Therapy Services and Fees
Therapy Services and Fees Policies and Procedures
Concierge Counseling Fee Structure
Initial Session Fees
Your first video session (60-120 minutes over 1-2 days)
The informed consent process
A good faith estimate of fees by service
A biopsychosocial history
Any necessary initial assessments
Setting up HIPAA-compliant communication channels (text, email, phone, video conferencing links)
Orienting you to the technology I use to provide your therapy services
Setting up your payment method via the payment processing portal
Creation of your private, secure therapy and training website with individualized learning content
The fee for the initial session is $575. Because we will not yet have met to set up your Square payment portal, I ask that you make your payment for the initial session to my business PayPal at least 24 hours prior to the appointment.
Follow these steps to pay for your initial session:
Complete the intake process.
Respond to my email with your preferred appointment times.
I will reply with a scheduled time.
Send your payment via PayPal.
I will confirm your schedule appointment via email.
Please be aware that your initial session appointment is not confirmed until payment is received. The payment policy for your initial session is the same as all other appointments; payment must be received 24 hours prior to your scheduled appointment or the appointment will be canceled automatically.
During the initial session, we will set up your Square payment portal. Square allows multiple payment method options, including credit cards and ACH electronic fund transfers. All current clients must have a credit card on file or services will not be scheduled. Your payment method will be charged in advance of each session once the cancellation window has passed. If payment cannot be charged within 24 hours of the appointment for any reason, the appointment will be automatically canceled. If the appointment is made less than 24 hours in advance, the fee will be charged as soon as the informed consent agreement is completed.
Base Hourly Rates
$240 per 60 minutes
$120 per 30 minutes
Not available in less than 30 minute increments.
$240 per 60 minutes
$120 per 30 minutes
$60 per 15 minutes
Text or Email Messaging (asynchronous)
Clients who wish to utilize text or email messaging for therapy can purchase 15 minute increments at $60 per 15 minutes, which covers up to 3,000 words total in both directions. The base rate of $15 per 15 minutes applies for any portion of a quarter hour. Please see the earlier section on concierge counseling services for guidelines on what constitutes therapy-related texting.
The cost of therapy by text messaging or email is calculated by prorating the base hourly rate of $240/hour in 15-minute intervals. Time for asynchronous services is based on an average reading speed of 200 words per minute.
Collateral and Family Sessions
Collateral sessions are sessions conducted between a healthcare professional and a client’s friends, family, other healthcare professionals, or legal team - basically anyone who is connected to the client and can provide insight or assistance with the therapeutic process. Collateral sessions are billed at the same base hourly rates that are listed above. Collateral sessions must be paid in advance to hold the appointment. Collaterals should be prepared to remit payment via PayPal if they are paying for the session instead of the client. If payment is not received within 24 hours of the appointment, the appointment will be automatically canceled.
You pay for the time you schedule. If you are late to your session, you will be seen for the remaining time and charged the full fee. If you choose to end a session early, you will not be refunded for the remainder of the scheduled time.
Fees for Late Cancellations
The first late cancellation will be charged at 50% of your scheduled session fee as a one-time courtesy for active clients. This courtesy will be handled as a credit, not a refund. Payment for scheduled time is charged 24 hours in advance. To accommodate the 50% one-time courtesy for the first late cancellation, 50% of the charged fee will be credited toward your next appointment. It will not be refunded. If you do not schedule a next appointment within a period of two weeks, you are no longer considered an active client and will not receive the 50% courtesy by credit or refund.
Any late cancellations thereafter will be charged at 100% of your scheduled session fee.
A cancellation is considered late if you cancel less than 24 hours prior to the scheduled appointment time. After three consecutive cancellations by the same client, the policy changes to 48 hours notice, and a cancellation will be considered late if you cancel less than 48 hours prior to the scheduled appointment time.
I reserve the right to terminate therapy with clients who show a pattern of late cancellations. If you’re on my caseload, I have a responsibility to meet with you regularly. If meeting at the scheduled time isn’t working out for you, please talk to me about finding a different time or switching from video to phone sessions.
Fees for Missed Sessions (aka No Shows)
The full fee will be charged for missed sessions based on the amount of time scheduled. Please be advised that services may be terminated in the case of repeated no shows.
Refunds for Missed Appointments/No Shows
Except in the case of a clearly established emergency, there will be no refunds for no shows/missed appointments. With two texting apps, two emails, and a voice mail, there is always a way to let me know if you cannot make your appointment, except in the case of an emergency. Documentation of the emergency may be requested. Refunds due to emergencies will be considered on an individual basis in limited circumstances. There will be no refunds when there is history of a pattern of last minute cancellations or missed appointments.
You are in the emergency room.
You are in the emergency room with an immediate family member.
Someone you care for has fallen ill suddenly.
You are in a serious automobile accident.
You are in a situation that involves the police.
Per HIPAA law, you have a right to your records. Fees for records are cost-based and vary depending on whether they are delivered digitally or via postal service. You will always receive a good faith estimate for any fees associated with records provision. Please see my records request policies and procedures for more details on the records requests process and associated fees. Records fees as outlined in the records request policies and procedures apply to existing records only.
Generation of new clinical documentation for specific purposes upon request is a fee-based service. Cost varies depending on the time and complexity of the documentation and is generally billed at my base rate of $240/hour.
Examples of new clinical documentation include but are not limited to:
Mental health disability application or accommodation
Emotional support animal letters
Jury duty accommodation or excusal related to mental health
Mental health works sick days
Documentation for SSDI application
Documentation for FMLA application
Documentation for legal issues
Requested updates to prior documentation
Certain types of assessments and associated reports
Documentation for the above can only be provided when the client has been engaged in active treatment, the length of which will vary on a case by case basis, and is seldom indicated during a first-time visit. Depending on the complexity of the service(s), fees for these services may require either a contractual agreement specific to payment for such services or advance payment or both, and must be remitted no later than the time of service. I will always provide a written good faith estimate so clients and involved third parties can make an informed decision regarding the request.
My practice is 100% online; I do not appear in court in person. Per my legal consultations and court appearances policies and procedures, I will appear in court via video tele-conferencing after receipt of a court order. All subpoenas will be referred to my attorney. Fees for appearing in court are charged hourly at my base hourly rate of $240/hour for any portion of an hour. Your regular payment method will be charged 24 hours prior to appearance in line with the payment policies of this practice. Payment for court appearances may require a contractual agreement specific to payment for the appearance(s) and will follow the cancellation policies of this practice. For instances where appearance is extended by unanticipated circumstances, payment must be remitted at the time of appearance. Court appearances must be booked seven days in advance to provide time to lessen the impact of schedule changes on other clients whose regularly scheduled appointments might be affected. Once scheduled, fees for court appearances are not nonrefundable with no exceptions. Should you decide to request my virtual appearance, you and your attorney are responsible for making arrangements to facilitate this appearance. The above policies and procedures apply to depositions as well. Fees for court appearances and depositions do not include preparation, consultation, and related documentation.
Please note that I am not a qualified expert witness or forensic evaluator and can only report facts, not opinions. I cannot draw inferences or establish causal relationships between your therapy and your legal case. Please consult with your attorney about the pros and cons of requesting my presence in court when a records request will most likely supply the same information that I would provide by appearing. Please keep in mind that staff at your attorney’s office may have access to any records sent, so in most cases, you may prefer to request a treatment summary rather than records. Note that a treatment summary is new documentation and is therefore billed under document fees. Another option is to have your attorney submit questions in writing which I can respond to once I receive your written authorization. Fees for records transmission follow my records requests policies and procedures, including fax transmission to third parties and related postage costs if sent by post.
Additional fees may be charged for lengthy assessments, consultations with other providers, interrogatories, family sessions, and preparation of paperwork for legal or other purposes outside the regular therapy sessions. These fees are determined on an individual basis depending on what’s needed. All additional charges will be quoted in advance and a good faith estimate will be supplied in writing. Payment for these services may require either a contractual agreement specific to payment for such services or advance payment or both, and must be remitted no later than the time of service.
Letters for emotional support animals (ESAs) require an evaluation. Please note that I will consider writing an ESA letter only for existing clients I see weekly for a period of at least three months. Please see my ESA policy for details. My policies and procedures are copyrighted materials and supplied to clients during the intake process. Policy downloads will be watermarked with the client's name and contact email to prevent unauthorized distribution.
This is a fee for service business. I do not allow clients to carry a balance. If you have an outstanding balance, I will not schedule any additional appointments for you until that balance is paid. This applies to standing appointments as well.
Appointment Policies and Procedures
Scheduling Initial Session
On your initial contact form, I will ask you to indicate your preferred appointment days and times. Because I am legally required to obtain your informed consent prior to treatment, you will need to complete the intake process and sign an informed consent agreement before your first appointment. Once I have received your signed informed consent, I will send you an encrypted, HIPAA-secure email to the email address you provided in your initial contact form and we will set up your initial session. In my email response to your initial contact form, I will give you appointment times to choose from based on the preferences you indicated on your initial contact form. You will select a time slot and respond by email with your selection. I will send you an acknowledgement and a payment link. Your appointment is not confirmed until payment has been received.
If payment is not received within 24 hours of your appointment, your appointment will be automatically canceled. Please see the cancellation policies and procedures below for more details.
You will receive appointment reminders via text and email at approximately 48 hours and at 24 hours. These reminders are a courtesy. Failure to see a reminder will not result in a waiver of fees for later cancellations or missed appointments. You are responsible for keeping appointments as scheduled whether you have viewed these reminders or not. I recommend that you add your appointments to your phone calendar and set up reminder alerts.
It is a good idea to be online at least five minutes prior to your appointment time. This gives you a chance to complete the check-in form, troubleshoot any login issues, and restart your computer if something isn’t working right. Think of it as the equivalent of coming to an appointment in person and getting there early to check in so your appointment starts on time.
The day of each session, from your initial session on forward, you will receive a web-based check-in form that can be completed on a computer or any mobile device. The check-in form will include a brief spot-check self-assessment and a location verification. The self-assessment gives us an ongoing opportunity to monitor your state of mind. The location verification fulfills my legal responsibility as a telehealth provider to provide services only where I am licensed to do so. The law requires me to confirm that you are located in the state in which I am licensed at the time of service. The check-in form automatically records your location. If you have location services turned off in your browser or on your device, you will need to turn this feature on to complete the check-in process. If this process doesn’t work for you, please find a therapist who will better suit your needs and preferences.
During your initial session, we will talk about how you’d like to schedule your appointments going forward. To maintain clinical integrity and preserve the therapeutic relationship, I recommend a weekly one-hour session at minimum for the first 6 months. Weekly appointments lead to greater momentum and focus, so therapy tends to be more productive overall. I suggest a weekly video session for at least one month before switching to phone, texting, or email as primary channels for therapy.
Every six months, we will review session frequency and format and discuss changes to the schedule based on what’s clinically indicated. If you feel a change is warranted sooner, feel free to bring it up in session so we can discuss it.
A minimum of one monthly video or phone session is required to stay on my caseload unless we explicitly arrange otherwise. I cannot be responsible for your care if I am not actively treating you.
If you prefer a certain day and time, I recommend that you book a standing appointment so you will have that slot reserved. A standing appointment is a recurring appointment. This means that you are reserving the same day/time slot every week or every other week (fortnightly). Please be aware that if you set up a standing appointment for every other week and need to reschedule, I may not have that slot open on the alternate week, so you may have to take a different slot or wait a month until your next regularly scheduled appointment. Provision of standing slots is at my discretion. Standing appointments follow the same cancellation policies and procedures as any other appointments.
Please do not schedule standing appointments unless you are certain you can commit to this time slot. Repeated cancellations for standing appointments is an indication that this is not a feasible time slot for you. If you reserve a standing appointment and cancel or reschedule it two times in a row, I will ask you to move your standing appointment to another slot or schedule your appointments from week to week instead.
Appointment Availability and Scheduling
I schedule appointments seven days a week from 12pm-9pm ET (yes, that includes weekend evenings). This does not mean I am available nine hours a day, seven days a week. It means these are the hours during which I schedule appointments. Some time slots are for video sessions and other time slots are limited to phone or text/email sessions.
Because I run a concierge service, I do not book appointments back-to-back. My schedule tends to book up a or more week in advance, so please keep that in mind if you've got a time preference.
I offer therapy sessions via HIPAA-compliant video, phone, text messaging, and email. Video and phone sessions are synchronous. Text messaging and email messaging are asynchronous. You may occasionally get an immediate response to a text or email, but that will be unusual and should not be expected.
I schedule video therapy sessions Tuesdays, Thursdays, and Saturdays between 12pm and 8pm ET, pending availability, with the last video session starting no later than 7pm ET.
I schedule phone therapy sessions seven days a week from 12pm-9pm ET, pending availability, with the last phone session starting no later than 8pm ET.
I do not answer phone calls except by appointment - no exceptions. I respond to voice mails and texts from current clients only. All other communications should be initiated using the relevant forms on my contact page.
If you are in distress and require emergency services, please call 911 or find immediate help from these resources.
Text or Email Messaging (asynchronous)
I offer therapy via text messaging or email throughout the week from 12pm-9pm ET seven days/week.
I keep the notifications for my apps set to silent, so feel free to text or email whenever it’s convenient for you. You will not wake me, interrupt a meeting, or disrupt a session. Really.
Please understand that if I am in session with other clients or otherwise engaged, I may not be able to respond immediately. For this reason, texts are mostly asynchronous. It is also unlikely that I will be manning the chat during regular sleep hours, though I may surprise you and respond before or after my business hours if I am awake and I see that you’ve just sent a message.
In general, I will respond throughout the day. If you message me (text or email) and do not receive a response or acknowledgement within twelve hours, you can assume that I did not receive the message. In that case, please try again or use an alternate communication channel.
Please note that these response times apply to existing clients only. Potential clients and all other contacts should reach out using the relevant forms on my contact page. In general, I will respond to forms from potential clients within 48 hours.
Requests from you for your records should be sent via the relevant form. HIPAA law allows up to 30 days for fulfilling records requests. I will make every effort to get them to you as quickly as possible. Requests for your records from anyone else should be initiated through you so you can sign a release of information. Records requests from third parties will not be considered without a signed release from you.
If you stop scheduling sessions, repeatedly cancel appointments, or miss two sessions in a row, I will assume that you have decided not to continue therapy with me. I will attempt to contact you via text and email to confirm. If I do not receive a response within a week of these communications, I will change your status to inactive and send you a discharge notice via email.
If you are unable to contact me due to a medical emergency, institutionalization, or incarceration, please have your emergency contact reach out to me to let me know if possible. If you would prefer that I reach out to your emergency contact when I do not hear from you, this is something you will tell me during our first session when we establish an emergency management plan.
Cancellation Policies and Procedures
Please help me to serve you and others better by keeping your appointments as scheduled. If you need to cancel or reschedule, please give as much notice as possible so I can offer that time to someone else. I will do my best to reschedule your appointment within the same week based on availability. At times, it may be necessary to set up your rescheduled appointment via phone rather than video conferencing based on scheduling availability or equipment and/or internet issues on either your end or mine.
If you need to cancel, I suggest canceling via both text and email just to make sure your message reaches me. You will have two email addresses and two text messaging apps through which to contact me. Feel free to send your message at any hour of the day or night. I keep device and application notifications set to silent, so you will not disturb or wake me.
A “no show” is when you simply do not show up for a scheduled appointment, including an online appointment - without calling, texting, or emailing. It is a missed session. If you show up 30 minutes late, that will also be considered a missed appointment, aka no show.
When you schedule an appointment and do not show up and do not bother to cancel, you make it impossible for me to book that time for someone else. There will be no refunds for no shows, and you risk termination of services if it happens repeatedly.
If you miss an appointment, I will reach out twice via text and email with an attempt to reschedule. If you do not respond to these two attempts at contact, I will assume that you have dropped out of therapy and make the space available for another client. In this event, I will send you a discharge notice via email and close your chart.
By scheduling an appointment, you commit to paying for that time, whether you show up on time, late, or not at all. If you are late to your appointment, but you show up, you will be charged for the scheduled time. If you're late, you're late. I won't take offense. But please be aware that if you're late, your appointment will not be extended past the originally scheduled time slot. If it's a video session, I will remain on the video call for up to 15 minutes. After that, I will log off video but will be available via text in case you are able to show up late. At that time, we can decide whether to complete the session via video or phone. At 30 minutes past the scheduled appointment time, you will be considered a no show.
I will send text and email nudges if you are late, but those are a courtesy. Failure to see a text or email nudge will not result in a waiver of fees for late cancellations or missed appointments. You are responsible for showing up to your scheduled appointments whether you have viewed these nudges or not. Please make a point to check your calendar for conflicts prior to scheduling. Most telemental health clients find it helpful to set appointment reminders on their phone calendars.
I make it a priority to be punctual to your appointments. I do everything I can to prevent unforeseen events, including technical issues, but they may happen. If you are ever inconvenienced by tardiness on my part, for any reason, I will credit you in time equivalent to the time missed and not as a refund in currency. You can choose to add that time to that day’s session if it’s available, or add it to a future session.
Canceling and Rescheduling
If you are unable to attend a session, please provide as much notice as possible. When you cancel a scheduled session without at least 24 hours notice, it compromises my ability to offer that slot to someone else who needs it.
Make sure to cancel your appointment at least 24 hours before your scheduled appointment to avoid a late cancellation fee. A cancellation fee is not a punishment. You’ve booked the spot and if you cancel with little or no notice, it cannot be offered to another client in time.
If you cancel with more than 24 hours notice, we will reschedule your session for the soonest available time. If you cancel half your appointments or more within a month, you will need to schedule appointments on the same day going forward, pending availability.
A cancellation is considered late if you cancel less than 24 hours prior to the scheduled appointment time. After three consecutive cancellations by the same client, the policy changes to 48 hours notice, and a cancellation will be considered late if you cancel less than 48 hours prior to the scheduled appointment time.
If you are going to be out of state during a scheduled appointment, please cancel in advance to avoid a late cancellation fee. See my travel policy for a discussion of the alternate arrangements that might be possible, but please be aware that these arrangements will need to be made well in advance if they are even possible.
Service Disruption Due to Technical Issues
I have redundancies built into my technology infrastructure. However, there may be events that are out of my control, such as an internet or power outage. In the event that internet and mobile connections are both down on my end, I will make every effort to reschedule your appointment for the same week - later that same day, if possible. Because an opportunity to reschedule is provided, I do not issue refunds when an appointment cannot be completed due to technical issues.
If the problem occurs on your end, we will also make every effort to reschedule that day or that week. If it happens repeatedly, we will need to examine your technology and confirm that it's possible for you to access this service reliably. Reliable internet is a necessity for services with this practice. If your internet is unreliable, I recommend you seek local, in-person services. Rescheduled appointments for frequent last minute cancellations due to technical issues may result in termination of services.
Cancellations Initiated by Clinician
If you show up for a scheduled appointment and it becomes apparent that you are not physically located in the state where I am licensed to practice, I will immediately terminate the appointment and there will be no refund.
In the event that I am ill or injured to the point that it is necessary for me to cancel our scheduled appointment, I will notify you by text and email, and I will make every effort to reschedule within the same week.
If I do not show up for a scheduled appointment, there would be three possible reasons: I made an error; I am ill or incapacitated to the point of being unable send text or email; I am dead. If I make an error, I will contact you as soon as possible to reschedule, and you will not be charged for the rescheduled appointment provided that the rescheduled appointment takes place within two weeks. If I am incapacitated to the point where I could not test or email you prior to our appointment, I will contact you as soon as possible to reschedule and the regular fee policies will apply. If I am dead, you will be contacted by one of my business associates and referred to another clinician.
If you show up for your appointment in violation of the conduct policy, the session will immediately be terminated without refund and you may be discharged from my services per my policies.
After three no shows (missed appointments), you will be discharged from my services.
Termination Policies and Procedures
According to the American Counselors Association code of ethics (2014, A.11.c.), “Counselors terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to benefit, or is being harmed by counseling. Counselors may terminate counseling when in jeopardy of harm by the client or by another person with whom the client has a relationship, or when clients do not pay fees as agreed upon.”
Please see all policies and procedures for guidance regarding termination, conduct and financial obligations.
I may terminate services if it becomes apparent that you would best be served by a clinician who specializes in services in which I do not have the needed training or experience, or if you need a higher level of care than can be provided by a teletherapy or by a solo practitioner.
In the event that termination is appropriate, I will notify you in writing and provide referral resources.
Payment Policies and Procedures
This practice is self-pay, also known as private pay or direct pay. This is different from being an out-of-network provider. I am not an out-of-network provider.
I do not accept insurance or contract with insurance.
I do not provide superbills for you to file a claim with your insurance.
I do not participate in contacting or billing your insurance.
I do not register with insurance companies, nor will l speak with them on your behalf.
On your informed consent agreement with me, you will be asked to opt out of submitting claims for my services to insurance and acknowledge that you agree to the payment policies of my practice.
I do not accept assignment.
I do not offer sliding scale fees at this time.
You are under no obligation to accept my policies; you have the option to work with a clinician who accepts your insurance or who provides superbills for out-of-network claims. Please see these resources to help you locate a provider who can serve your needs.
My business model does not accommodate the restrictions and administrative demands required when dealing with insurance. If you’re curious why I chose this business model, please read my description of concierge counseling services and my answers to frequently asked questions. At your request, I will be happy to provide you with a receipt for any services you receive from me, but please be aware that a receipt will not be accepted by your insurance company as a means of obtaining reimbursement. I would love to work with you, but if you have insurance and plan to file an out-of-network claim, I am not the clinician for you. You need a therapist who provides superbills, whether they are in-network or out-of-network.
You can pay for your initial session via my PayPal business account or Square. If you already have a PayPal account, this will be the fastest and easiest method. Please note that PayPal is not HIPAA-compliant, while Square is. Usually, we set up your Square payment portal during your initial session. If you would prefer to set up your Square payment portal prior to your initial session so you can use it to pay for that session, please let me know by replying to the email you receive from me in response to your initial contact form. After you have completed your intake process, please pay for all services through my Square business account. Square is HIPAA-compliant and allows for secure storing of your payment information. The merchant listed on your charges will be Michelle Robin Gould Corporation and will be identified as a healthcare/medical service.
Both Square and PayPal allow you to connect multiple payment methods, including your bank account and credit cards. Please be reminded that I do not accept insurance. If you need a referral to a clinician who accepts insurance, please contact your insurance company for a list of contracted providers.
A credit card must be left on file for all therapy services. Clients are responsible for ensuring the payment method is current and is updated. If there is no current, unexpired payment method on file with Square, scheduled services will automatically be canceled and asynchronous services will not be available. If the payment method on file indicates that there are insufficient funds, scheduled services will be canceled and access to the private client website and learning content will be suspended.
You will receive a good faith estimate for your services shortly after you schedule. If there are any changes to pricing or to the services you schedule, you will receive an updated good faith estimate.
A monthly paid invoice can be provided upon request. An invoice will have the dates of service, the services received, and the amounts paid. As a reminder, I do not provide superbills.
Session fees for scheduled appointments are charged per the amount of time scheduled and will not be prorated if the session ends early. For impromptu sessions or additional time added on at the end of a session, fees will be prorated in 15 minute increments for any portion of 15 minutes. Time calculations will be rounded up to the nearest quarter hour.
If your payment is declined either because your card expired or there is no payment method on file, your appointment will be canceled.
You will be charged for your appointment 48 hours prior to your appointment time. This gives you time to update your card if it has expired prior to the cancellation window so you do not lose the slot. If you set up your appointment less than 48 hours in advance, you will be charged as soon as you schedule your appointment.
If you have scheduled appointments and your card is declined, I will contact you by email or text and ask you to either update your card or pay with a different card. When there is no valid payment method on record with Square and no response to my email or text regarding your payment method, scheduled appointments will be canceled 24 hours prior to the appointment time and future appointments will be suspended. If you do not have a valid payment method on record and you do not respond to my emails or texts within one week, you will receive a notice of intent to discharge.
Charge Disputes and Collection Practices
Please be reminded that when you contract with a service provider, you agree to pay for services received. To accept services and not pay for them is fraud, as is the initiation of a reversal or chargeback for services received. It’s analogous to shoplifting, only with services instead of goods. Please be advised that financial disputes for healthcare services are not protected by HIPAA law.
Payment policies are in place to avoid misunderstandings and conflicts. Payment conflicts are rare, but policies are necessary to avoid confusion. In the event of a payment conflict, I will make good faith attempts to communicate with you, but I will not chase you down. After three attempts to reach you and resolve a payment conflict or outstanding balance, I will discharge you from my service and refer your account for collection.
If you dispute a charge with your credit card or other payment processor and service was received, you grant me permission to provide proof of service to them, including records and communications such as texts, emails, phone records, faxes, invoices, signed informed consent agreement, policies, and progress notes. You acknowledge that such proof may contain PHI, and you waive confidentiality for the purpose of providing proof of service. If you reverse charges for provided services for any reason, you forfeit confidentiality for the purpose of collection, and I will pursue collection by all means necessary.
In your informed consent agreement, you acknowledge this payment policy and agree to pay the listed fees for late cancellations and missed appointments. If you dispute a charge with your credit card or other payment processor for service that was scheduled but not canceled within the policy time frame, you grant me permission to provide proof of obligation to them, including records and communications such as texts, emails, phone records, faxes, invoices, policies, and signed informed consent agreement. You acknowledge that such proof may contain PHI, and you waive confidentiality for the purpose of providing proof of service.
Uncollected balances may be turned over for collection, reported to the credit bureaus, and/or reported to the state’s attorney’s office and law enforcement if there is a clear case of theft. Please be aware that the HIPAA Privacy Rule permits healthcare providers to disclose protected health information for the purpose of billing and collection activities, including limited disclosures to consumer reporting agencies (aka credit bureaus), debt collection agencies, and law enforcement.
Concierge Counseling Services Policies and Procedures
Video or Phone Therapy
HIPAA-Secure Text or Email Therapy
Therapy via text messaging or email includes text/email messaging in both directions and is a clinical service. Text-based therapy should not be used as a substitute for therapy via video conferencing; it should be used as a complement to it.
For existing clients, there is no charge for text messaging or emails that are related to the items on this list:
You want to share a thought before you forget and let me know it’s something you want to work on in your therapy, but you’re not looking for a substantive response.
Responses to texts on the above topics will be brief and usually asynchronous. Texting and emailing for any other purpose is considered therapy and charges will apply per my fee schedule.
Examples of therapy-related texting/emailing:
You want to share your reaction to content while it’s fresh in your mind.
You want to check in and let me know how you’re doing, either for accountability or to touch base.
You have a question about something you’re working on in therapy.
You want to add a new subject area to your therapy.
You want to include someone else in your treatment.
You want records sent to you, a personal support, or another healthcare provider.
Please note that per HIPAA law, text and email messages are saved in the client’s chart and become part of the medical record. Please see my technology and security policies and procedures for a description of the technology used to keep these communications secure.
HIPAA-Secure Text Messaging Apps
HIPAA-Secure Email Communications
Private Therapy and SEA/KSA Training Website
SEA = Support, Encouragement, Accountability
KSA = Knowledge, Skills, Attitudes
Follow-Up Client Care Plan
Collateral sessions are sessions conducted between a healthcare professional and a client’s friends, family, other healthcare professionals, or legal team - basically anyone who is connected to the client and can provide insight or assistance with the therapeutic process. This may take place during a client session or as a separate conversation referred to as a collateral interview. As the clinician, my role in a collateral session is to gather information and provide educational resources or clinical referrals when beneficial.
Collateral sessions should not be misconstrued as therapy for the collateral. Collaterals are not clients and are not protected independently of the client; the client holds the rights to confidentiality and the rights to access and transmit records regarding collateral sessions. I will not hold secrets for a collateral regarding information they offer regarding a client, nor will I keep from a client that someone contacted me about them.
Collateral sessions are useful for family and friends of clients who have been affected by a client’s struggles. Collaterals should not substitute these sessions for their own therapy and recovery. A collateral session that takes place without the presence of the client is designed for client support persons who would like to
provide background information or another perspective on the client’s history and current struggles
receive education and resources regarding the client’s diagnosis and symptoms
improve communications with the client
set healthy boundaries between themselves and the client
support the client’s progress
stop enabling unhealthy behaviors
Because there is no informed consent agreement with a collateral, collaterals are not protected under HIPAA law and are not entitled to any records resulting from the interview. A signed release from the client is required before a collateral session will be considered.
Please note that I do not work with couples or offer family therapy where the family is the client. I do, however, strongly encourage family members to get involved in supporting their loved one’s treatment, and I will invite a family member to join you for your session if you and I agree that it would be helpful. In this context, family sessions should be considered collateral sessions, where the client is the individual in therapy and not the collateral. The collateral is a guest, and is there to support the client. Such sessions are billed at my base hourly rates. Your family and friends should not expect phone, text, or email contact with me outside of sessions. If I am contacted by your family and friends outside of a collateral session, I will
not respond at all unless I have a written release of information from you to speak with them.
respond in a limited manner according to the written release of information you provided specifically for that contact.
respond with “Per HIPAA law, I can neither confirm nor deny whether someone is or has been a client, or even if they have contacted me”.
not respond to voice mail messages from collaterals because it is my policy to limit calls to appointments only.
No Surprises Act and the Good Faith Estimate
No Surprises Act
As of January 1, 2022, under the No Surprises Act, all healthcare providers were asked to provide transparency regarding fees for healthcare services. The spirit of this legislation is to protect consumers from receiving unanticipated medical bills. Although my practice is self-pay only (aka private pay or direct pay), it is my policy to provide a good faith estimate (GFE) to all clients whether or not they intend to submit claims to insurance for possible reimbursement. This GFE will be provided both orally and in writing.
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your healthcare provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate. Save it in a secure location.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059.
Good Faith Estimate and Diagnosis
The No Surprises Act requires the inclusion of a diagnosis on GFEs. This is a source of contention for many clinicians, including me, for two reasons: 1) We question the ethics of diagnosing a client before getting to know them, and 2) One of the reasons we choose private practice is to mitigate the stigma of locking clients into diagnoses as required by insurance companies and the medical model.
For initial sessions, we are to say TBD (to be determined) in place of a diagnostic code on the GFE. After we complete your intake and initial session with evaluation, I will update your diagnosis and provide a new GFE that reflects the update. In compliance with this new law, I will provide you with a new GFE any time there are changes to your diagnosis, frequency of sessions, or cost of sessions.
Counseling Services Caveats Policies and Procedures
My counseling services are available only to clients located in Florida at the time of service. Note that location will be verified electronically to ensure that we are following state laws.
I am currently licensed in the state of Florida only. By law, any client for whom I provide mental health counseling services must be located in the state of Florida at the time of service, regardless of whether that service takes place in person or online.
This means that if you are an existing client and log into our session from outside of Florida, we will not be able to continue the session. If you show up for a scheduled appointment and you are not located in Florida, the session will be terminated immediately and you will be charged for the session you scheduled.
If you are a Florida resident but currently working, traveling, or vacationing out of the state, I cannot provide counseling services for you until you return to Florida. It is best if you let me know in advance when you are going to be out of state so we can find you services at that location, should you want them. Note that laws vary widely from state to state, so this may be possible and it may not. I am happy to check, but please be aware that this process takes time - often weeks or months, so don’t wait until the week before your appointment. To request that I look into obtaining permission to work with you while you are temporarily located in another state, please fill out this form for current clients. Please refer to my cancellation policy for details about last-minute cancellations.
If you are an out-of-state resident but are physically located in Florida, I can offer counseling services for you only while you are in the state.
If you reside in another state and would like me to look into licensure in your state, please complete this form for potential clients from out of state.
Please note that my services are designed to serve long term adult clients, ages 18 and up. Research shows that long term therapy has a greater chance of long term success. If you are looking for brief therapy or two-week stabilizations, this practice will not be the right fit for you. Long term in this context refers to anywhere from six months to multiple years.
If You Have Questions
Once I receive your initial contact form, I will reach out via secure, encrypted email. Feel free to respond to that email with any questions I have not covered on my website.
If you have not yet sent your initial contact form, please use this form for questions about counseling services that were not answered on my website.
If you are a person with disabilities, please visit my disability accommodations page. If your questions are not answered there, please use this form to send any questions about counseling services accommodations for persons with disabilities.
Materials Copyright Notice Policies and Procedures
As part of your counseling service packages, you will receive supplemental resource handouts and workbooks. Where indicated, counseling clients may download copies for personal use. Downloading, distributing, and altering these materials in any way is a copyright violation that can result in litigation and fines. These materials are copyrighted intellectual property and are for your use only. These materials cannot be shared, distributed, altered, or used for any other purpose on penalty of legal or financial repercussions. Please keep in mind that if you download materials that contain personal information, you take responsibility for the safety and security of that information. I recommend that you complete workbooks and therapeutic exercises within the HIPAA-compliant platform I provide to protect your safety and security. Should you choose to download them, please keep them in cloud storage that is password-protected and requires two-factor authentication for access.
Please note that access to your learning materials and therapy and training website is intended for clients only. These materials are proprietary and are subject to U.S. and International Copyright Law. Counseling materials are intended for the personal use of clients of Michelle Robin Gould, LMHC, NCC, BC-TMH and/or the Michelle Robin Gould Corporation. Payment for counseling service packages does not entitle or grant clients licensing rights to intellectual property. Counseling and learning materials may not be further retained or further disseminated without express written permission.
Materials created by other entities and supplied to counseling clients by Michelle Robin Gould, LMHC, NCC, BC-TMH or Michelle Robin Gould Corporation in the course of therapy have been purchased by or licensed to Michelle Robin Gould for use with clients. Clients may use these materials for personal use only and may not share, distribute, alter, or use these materials for any other purpose on penalty of legal or financial repercussions.
Instructional Design Services
Instructional design services are available to all business owners. Please see the instructional design page of this website for more information.
Practitioner materials are available to licensed or certified mental health professionals and teaching professionals everywhere. Please see the practitioner materials page of this website for more information.
Continuing education is available in states where applicable. Please see the continuing education page of this website for more information.