OFFICE POLICIES, EFFECTIVE January 1, 2013
Staff Therapist: Donny Baca, MA, LPC is the sole proprietor of DLB Counseling & Consulting, LLC. All consultants, independent contractors, interns or administrative personnel working for or on behalf of DLB Counseling & Consulting, LLC are required to maintain client confidentiality.
Office Hours: My office is open Tuesday – Thursday, 3:00 p.m. – 8:00 p.m.
Appointments: I see clients by appointment only. If you have any changes to your demographic information (such as a change of address or insurance), please advise me at the time of your scheduled time appointment.
Running Late: Clients arriving more than 10 minutes after their scheduled appointment may be asked to reschedule and will be charged a $45.00 late cancellation fee.
Emergency Situations: In the event of a life-threatening crisis or an if an emergency situation arises that requires immediate attention you should contact 911 or go to the nearest hospital emergency room. Additional resources available is the National Hopeline Network at 1-800-Suicide/1-800-784-2433 or National Suicide Prevention Lifeline at 1-800-Talk /1-800-273-8255 or dial 911. Hearing and Speech Impaired should call 1-800-799-4TTY/1-800-799-4889.
Contacting Me: I am often not immediately available by telephone. I do not answer my phone when I am with clients or otherwise unavailable. At these times, you may leave a message on my confidential voicemail and your call will be returned as soon as possible, but it may take a day or two for non-urgent matters. If, for any number of unseen reasons, you do not hear from me or I am unable to reach you, and you feel you cannot wait for a return call or if you feel unable to keep yourself safe, 1) go to your local Hospital Emergency Room, or 2) call 911. I will make every attempt to inform you in advance of planned absences and provide you with the name and phone number of the mental health professional covering my practice.
Payment for Professional Services Rendered: DLB Counseling & Consulting, LLC accepts Cash, Visa, MasterCard, American Express, and Discover for your convenience.
Private Pay: If you do not have insurance, payment will be due at the time of service. I require a minimum of 100% of the balance to be paid at the time of service.
Insurance: Although I am contracted with several insurance companies, it is your responsibility to make sure that Donny Baca, MA, LPC in your specific plan. If Donny Baca, MA, LPC is not a participating provider for your plan, you may still select me for your behavioral health care; “out of network” benefits will apply. It is also your responsibility to know your insurance benefits. Donny Baca, MA, LPC will not advise you of your insurance benefits. Please contact your insurance company at the Customer Service phone number printed on your insurance card if you have questions pertaining to coverage. As a courtesy to my clients, I will file insurance forms from my office. In order to do this, I require all information to be completed on the Client Portal account. I must have this information prior to your appointment. Please present your insurance card at each appointment. A photo ID is required at your first visit. I make every effort to verify insurance prior to your appointment. If I am unable to verify your insurance eligibility, you will be required to pay for your visit at the time of your appointment. If you provide the correct insurance information to my office in a timely manner, I will file a claim on your behalf. I will refund to you any portion that is determined to not be your responsibility. You are responsible for paying all co-pays at the time of service. Co-pays, co-insurance, deductibles and non-covered services cannot be waived by my office, as it is a requirement placed on you by your insurance carrier. Failure to pay your portion of services rendered will be reported to your insurance company and could result in termination of your insurance plan.
Billing: If you receive an invoice from my office for a balance due, it is because that is the balance your insurance policy requires that you pay. Please contact your insurance company first if you believe there is a problem. The balance on your invoice should be equal to the “Patient Responsibility” portion on your Explanation of Benefits that you received from your insurance company plus any “non-covered services” (less any copay that was collected at the time of service). If there is a discrepancy, please call Donny Baca, MA, LPC immediately to advise me. You will continue to receive invoices and be subject to collections if you do not advise me of discrepancies. Donny Baca, MA, LPC may be reached at (719) 459-9928.
No-Show or Less Than 24 Hour Notice Cancellation: If you it necessary to cancel a scheduled appointment, a 24-hour notice in advance is required to avoid charges. Sessions missed without a 24-hour cancellation will be responsible to pay the full session fee for the missed appointment. This fee must be paid prior to attending the next session. This charge cannot be submitted to your insurance company for payment. Failure to pay no-show fees could result in termination of services until paid. If your insurance program does not allow this office to charge for no shows/late cancellations, you will be allowed to rescheduled one (1) time and any subsequent no-shows or late cancellations will be cause for termination of treatment.
Cancellations MUST be made through your client portal account or by calling or texting Donny Baca at 719-459-9928.
Change of Fees:
The fees established for services provided may be subject to change. In the event service fees are increased it will be posted on the business website under Rates, 60 days prior to the increase. If you are actively receiving counseling services you will be notified by Donny Baca, MA, LPC and the current rates will remain the same for an adjustment period of 60 days. Clients receiving Pro Bono or reduced counseling fees may not be subject to the fee increase.
Record Review and Record Copying: Clients have the right to review and copy their clinical record and I will review the record with the client. I will require up to 30 days for locating and producing a copy of the record. There will be a $45.00 fee associated with the production of client records (research & copies). Clients will be required to pay this fee upon request of their records. If a client records request is made from an outside agency/source I will require a signed release of information form from the client.
Court Testimony: When served with a subpoena for my appearance in person or a disposition subpoena for my appearance, the following fee policies will be an effect. This is the case unless you receive a signed, written amendment from me. A $1,000.00 retainer will be required and will be due with the subpoena. My fee for testimony preparation and a scheduled appearance is $250.00/hour paid in advance. There will be a $500.00 fee for my scheduling the day or any fraction of the day. The $500.00 fee is non-refundable and is due whether or not I am actually called on that day. The fee is due even if the appearance is canceled by anyone other than me for any reason and at any time. 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.
Overdue Accounts: In the event there is a balance on your account you will receive a monthly bill from my office. No services will be provided if there is a balance due of more than $200.00. Payment is expected 15 days after receipt of a statement. If more than 90 days lapse without payment, unless arrangements have been made, I reserve the right to turn the account over for collection to my attorney or collections agency.
Ethics and Professional Standard: As a therapist, I agree to abide by and uphold the most responsible ethical and professional standards possible. I will make every effort to protect the welfare of those who seek my services and to ensure that my services are used appropriately. If you are ever unhappy with my services or services provided by an independent contractor hired by me, it is especially important that you try your best to communicate with me the source of your dissatisfaction. Some clients do this in writing if they feel unable to do so verbally. If we should not reach an agreeable solution and you need help finding additional or alternative assistance, I will do my best to help you locate a more suitable referral of therapy services. Since therapists generally agree that it is not the patient’s best interests to be receiving similar services from another professional, should you wish to contract with another psychologist, psychiatrist or therapist for services, it is important that you indicate your desire to make a change and your basic reasons for doing so. There is also a complaint form you can request and fill out to report a problem. I take concerns or complaints very seriously and will respond immediately to all formal complaints.
Psychiatric Coverage: If you need a referral to a psychiatrist, medication or hospitalization I can refer you to a number of different psychiatrists in the area, or if you already have a psychiatrist, I will be glad to work with whomever you need to be seen by. If you prefer to work with your family physician, I will also be willing to consult with him or her.
Questions: If, during the course of your therapy you have any questions about the nature of your therapy (i.e., therapeutic goals, procedures, policies, fees) please ask me. This issue is even more important on matters which you fear might be embarrassing to either yourself or me. I strongly encourage you to bring such matters up for consideration since dealing with such matters is often an important part of your treatment.