONLINE SERVICES.  All clients who are seen face to face in the office of LaRose may be seen regardless of residency in DC, FL (or any other state) since you are being seen in the office of LaRose.  The reason for this condition, limiting online services access to residency, is that licensing boards in the US do not currently have a universal 50 state credential and licensing fee structure to provider online services across jurisdictions.  Online Summary: if you are resident of DC or FL and you wish to have video/chat/telephone and other online services you may do so at any time.  Face to Face Summary:  regardless of residency, if you are seen face to face in the office of LaRose, you may receive those services with LaRose. 

NON-24 HOUR CANCELLATION POLICY.  LaRose assesses fees for no shows and non-24 hour cancellations (without a documented medical or legal document) when the cancelled spot cannot be filled by someone else. If clients must cancel less than 24 hours, they will have to contact LaRose via secure server email/text as soon as they know they need to miss. LaRose will have to cancel a session when it is going to be missed with less than 24 hour notice.  When cancelled prior to the 24 hour notice, clients may do so at will in the server, without notification to the office of LaRose.  Clients are encouraged to cancel sessions online as soon as they know they cannot be seen and will be able to do so freely in advance of the 24 hour notice.  LaRose will make every effort to fill a non-24 hour cancelled spot, however except in medical and legal documented scenarios the no show fee is assessed. Cancellations prior to the 24 hour window, are the responsibility of the client, completed by clients using the online scheduling platform in the server.  The fee for non-24 hour cancellations is assessed at a reduced fee of $90 when requested, otherwise the cancellation fee is equivalent to the current hourly fee.  Deposits on hypnosis sessions, onsite services, and preplanned retreats cannot be refunded due to cancellations as numerous hours and scheduling adjustments are made to effect these specialty services. 

Payments, Refunds, Collections. All amounts due via electronic notification are billed until payment is received. At 30 days electronic billing may be transferred to the billing agent for USPS invoicing and collection procedures. The office of LaRose reserves the right to file any past due amounts with the billing agent, collections agencies, and credit bureaus.  Billing with the practice of LaRose may continue into perpetuity, or until such time as the balance is satisfied, due to the nature of automated online digital technology, or until and as limited by state and federal laws, if applicable. 

All person's using credit cards to make payment for services agree NOT to pursue charge backs because social service technology and information (therapy, counseling, psycho-education, communication based services and interventions) are non-refundable. In the event a refund is requested, a charge back is issued or a stop payment/returned check occurs, the original fees and all subsequent fees as a result of refund, chargeback or stop payment requests, will remain (and may increase the overall costs) the financial responsibility of the client. Charge backs, refund requests, stop payments on checks, returned checks and denied credit card payments will be referred to the billing agent for traditional collection procedures as soon as the office of LaRose is notified of such stop payment actions. If/when necessary the office of LaRose (and the services offered through the Talkifuwant secure portal) are forwarded to credit bureaus; once an account is transferred to a credit bureau, settlement and payment arrangements must be arranged with the appropriate bureau. Clients agree that if there is a fee dispute to resolve the matter with the practice.  Because fees are non-refundable, all efforts to stop payments as they are agreed upon here, are referred to collections, based on this agreement.  This is your (the client) agreement to pay for all services as outlined in this initial and online consent, effective for all services rendered for the duration of any amounts due, up to and until payment is received (even in perpetuity in cases where non-payment occurs and in cases where the law permits "in perpetutity" collections).

Billing Agency & Credit Bureau Procedures. A third party billing agency may assist the office of LaRose with billing practices when USPS services are initiated, and only the information necessary to facilitate billing and collection is released to effect collections. In cases where collections are referred to credit bureaus, the referral is labeled as "professional services" provided to a client name, address, ID information, and social security information (needed at registration in the event of non-payment for the purposes of registering to credit bureaus where default occurs) and the practice of Kurt LaRose MSW LCSW is named as well. Credit bureau reporting may have negative financial implications, thus clients are encouraged to determine acceptability of the services offered in the initial consultation. This is your (the client) agreement to pay for all of the costs for the services incurred by you (up to and including any costs added during a collections process). 


Hardship Fee Reduction Agreements and Discount Options for Fees.  If, after starting services with the practice, clients experience a hardship, and you (client) cannot afford the services provided by the practice, due to an inability to pay, reduced fee agreements can be requested based upon verifiable income, verifiable hardship, and a credit report requested by the practice on your behalf.  Hardships can and do occur in the course of therapy, and when documented and evidenced, the interruption of care is NOT recommended; it is in these scenarios where fee reduction agreements become an option.  Clients who are self pay and wish to obtain a discounted fee, not as a hardship but as an option in the bundling of services, are able to obtain a lower rate per session if they pre-purchase set numbers of sessions (see TalkifUwant.com/prices_fees.htm for the breakdown of packages) and when prepayment occurs.  These discounted packages are a "use it or lose it" package; for example, if clients purchase 24 sessions for a calendar year with a discounted prepayment fee and the client only uses 20 of them, the remaining 4 sessions expire at the end of the 12 month term. 


ACCOUNT ADJUSTMENTS. Credits and debits will be made electronically as they are realized to the client online secure billing profile, and any adjustments will be explained in a secure email in the server to the client. Any credit posted to the digital billing profile where a credit on the account balance is realized (in the event of automated electronic billing errors or when an over payment occurs) are refunded upon request of the client (or when realized by the practice using the card that was used at the time of the fees were assessed). In some cases the credit cannot be applied to a card on file (for a number of scenarios related to the merchant account and the server gateway) and in such cases a paper check will be mailed to the address on file in the secure server. The digital billing profile is accessible in the secure client area of the TalkifUwant.com website - 24 hours a day and clients agree to check the billing profile once notifications of fees and credits occurs; clients may elect to make payments (by clicking one button) in the billing profile as well.

MENTAL HEALTH ONLINE, SAFETY & 911, LICENSING, and MALICIOUS BREACH. Online communications in mental health service delivery is considered a non-traditional form of service. National Professional standards, specific legal limitations, and matters involving aspects of online communication that are not a factor in face-to-face sessions require consent.  Clients using such services acknowledge that these services are still, in 2018, considered non-traditional.  Confidentiality, for example, in a digital based session cannot be managed ONLY by the therapist; clients assume a responsibility in ensuring their own confidentiality during video/chat/telephone/secure email/shared journaling, and by NOT sharing their user names and passwords related to the secure server.  Other examples include the difficulty in determining safety if/when a video or chat session is interrupted (either by the client or by an act outside the control of the client and LaRose) and if in the course of a session safety risks are realized and cannot be determined in real time wellness checks are used to determine client safety (a wellness check involves having law enforcement visually determine a questioned safety concern is resolved).  Further, in chat sessions (or all other digital mental health services) it can be difficult to accurately read a situation with a client when the client is NOT face to face with the therapist.  Innuendo related to violence by journals and secure emails are strongly discouraged as asynchronous informational access (time lapses between the time it is recorded and when it is reviewed) may require immediate response time once realized.  


Online mental healthcare is a specialty practice.  LaRose has self published on the online digital services model in 2012, and was using digital mental health options before state, national, and association language addressing such uses were yet created (prior to 2012).  LaRose has been a National Association of Social Workers Florida State Lead Presenter on the topic of digital mental health services in 2016.  Additionally LaRose is heavily involved in consulting other online platforms in expanding the technology to other providers and other services (such as peer to peer online consults for licensing and situational collaborative interventions).  Either way, clients using digi-mental health are aware that it continues to be considered a non-traditional service.  As such, journaling, emailing, file sharing, even in the end to end encryption platform remains on the cutting edge of social services technology.  To date, the server has not been hacked; however the DOD, the IRS, BCBS, the DNC and other organizations of paramount security expertise have been; the risk of such occurrence is expressly noted and acknowledged.  HIPAA laws and rules govern the access of private health information and licensing standards govern the disclosure of peer to peer consultative information, when such events occur; this practice complies with the notification, sentinel events recording of, and corrections policies.  The practice has not experienced hacking since its implementation of the secure digital server in 2012.  The services with LaRose, as they are stored and recorded in the server are all HIPAA compliant in security (unlike many other video/chat platforms).


Use of Government and Business Email Accounts and Sharing of Server Usernames and Passwords.  Clients agree NOT TO DISCLOSE or SHARE THEIR SERVER USERNAME AND PASSWORD WITH ANY OTHER PARTY.  Clients agree to use their personal email address for communications with the practice of LaRose and in registering for services with the practice (clients should not use government email addresses and unless self employed controlling your own email account, clients should not use company based email addresses when registering and working with the practice).

Safety. Persons who are aware that safety is a relevant consideration in their mental health history (past or present) are encouraged to contact a mental health professional via telephone, rather than via online methods. Where safety concerns are compelling, users should contact 911 (24 hours a day). Safety threats via online communications may require quicker response times (particularly in cases where clients disconnect without consensus) to ensure client and other well being.  Matters of safety such as child and elder abuse, actual and imminent threats of harm, suicide and homicide risks are all assessed when/if these are reported by clients or suspected by LaRose.  Confidentiality standards, that is the release of protected health information and mental health records laws, are superseded by safety laws and standards of care.  That is to say, clients are advised and agree they are aware that in matters of safety risk determinations these matters are of a mandated reporting standard, and as such are reported to the appropriate regulatory and enforcement body.  While mandated reporting is often confidential from those who make such reports, it is USUALLY (not always) the practice of LaRose to explain the reporting and to assist clients in dealing with services that are provided outside the scope of the practice; mandated reports are not handled by the practice (only reported when the scenario is evident and/or reasonably suspected by the practice), as such the interventions and legal steps taken by the receiving party of the mandated report is handled and resolved between the client and the agency who handles such reports.   It is common during the course of mandated reporting for other information to be disclosed to the receiving agency - over and above the harm or risk of harm, such as diagnosis information, disability information, concerns about weapons, location of the client, etc.  It is also common for follow-up communications to occur between the receiving agency and the practice.  The exception to confidentiality is explained here to inform clients of other ways health and session related information could be shared, when/if safety risks are evident.


Confidentiality and Release of Records.  Mental health providers cannot acknowledge or deny knowing a client under any circumstances (outside of safety) without a written specific consent that explains what information is being shared, why it is being requested, if it is denied by the client what impact such denial may have on care, and how long the release is permitted.  Mental health providers cannot talk to family members, friends, or other providers about a client without written consent.  Likewise the practice of LaRose cannot obtain other provider information about a client, without written consent.  If another provider, based on client consent, releases information to LaRose, those 'other provider' records are scanned into the client digital file, after review, and the client is notified of such receipt and review in the secure server.  Those records can be discussed.  Providers cannot forward the records of another provider, even with client consent, and even if those records are scanned into the server.  Each provider must generate their own records and clients wishing for all records to be forwarded to a certain provider would need to sign a HIPAA compliant release for each provider to do so.  In the case of court orders, or subpoenas, the practice of LaRose must respond to properly served subpoenas and will do so.  Even with subpoenas clients are notified of the subpoena and they are asked if they would like to review the records that are court ordered, prior to a release (even if the subpoena is from the clients own attorney).  Clients have a right to review their records and they have a right to request that any errors be corrected; in the case where a client disagrees with the record (that is it is not factually or clinically in error) the client has a right to include a statement of their disagreement into their medical records, and the practice of LaRose will include such disagreements in the record to reflect the client notice.  Notification of a correction/error/disagreement can be made in the secure server, at the time it is realized, and LaRose will respond to the notice within a 14 day period (often within a day or two, due to speed of digital records storage, retrieval and generation).  Some records, those that are deemed to be the property of the provider, not the client, can be withheld in released records.  Usually, when a records request occurs, the entire file (excluding shared file attachments - as these are recorded and explained in all session notes) is generated, including treatment plans, progress notes, general notes, secure emails, shared journals, and all legal consent documents.

Licensing. Florida and DC licensing allows online sessions with residents of the state; out of state online requests, at least in the current evolution of social communications technology, is not yet standardized and is not permitted.  Online clients will be asked to show a valid government issued ID with their picture, DOB, and address on the screen (and to upload an image of such in the secure server email by clicking the square/64 icon in the email platform) at the time of or prior to online sessions.  This is done to ensure that LaRose is NOT treating clients online, outside of the jurisdictions where he is licensed.  Residents of DC and Florida who are traveling out of the state, can continue to be seen digitally, as long as they continue to be active residents while travelling (an added plus to online options).  US wide services generally cannot be provided (state licensing standards rule) online at this time as standards of care and regulatory bodies remain behind the current trends in social service digital mental health provisions of services.  All clients, regardless of residency, can be seen in face to face sessions in both DC and FL by appointment.

Malicious Breach. I (the client) agree that in the unlikely event of a breach of confidentiality involving encrypted/secure online communications occurs, it will be deemed a malicious and intentional act by the office of LaRose and TalkifUwant.com and the secure server linked to TalkifUwant.com (the secure client area). Upon awareness or suspicion that such acts are occurring, I understand that LaRose will contact the appropriate law enforcement authorities while releasing all information necessary to facilitate their investigation. I agree to cooperate fully with any law enforcement agency investigating a malicious confidentiality breach.  I (the client) agree that I will not attempt to breach any areas of the server during the course of my care; I understand that at anytime I may be blocked if/when suspicious behavior is recognized by the server.


Server and Practice Access.  Clients agree that while they have full 24 hour access  to online service options in the server, the server remains as the digital practice of LaRose.  As such, clients agree that LaRose, with or without notice, may limit or block client access to services in the server due to non-payment, verbal aggression that cannot be regulated by interventions (as in repeated requests and problem solving that does not cause verbal aggression to cease), misuse of any of the online services, including excessive scheduling and cancelling of appointments (as in taking more than the intended number of sessions simply to hold a spot and then later cancelling, excessively), or in the case of any other cause that LaRose may explicate by secure email in the server.

ONLINE AND SOCIAL MEDIA PRESENCE, CLIENT REVIEWS AND DIGITAL ETHICS DISCLOSURES. For more information on the developing standards in online social services communication, users may want to view ==> http://www.naswdc.org/ldf/legal_issue/2007/200704.asp  It is important that clients (you) understand that the HIPAA secure digital server as explained above and elsewhere is NOT THE SAME THING AS DIGITAL SOCIAL MEDIA PLATFORMS (Skype is a social media - non HIPAA secure platform; Facebook, Instagram, Twitter, and the like are social medai platforms).  In November of 2017 the National Association of Social Workers advanced and developed its social media and digital online policy statements in its national code of ethics.  The most recent governing protocols for the practice of LaRose can be found at: www.socialworkers.org (see code of ethics).  Clients using other digital platforms (social media), outside of the practice secure server (which is NOT social media), relating to the practice in any way, may run the risk of identifying themselves as a patient/client.  Users should use caution in other non-secure platforms.  LaRose maintains a large social presence on Twitter, Facebook, Linkedin, Instagram (and a myriad of other platforms). Users may access LaRose via other social medial platforms ONLY IN THE PROFESSIONAL ONES USED BY LAROSE; professionally practice related content is available using the #TalkifUwant.  Personal access is not permitted between clients and LaRose thus any link requests where such is known to be with a client and LaRose in a personal platform - will be refused by LaRose at the personal level.  Professional contacts @talkifuwant are okay, however disclosures of self as a client is NOT recommended.  Client reviews of the services by LaRose are encouraged (google reviews, healthgrades, yelp, etc.), however clients are not required to do so and many can be done confidentially.  Online reviews increasingly provide the tools by which providers using online social services models are being employed and recruited by clients.  Please keep the practice in mind when/if you make referrals, as you consider using these services, and whether that by online reviews or direct person to person suggestions is something you are comfortable with.  Reviews and referrals should be done anonymously; that is without identifying yourself by name.  LaRose cannot acknowledge or deny seeing a person without written consent, thus if a referral is made LaRose will not identify the referring party as a patient/client. 


This secure server is NOT social media.  No other party, besides LaRose and office personnel that may be needed to effect your care/services (if they are involved at all), can access your file in this secure HIPAA compliant platform.  Emailing, journaling and all records are encrypted, end to end (from therapist to client and from client to therapist) ONLY.  Users of this platform cannot cross communicate or access each others information as the server is a client by client secure file within the online secure server of the practice.

ONSITE SERVICES, ON LOCATION SERVICES, SUPERVISION, PROVIDER DEVELOPMENT, CONCIERGE AND ANNUAL RETREAT SERVICES.  The practice of LaRose offers and provides various non-traditional behavioral health, mental health, coaching, hypnosis, consultation and retreat type services, in addition to the online video/chat/journaling sessions and the traditional face to face options. These expanded services allow for remote counseling program implementation, remote supervision and licensee consultation, in and out of state therapy/education based retreats and get aways, provider practice set up services each unique and customized to the needs and demands of clients, peers, supervisees and institutional based services.  This agreement provides for an overview of the practice involving billing, records, the use of the digital server and general cancellation matters.  Specific terms are provided subsequent to this initial consent and server portal set up process, related to the specific requests of the user, as fitting and appropriate to your situation. It is disclosed here, that in addition to these terms, other contract terms may be added later, to accommodate the specific and unique requests of other parties involving onsite services, hypnosis and coaching services, retreat services, supervision services and provider set up services.  If and when your situation requires an addendum contract or an alternative contract subsequent to this portal registration, this will be discussed in your free consult.  Upon registering and logging in you will choose what service you are seeking from the practice (and you can choose multiple services) which will be reviewed and discussed during the initial consultation. 

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ANNUAL RENEWAL FOR BILLING PRACTICES, HIPPA, AND POLICY UPDATES AUTHORIZED BY USERS. This authorization will be renewed annually via annual forms that are required upon server log ins the first month of every calendar year. This summary will be incorporated into the new year policy changes and updates, where clients must provide new authorizations for billing, updated contact and emergency contact information, and annual renewals of privacy statement updated regarding protected health information. These updates mean that new clients may be required to complete an initial authorization, and an "updated one" due to automation limitations.  Clients agree that this and any other subsequent authorization and information regarding protected health information is available to be printed out in the server, at the time it is completed, and/or the client acknowledges that a copy of such documents can be requested and printed out by the practice of LaRose.  Each years forms, as updated, are incorporated herein as well and this document in incorporated therein - thus this document and the updated yearly renewal forms reciprocally reference each other (necessary for ongoing authorizations). Example: this form is the initial required agreement between you and the practice for all services, however, every year various rules, laws, contract terms, and standards of care/practice require renewed authorizations (both forms are active from year to year, as these occur). Any revisions to billing practices, collections, health information standards etc. etc. are referenced in the newest renewal forms that clients will be required to complete each year, after logging in.  Each form as it is updated, includes an update chronology sequence on the form itself. 

Questions?

OFFICE: 202-816-6985
CL & TXT: 850.545.2886
EM: Kurt@TalkifUwant.com (non secure emails are not replied to here; use of the secure email platform is recommended)
WB: www.TalkifUwant.com

| LicensedClinical Social Worker | Credentialed in Clinical Hypnosis | CSW Qualified Supervisor | Licensed Independent Clinical Social Worker | DC Lic. LC50081569| Fla. Lic. SW9297 |

Initial Online Information & Consent Revision History: 02/2012, 12/30/2012, 10/16/2014, 06/15/2015, 6/26/2017, 11/02/2017, 12/12/17; 4/13/18; 4/26/18; 7/11/18

( Type Full Name )
Updated Practice Information, Extension of terms each year, and Changes
IN every new calendar year, there are changes that take place that may/will impact services with the practice; however, many aspects of the practice are not affected by these changes. This document explains the changes, as appropriate, and incorporates other agreements, as previously signed between you and the practice of Kurt LaRose MSW LCSW LICSW. Please take a moment to review, agree, and accept these changes, as summarized here. The terms "I, me, my" reference you as the client. The terms "the practice, the office, Kurt LaRose MSW LCSW, Kurt LaRose MSW LCSW LICSW, LaRose" reference the office and practice of Kurt LaRose MSW LCSW LICSW (and the affiliated assignees who partner with the practice to effect care). 


1) In February 2012 the practice of Kurt LaRose MSW LCSW initiated electronic health records compliance and added the digital secure server for client side 24 hour online access; the updates and changes listed here, incorporate and extend the "Initial Online Information & Consent" practice terms, policies, and procedures as they were included at that time, with modifications as noted in the chronological dating sequence, where and when updates and modifications were deemed necessary.  "Deemed necessary" relates to the ever changing health care industry, third party payor complexities, changing rules, regulations, and laws, practice protocol changes (ie: new forms, updated contact information, etc), changes in the professional services fee structures (ie: moving from an insurance based model to a self pay), developing specializations such as hypnosis credentialing in Florida and adding licensing credentials in the District of Columbia, adding non-traditional services (ie: video sessions, chat sessions, journal exchange digi-therapy, 24 hour online practice feature accessibility, etc.), office relocation to the District of Columbia, rate changes and expanded services (concierge services, concierge retreats, onsite services, multi-state services, etc.), and a myriad of other rationales that justify updates and changes to keep clients, patients, supervisees, other professionals, and the like, informed.   As such these changes are/were/will be "deemed necessary."  

You, the client, are asked to review and agreement of this digital document (titled "Updated Practice Information Extension and Changes" digital document), which was added subsequent to the 2012 initial policies, I am agreeing to extend the "Initial Online Information & Consent" terms and I am agreeing to the 2013, 2014, and 2015 updated changes here. With my agreement, effective with my digital signature and acceptance, I consent to the prior terms (the 2012 document) and these various added terms (this annual update).

2) All agreed upon terms between me and the practice are digitally signed and stored in the secure server. Agreements can be accessed, reviewed, and printed at any time by clicking on the FORMS icon, after logging into the secure client area. By logging into the secure server, and clicking on the FORMS icon, I am acknowledging that I have received a copy of this (and the other) agreements, as digitally signed by me.

3) Insurance deductibles, co-pays, and out of pocket costs are usually affected by a new calendar year (beginning in January). The amount I pay may increase beginning in every calendar year, or every policy year (as determined by your insurance carrier). Deductibles, co-pays, co-insurance, and any "patient responsibility" amounts are due and payable from me to the practice at the time of service (or as soon as a cancellation fee is realized) and I agree to pay all fees incurred at the time of service (or at the time they are realized). November 2, 2017 the practice of LaRose is currently accepting new patients who are SELF PAY. This change currently affects only new patients. IF YOU are already a patient of LaRose, effective prior to 11/2/17, please continue to schedule your sessions as you have always done.   

4) Because of varied third party limitations, inconsistencies, changes in insurance policies (contract terms, legal mandates, out of pocket adjustments, limits to allowable amounts, policy riders, exceptions, and terms between payors and their members) I acknowledge that the office of LaRose may/will need to adjust fees for sessions according to the terms that specifically apply to my care and my cost share for care with the practice. I agree to pay the adjustments as soon as I am notified that an amount is due. I also agree and understand that any balances due will be and can be located in the secure server by clicking the BILLING icon and I understand and agree that I can make payments online 24 hours a day. If I do not make a payment at the time of service I agree that the practice may process the payment on my behalf using the credit authorization information I have / will provide to the practice.

5) I understand that the practice does not necessarily have accurate or up to date information about insurance changes made between me and my insurance or EAP payor(s); I agree to inform the office of LaRose prior to upcoming sessions of insurance and third party changes. I also agree, that as soon as an insurance change occurs, I will send a secure email to the practice via the secure server, with the updated insurance POLICY NUMBER, EFFECTIVE DATE, POLICY HOLDER, and INSURANCE COMPANY. I agree that in the event a change causes a claim or session invoice to be declined or rejected by the insurance company or other third party payor - that the amount due is my financial responsibility. I understand that if coverage is no longer available, regardless of the reason that the claim has been rejected, any third party contracted/regulated/allowable fee reductions through the third party payor may (or may not) be extended to me. I understand and agree that the full fee ($105 per hour) will be due when claims are rejected and/or denied for any reason and I agree to pay such fees.

6) I agree to review and update the "My Info" section in my digital profile (see the gear Icon after logging in) with my current mailing and billing address and phone number(s) where I can be contacted, when and as changes occur.

7) I understand that the practice, beginning in 2013 (and in all subsequent years since), will/does require all clients doing business with the practice to provide social security number(s) for all clients (and all financially responsible parties). I understand that my social security number will be used, in conjunction with my date of birth, for the purposes of billing practices, and that it will specifically be used when/if collections are initiated through billing agents and credit bureaus.

8) I understand that with every new calendar year, and upon logging in each January, that I will be prompted to provide updated billing information, updated authorizations to bill third party payors, and to renew any and all prior agreed to policies that are still in effect from the prior year (where prior year services exist) as a condition for ongoing services. This is document, incorporating initial online consent terms, is the prompt requesting you to provide current billing information.

9) I understand that a current copy of these terms, as they are saved in their original signed format can be printed after I log in to the server - and that these copies are my copy - accessible any time in the server 24 hours a day.

10) I agree and understand that as policy changes occur, a revision note will be made under a 'revision history' heading, that includes the prior dates of the policy and each date that the policy is/has been modified (knowing that only my original signed version is the one that can be printed). I agree that these changes will occur with or without notice to me in advance (except as already noted in the new calendar year clauses above).

11) HIPAA limits what information can be shared regarding my health information by mental health providers. This "Updated Practice Information, Extension of terms each year, and Changes" document also serves as my authorization (if I am a current client of the practice it is my re-authorization) for the practice to take steps necessary to bill third party payors (EAP and Insurances, for example) including my consent for the practice to share with the payor(s) their required information involving my legally protected health information - up to the degree necessary to obtain payment and/or ongoing care. I understand that the practice uses a third party billing agent and that the practice uses an office assistant to effect care, including related health information to do so.

12) HIPAA regulates or provides information regarding text messaging of health information - including appointment times with a mental health provider. I agree here, that the Practice may notify me of appointments and other related information involving my session appointment times by text message - using the phone number I have / will provide in the server.

13)SPECIAL CONSIDERATIONS AND LIMITATIONS FOR YOU TO AGREE TO FOR OTHER FEES (WHEN USING DIGITAL SERVICES BETWEEN SESSIONS) AND ACKNOWLEDGEMENT BY YOU IF YOU WISH TO USE HEALTH INSURANCE AND IF YOU HAVE OUT OF NETWORK BENEFITS.


-I understand and agree that the practice of LaRose, effective November of 2017 is accepting clients who are SELF PAY.  I acknowledge that I have been informed that the practice is a self pay practice, as it is publicly posted on the talkifuwant domain, with google, healthgrades, psychology today and other publicly accessible sites.  I understand and agree that it is possible that LaRose is listed as a provider on a network by an insurance carrier site, as the carrier has yet to update their panel listings.  Because LaRose has terminated all insurance related contracts for network status I am aware and agree that I am going to utilize the services (explained here) as it relates to insurance benefits for out of network billing processes, records sharing, and other billable services that are billable only to me and not to insurance.   


-In the self pay model, clients have more diversity in services and treatment options, they can now use supplemental digital services (for those who enjoy encrypted asynchronous communication in the client portal between sessions).  Additionally, self scheduling allows for faster recovery times (and increased motivation for patients who seek care here) and is accessible 24 hours a day in the secure server.  


-For clients who have out of network insurance benefits you are agreeing that that you will verify out of network coverage with your carrier in advance of seeking re-imbursement from your insurance company and you agree that you will do so before involving the practice in insurance billing factors/procdesses.  


-Electronic billing option and fees if selected: The practice CAN in most cases, electronically bill the insurance company as each session occurs (usually done when as the session begins or ends). I agree that if I would like LaRose to process my claims for out of network benefits, and if my carrier is listed on one of the leading national electronic gateways in US for electronic healthcare claims submissions, the practice will charge for the service.  The electronic filing fee if I request it of the practice is charged monthly at $25. The fee covers the time involved in setting up the gateway processes with my insurance carrier and it covers the costs incurred by the practice to process insurance claims.  I understand, if I choose the electronic OON processing option with LaRose that this fee is the same whether  one claim or five claims are submitted in the same month.  I agree, that if I choose electronic filing services for OON claims, and if my carrier is a part of the gateway LaRose uses with the digital server, the fee is charged with the first claim that occurs each month to the card on file.


-Payments made to LaRose by carriers will end all electronic billing to the carrier.  If in filing electronic claims the insurance carrier issues payments to LaRose (instead of to me the client) I agree and understand that LaRose will immediately discontinue electronic billing services.  I understand and agree that this may be necessary because my insurance company is supposed to make reimbursement payments to me, since the billing is for OON coverage (and LaRose is OON).  Additionally, I understand that when an insurance company submits payments to LaRose (besides this being erroneous on their part) the company may/will require a 1099 to file with the IRS as if it is income to LaRose (and it is not since I am paying for services and then seeking OON reimbursement to me).  I acknowledge that I can contact my insurance carrier to ask them if they will issue the re-imbursement to me if an electronic claim is submitted directly from the provider.  NOTE:  All claims show charges and that the total is paid by clients, thus no payment is being sought on clients behalf in electronic filing.  Some insurance companies appear to misunderstand or misapply processes with providers (and this is, from the provider experience seemingly random).  As such how the insurance carrier will and will not handle electronic claims processes, is out of the control of the practice. 


-Self submission OON billing options:  I understand too that I  can file the paper claims using my insurance company forms (as provided by them) along with the various forms that are provided here in the server to be (under the BILLING tab).  The server billing forms that will be needed in self filing of OON claims can be printed and accessed by me (client) or for the forms can be generated at each session by LaRose from the server; the BILLING forms can be printed at the end of each session (if time permits it and if I ask LaRose in advance) and I understand that they can be accessed and printed anytime from my own PC/computer.  If I elect to file my own OON claims with my carrier I understand that I will not be charged the monthly electronic filing fee. 


-What is contained in every invoice and in any claims filed with the insurance company. I understand, acknowledge and agree that my insurance company requires a wealth of information about me, when they are billed, as follows: 

1) - my mental illness diagnosis (diagnosis: required in order for insurance companies to pay for "medically needed" services), 

2) - the current procedural terminology code (CPT; showing my SESSION time along with the type of psychotherapy, counseling, diagnostics, crisis intervention, and/or behavioral health services I obtained from LaRose), 

3) - the international classification of diseases coding (ICD10; identifying what global illness category my diagnosis is most fitting) and

4) - the location code (G; whether my session was in the office, video, chat or telephone).  


-Additionally, the BILLING forms in the server and/or the electronic claims will indicate provider related identifiers for carriers to locate LaRose, which I agree that I have been informed of in the event my carrier elects to reject payment based upon missing information; the information for the insurance company includes the following indentifiers:

5) license numbers that establish LaRose as a district and state licensed clinical professional able to diagnose and treat behavioral health, mental health, and mental disorders (as an LCSW in FL and an LICSW in DC), 

6) numbers that indicate LaRose is a registered sole proprietor with the IRS, including an Federal Employer Identification number (FEIN),

7) identifiers that locate LaRose as a registered clinician with the national provider identification (NPI) database which insurance carriers (federal and private) utilize for payment and billing processes.  There will be two NPI provider numbers included: the individual and the group NPI as some carriers require individual NPI's and others require group NPIs.  

8) the BILLING invoice/receipts and/or electronic claims also will indicate the total fee for each session and it will show my (client) payment; 

9) and lastly because some insurance companies also subsequently request signatures on forms electronic or otherwise, each will print with the digital signature of LaRose.


-I understand that even if my insurance company does not pay me for sessions, I am responsible for those fees, they are paid and payable to LaRose, and they are non-refundable.


-Disclosure of health information outside of the practice and the health insurance companies.  Additionally, I understand that many (if not all) insurance companies report to a national non-profit database various codes and identifiers which are sometimes used to decide about future policy purchases (such as other health care coverage and life insurance policies) when they are billed for mental health services.  I understand and agree and acknowledge that such information about me may be shared and that such sharing of additional information is outside of the control of LaRose, since information billed to my carrier from billing forms of LaRose may be used by my carrier for other reporting purposes.


-I am not on any insurance panels, after years of working with as many as 20 different carriers, both private and public insurers, and the inconsistent manner in which all private carriers pay made the job of accepting policies unmanageable, unstable - and   ultimately they prevented me from providing the best care for clients with unique needs (at times companies would reject digital services or hypnosis sessions even as patients were getting better with these services).  Lastly, please know that even as I am willing and able to provide information and bill your carrier, whether they approve or pay for sessions, online digital interactions (journaling, emailing, video, chats), extra time or extra sessions - will be a matter for you to work out with them.  


-Medicare OR Medicaid. I understand that LaRose is not a provider on federal panels and that because Medicare and Medicaid are federally governed programs I cannot be seen by LaRose, if I want to also use my Medicare or Medicaid coverage. I understand, if I do want to be seen by LaRose and if I have Medicare or Medicaid I must pay LaRose for these services.



Updated Practice Information Extension and Changes Revision History: 01/04/2013, 10/16/2014; 12/29/2014; 06/15/2015; 6/26/2017; 11/02/2017; 7/11/2018

Please indicate your agreement to the above terms, as indicated above.

| Fla. Lic. SW9297 | Florida - Licensed Clinical Social Worker | Credentialed in Clinical Hypnosis | CSW Qualified Supervisor | 

                       | DC Lic. LC50081569 | District of Columbia - Licensed Independent Clinical Social Worker |

( Type Full Name )