DLB Counseling & Consulting, LLC's Client Information and Policies can be reviewed below.
Date Revised: 06/09/2020
Staff Clinicians & Office Locations
All Consultants, Independent Contractors, Interns or Administrative Personnel working for or on behalf of DLB Counseling & Consulting, LLC are required to maintain client confidentiality.
Donny Baca, MA, LPC
Email: [email protected]
Andrea Pazdera, Ph.D., LMFT
Email: [email protected]
Michael Chumbler, MSW, LSW
Email: [email protected]
4905 N. Union Boulevard, Suite #200
Colorado Springs, CO 80918
By appointment only.
Planned Office Closures
· Independence Day Friday, July 3, 2020
· Thanksgiving 23rd through 27th
· Christmas 21st through 25th
· New Years Friday, January 1, 2021
Please be advised during the winter months, there may be times when we need to close due to inclement weather. DLB Counseling & Consulting, LLC will post any office closures on the Home page of our website. Additionally, your clinician will contact you by phone and/or email if there are office closures. Please feel free to check in with your clinician if the weather is bad.
Client Contact Information
If you have any changes to your demographic information (i.e. change of address, telephone number, emergency contact or health insurance), please notify your clinician at the time of your scheduled appointment and/or you can update the information through your client portal account.
Communication Between Sessions
Non-Emergent Contact: DLB Counseling & Consulting, LLC clinicians cannot promise that we will be available at all times. Although, we are in the office during business hours, we usually do not take phone calls when we are with clients. During business hours you can contact your clinician at the numbers above. If we are unable to answer your call, leave a message on the confidential voicemail and your call will generally be returned within two business days.
Emergent/Crisis Contact: DLB Counseling & Consulting, LLC clinicians do not provide after-hours behavioral or emotional crisis services. In the event of a life-threatening crisis or an if an emergency situation arises that requires immediate attention you or your family members should contact 911 or go to the nearest hospital emergency room.
Community Emergency Resources
Colorado Crisis Services: 1-844-493-8255
National Suicide Prevention Hotline: 1-800-273-TALK
Text HOME to 741741 for free 24/7 crisis support
Teens: Text TEEN to 839863 or call 1-800-TLC-TEEN or email https://teenlineonline.org/talk-now
Local Emergency Departments
UCHealth Memorial Health Central: 1400 E. Boulder Street Telephone: 719-365-5000
UCHealth Emergency Care North Campus: 4050 Briargate Parkway Telephone: 719-364-5000
Penrose St. Francis Main: 2222 N. Nevada Avenue Telephone: 719-776-5000
Penrose St. Francis Health Services: 6001 E. Woodmen Road Telephone: 719-776-5000
As a client, you have the right to terminate your treatment at any time. You are encouraged to have a termination session to discuss your treatment progress and/or recommendations with your clinician. We ask that you if choose to permanently or temporarily discontinue your treatment that you discuss this decision with your clinician.
If you have not scheduled an appointment within 30 days from your last scheduled appointment it will be assumed you have decided to end treatment. You will be discharged from our practice, our counselor-client relationship will end, and your case will be closed.
If you have three or more missed and/or canceled appointments your treatment will be subjected to termination.
Your first appointment is a Psychiatric Diagnostic Evaluation (non-medical services) and will be approximately 50 minutes. Following this, you will usually meet for a 50-minute session once or twice a week, then less often with your assigned clinician.
Appointment reminders are offered but not guaranteed. If you wish not to receive or discontinue this service notify your clinician. Appointment reminders are sent by an automated system to the contact number on your client portal account the day prior to your appointment. You will be asked to confirm by selecting the #1 or cancel your appointment by selecting #2 at that time. This automated text reminder is not monitored and any non-standard (#1 to confirm or #2 to cancel) appointment reminder will not be responded to.
We ask that if clients have to reschedule, they do so by giving as much advanced notice as possible. This will allow your clinician to schedule appointments that were not previously available.
Clients can cancel and schedule appointments by the following:
· Contacting our Office Manager at 719-459-9928 ext. 0.
· Email at [email protected].
An appointment is a commitment to your therapeutic work. We agree to meet here and to be on time. If your clinician is ever unable to start on time, we ask for your understanding. We also assure you that you will receive the full time agreed to. If you are late, your session will not likely be for the full time, because it is probable that your clinician will have another appointment after yours. A cancelled appointment delays your therapeutic work. We will consider your counseling sessions very important and ask you to do the same. Please try not to miss sessions if you can possibly help it.
If clients are more than 15 minutes late, they will have to reschedule their appointment and will be charged the full fee for a missed appointment.
Clients will be charged the full fee for a "No Show" or sessions cancelled with less than a 24-hour notice, for other than the most serious reasons. Insurance will not cover this charge.
We request that our adult clients not bring children with them if they are young and need babysitting or supervision, which your clinician cannot provide. We do not have toys, but we can provide reading materials suitable for older children.
Clients will be charged for any damage to, or theft of, property in this office by them or anyone for whom they are legally responsible for.
DLB Counseling & Consulting, LLC cannot be responsible for any personal property or valuables clients bring into this office.
Client Portal Account
DLB Counseling & Consulting, LLC uses Theranest as our practice management software. After activating your client portal account, clients will have access to pay their invoice or update demographic information. Clients can access their client portal accounts at https://dlbcounselingandconsulting.mytheranest.com/Home/Loginor.
Credit Card on File
It is DLB Counseling & Consulting, LLC’s policy that all clients (Excluded: EAP, Medicaid or Veteran Affairs) provide a credit card number to be stored in advance and available for payment for copayments, coinsurance, self-payments or services rendered that are not covered by their insurance company. Credit card details are taken in a secure manner and passed directly to a payment gateway to make the payment. Clients who would prefer to pay for services using cash and/or check or do not wish to have a card on file will be asked to maintain a $100.00 retainer on their account. The retainer will be refunded in full at the completion of services. Clients who have any concerns about this policy are encouraged to discuss these concerns with their assigned clinician.
Self-pay sessions, co-payments, co-insurance payments and deductible payments in addition to non-covered services will be charged to the credit card on a client’s account if they are not present. Non-covered fees include but are not limited to missed appointment fees, late cancellation fees, written correspondence, record copying, consultation and support services.
Fees for Services
DLB Counseling & Consulting, LLC's are available upon request and located on DLB Counseling & Consulting, LLC's Agreement to Pay for Professionial Services form.
Record Review and Record Copying Clients have the right to review and obtain a copy of their clinical record and can do so with their clinician upon request. DLB Counseling & Consulting, LLC will require up to 30 days for locating and producing a copy of the requested medical record. Clients will be required to pay a fee upon request of their records (see fee chart below). This fee encompasses the cost of copying (including the cost of supplies for and labor of copying) and postage. If a client records request is made from an outside agency/source DLB Counseling & Consulting, LLC will require a signed release of information form from the client. Fees are set in accordance with HIPPA.
Delivery Method and Fees
· Electronic (Fee $35.00)
· USB drive (additional $5.00)
· Fax (Fee $35.00)
· Paper Copy
$18.53 flat fee (first ten pages)
$0.85 (pages 11-40)
$0.15 (each additional page after page 40)
· U.S. Mail (Additional fees apply for postage)
Payment for Professional Services Rendered
DLB Counseling & Consulting, LLC accepts cash, check, most major credit cards and Health Savings Account debit cards. There will be a $25.00 fee for returned checks.
If a client ever becomes involved in a divorce or custody dispute, it is important understand and agree that your clinician will not provide evaluations or expert testimony in court. Clients should hire a different mental health professional for any evaluations or testimony they may require. This position is based on two reasons: (1) A client’s clinician’s statements will be seen as biased in their favor because a client has a therapy relationship; and (2) the testimony might affect a client’s therapy relationship, and the counselor-client relationship must be put first.
In the event a clinician with DLB Counseling & Consulting, LLC is served with a subpoena for an appearance in person or a subpoena for a disposition appearance, the following fee policy will be an effect:
DLB Counseling & Consulting, LLC requires a $1,500.00 retainer due upon service of the subpoena. The minimum billing interval is .25 of an hour at a rate of $62.50 for service including but not limited to testimony preparation, consultation with attorneys representing any involved party to the case, or any written correspondence related to the case.
Clinicians will schedule a minimum two-hour block of time to appear for any court testimony or disposition appearance and a $500.00 minimum fee will be deducted from the retainer. The $500.00 fee is non-refundable and is due whether or not the clinician is actually called to testify on that day. The fee is due if the appearance is canceled by anyone other than the clinician for any reasons and at any time.
If the clinician is required to remain at the court appearance or disposition beyond the two-hour block there will be a subsequent fee of $250.00/hour.
If a clinician is required to appear outside the 4th Judicial District clients will be required to pay $0.57.5 cents per mile and all associated traveling fees (tolls, parking, meals, hotel accommodations etc.). If funds are not available from the retainer to pay for services requested or rendered, clients will be required to pay any balance due within 30 days of receiving an invoice for services billed.
Most often, insurance companies will not reimburse for these services. It is the client’s responsibility to coordinate with their insurance company to determine if they are eligible for reimbursement for a court ordered appearance.
We believe that telephone consultations may be suitable or even needed at times in our treatment practices. If so, we will charge at the minimum billing interval of .25 of an hour at the client’s self-pay or health insurance contracted rate. If we need to have long telephone conferences with other professionals as part of a client’s treatment, clients will be billed for these at the same rate as for regular therapy services. If clients are concerned about these practices, please be sure to discuss it with your clinician in advance. Of course, there is no charge for calls about appointments or similar business.
Occasionally it may be better to go on with a session, rather than stop or postpone work on a particular issue. When this extension is more than 10 minutes the clinician will advise their client, because sessions that are extended beyond 10 minutes will be charge at the minimum billing interval of .25 of an hour at the client’s self-pay or health insurance contracted rate.
DLB Counseling & Consulting, LL will not charge clients for my time spent making routine reports to your insurance company. However, we will have to bill client for any extra-long or complex reports the insurance company might require at the minimum billing interval of .25 of an hour at their contracted rate. Most often, insurance companies will not reimburse for these services.
Change of Fees
The fees established for services provided may be subject to change. In the event fees for services are increased clients who are currently receiving services will be notified by their clinician or a designated DLB Counseling & Consulting, LLC staff member in writting and their current rates will remain the same for an adjustment period of 60 calendar days.
If a client receives an invoice from DLB Counseling & Consulting, LLC for a balance due, it is because there is the balance their health insurance policy requires them to pay (i.e. co-payment, deductible non-covered fees). Clients are requested to contact their insurance company first if they believe there is a problem.
The balance on the DLB Counseling & Consulting, LLC invoice should be equal the “Patient Responsibility” portion on the health insurance company’s Explanation of Benefits (EOB) that clients receive from their insurance company, less any co-payment that was collected at the time of service.
If there is a discrepancy, please contact Donny Baca at 719-459-9928 to advise him of the billing discrepancy.
No services will be provided if there is a balance due for more than $200.00, unless arrangements have been may with a client’s clinician.
In the event there is a balance due on a client’s account they will receive a monthly invoice from DLB Counseling & Consulting, LLC to the email account we have on file. If clients do not want the invoice sent to them via email, they shall advise their clinician in writing and provide an alternate email address or request the invoice be mailed to the address on their account.
Payment is expected within 30 days after receipt of an invoice. A delinquent account may be subject to collections. If more than 90 days lapses without payment, unless arrangements have been made with DLB Counseling & Consulting, LLC, we reserve the right to turn the account over for collection to our attorney or collection agency.
Ethics and Professional Standards
Management Team: Donny Baca, MA, LPC
DLB Counseling & Consulting, LLC’s clinicians agree to abide by and uphold the most responsible ethical and professional standards possible. Our staff will make every effort to protect the welfare of those who seek our services and to ensure our services are used appropriately.
If a client is ever unhappy with their clinician’s services or services provided by a DLB Counseling & Consulting, LLC independent contractor, it is especially important that clients try their best to communicate with their clinician or our management staff the source of the dissatisfaction.
Clients may prefer to communicate their concerns in writing if they feel unable to do so verbally. If the client’s clinician or our management team is unable to reach an agreeable solution and additional or alternative assistance is needed, management will do our best to help clients locate a more suitable referral of therapy services.
Since clinicians generally agree that it is not the client’s best interest to be receiving similar services from another professional, should a client wish to contract with another clinician, psychologist, or other mental health professional for services, it is import clients indicate their desire to make a change and their basic reasons for doing so.
If clients would like to submit a complaint or report a problem they are welcome to request a complaint form from Donny Baca, MA, LPC at [email protected] or by calling 719-459-9928. Management will consider all complaint or concerns serious and will respond immediately to all formal complaints.