Our Forms & Policies
Not every clinician at Seasons Psychotherapy Associates LLC works with every insurance company. If one of our providers can provide you with in-network care and you wish to use that coverage, we will collect your estimated co-pay or cost share after each session is provided.
It is your responsibility to know your insurance coverage and to notify Seasons Psychotherapy Associates LLC of any changes to your insurance, coverage, or policy. In the event that your insurance coverage has changed, you must notify Seasons Psychotherapy Associates LLC prior to your next visit. Any services provided that are not covered by your insurance company are your financial responsibility and are subject to our standard collection procedures.
Out-of-Network Insurance Billing
If your clinician is not individually contracted with your insurance company, your insurance is considered “out-of-network.” This means that it may be subject to a different set of deductibles, co-pay formulas, and limits on coverage and we cannot guarantee your insurer will reimburse you for your care. Clients wishing to use out-of-network insurance coverage must pay the cash rate at the time of service.
We do not submit claims on an out-of-network basis for our clients. If you want your claims submitted on an out-of-network basis, you may contact our Billing Coordinator and request a “superbill” that you can personally submit to your insurer.
In the event that your out-of-network insurance coverage fails to cover your care, you will be held liable for our standard rate for cash pay clients.
Working with us you consent that all submissions for reimbursement sent to insurance companies, employee assistance plans, and other third parties may include private health information such as your diagnosis, identifying information, dates of service and amounts paid to our practice. In the event that a family member or other acquaintance agrees to pay for your services, we reserve the right to communicate to them about session attendance, no shows / cancellation fees, and the expected duration and effectiveness of therapy.
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. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute your bill. Make sure to save a copy of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 800-985-3059.
Insurance companies will not cover mental health services where a valid diagnostic code is not provided and/or there is no evidence of medical necessity. Seasons Psychotherapy Associates LLC defines medical necessity as a condition that impairs your relational, vocational, emotional, physical, or spiritual functioning. For families and couples seeking counseling, at least one individual must be assigned an individual diagnosis code and treatment must be appropriately focused on treating the individual’s diagnosis. Additionally, insurance companies do not cover no-show fees, cancellation fees, records fees, letter writing fees, or fees associated with our legal retainer. These fees are your sole responsibility.
As part of providing therapeutic services, various Seasons Psychotherapy Associates LLC staff beyond your clinician will have access to your private information as needed to perform their job duties. Your rights to privacy and explanations of how your information is used are more fully explained in the separate document entitled “Notice of Privacy Practices for Seasons Psychotherapy Associates LLC.” If you have not received this document or would like another copy, you can request one.
Call Recording Policy
All phone calls to our administrative staff and clinicians may be recorded and be archived for up to six months for quality control and training purposes.
All clinicians at Seasons Psychotherapy Associates LLC are subject to the full supervision of our clinical directors. This means that your case and private health information may be discussed with your clinician’s supervisory chain of command. Additionally, notes for every session performed by provisionally licensed clinicians or unlicensed graduate interns are reviewed by their clinical supervisor and may be anonymously discussed in class at their university as part of their graduate training program.
From time to time, our clinicians will also seek outside consultation from other industry professionals regarding their clients. Additionally, our therapists may use anecdotes from therapy as part of writing, speaking, teaching or being interviewed in public settings. In all of these instances, no client names or case specifics will be shared, ensuring confidentiality remains unbroken.
When working with multiple persons within the same family, Seasons Psychotherapy Associates LLC adheres to a “no secrets” policy. This means that we cannot and will not guarantee confidentiality between the multiple parties engaged in marital, couples, or family therapy. Further, our clinicians reserve the right to break confidentiality when they encounter information that any party involved in treatment might feel betrayed or aligned against if the information remained a secret. Your clinician may attempt to notify you prior to disclosing material facts to another adult involved in conjoint therapy with you but does not guarantee this.
Seasons Psychotherapy Associates LLC occasionally has more than one clinician in the practice treating different family members. Case consultation among the different clinical providers is expected when multiple family members are being seen by Seasons’ clinicians. The confidentiality between multiple parties engaged in psychotherapy from the same family with different therapists within the practice is not guaranteed and our clinicians reserve the right to break confidentiality when it is therapeutically appropriate to do so.
Communications between clinicians and clients who are minors (under the age of 18) is confidential. However, in the exercise of their professional judgment, your clinician may discuss the treatment progress of a minor patient with the parent or legal guardian as is beneficial to the child. We strongly discourage parents from using their right to a child’s medical records to violate this confidentiality. We believe it destroys a child’s trust in their clinician and the mental health process.
Policy: Smoking or vaping of any kind (tobacco, marijuana, etc.), possession or consumption of alcohol, or use of any other illicit, illegal or mind-altering substance, is strictly prohibited by both staff and clients within our facilities and during telehealth sessions.
Seasons Psychotherapy Associates LLC is not responsible for the safety and security of items brought by clients, staff and visitors onto its premises. In the event that an item is left behind by a client, staff or visitor and is found by one of our staff, we will make our best attempt to secure those items in that office to be claimed later. Illegal or illicit items will be disposed of or turned over to law enforcement, as safety dictates. Medications left behind will be transported to the nearest pharmacy and/or turned over to law enforcement.
Seasons Psychotherapy Associates LLC may, without notice, break client confidentiality and contact the appropriate authorities with all pertinent information when we suspect:
- Child, elder, or dependent adult abuse / neglect is revealed about any party, including those not in therapy. This includes witnessing domestic violence.
- A client poses a serious physical threat to themselves or others.
Seasons Psychotherapy Associates LLC may be forced to release information when ordered by a judge or court of law under threat of sanctions to our practice or staff.
Seasons Psychotherapy Associates LLC uses a number of software, web-based, and electronic applications created and administered by third party providers. These include but are not limited to Simple Practice, Docu-Sign, Google Gmail and Business Applications, Abby phone services, AT&T, Fax.com, and various cell phone providers. Additionally, third party applications may be implemented by our practice without any additional disclosures to you as the client at any point in the future.
While Seasons Psychotherapy Associates LLC has secured a “business associate agreement” from each of these service providers, we cannot ultimately guarantee their compliance with HIPAA and other regulations. As part of receiving services from us, you exempt Seasons Psychotherapy Associates LLC from liability or blame for any privacy violations that occur due to any action on the part of these vendors.
All complaints and disputes, with the exception of collection actions initiated by Seasons Psychotherapy Associates LLC, will be handled through a certified mediator. The mediator will be chosen by Seasons Psychotherapy Associates LLC and paid for by the party initiating the complaint.
No weapons of any kind may be brought into any Seasons Psychotherapy Associates LLC building or office, even if otherwise allowed under state concealed carry laws, unless in the possession of a bonafide law enforcement officer. Failure to abide by this policy will result in immediate termination of services.
Quality and integrity are core values at Seasons Psychotherapy Associates LLC. Should you ever have concerns or complaints about the quality of your care, the integrity of our billing procedures, the protection of your privacy, or our commitment to uphold the dignity and protect against the discrimination of every individual we serve, you can contact our Clinical Director at the main number 954-342-0982. All calls are confidential, may be made anonymously, and will be responded to if requested.
Florida law requires that your healthcare provider or healthcare facility recognize your rights while you are receiving medical care and that you respect the health care provider’s or health care facility’s right to expect certain behavior on the part of patients. You may request a copy of the full text of this law from your health care provider or health care facility. A summary of your rights and responsibilities follows:
- A patient has the right to be treated with courtesy and respect, with appreciation of his or her individual dignity, and with protection of his or her need for privacy.
- A patient has the right to a prompt and reasonable response to questions and requests.
- A patient has the right to know who is providing medical services and who is responsible for his or her care.
- A patient has the right to know what patient support services are available, including whether an interpreter is available if he or she does not speak English.
- A patient has the right to bring any person of his or her choosing to the patient-accessible areas of the health care facility or provider’s office to accompany the patient while the patient is receiving inpatient or outpatient treatment or is consulting with his or her health care provider, unless doing so would risk the safety or health of the patient, other patients, or staff of the facility or office or cannot be reasonably accommodated by the facility or provider.
- A patient has the right to know what rules and regulations apply to his or her conduct.
- A patient has the right to be given by the health care provider information concerning diagnosis, planned course of treatment, alternatives, risks, and prognosis.
- A patient has the right to refuse any treatment, except as otherwise provided by law.
- A patient has the right to be given, upon request, full information and necessary counseling on the availability of known financial resources for his or her care.
- A patient who is eligible for Medicare has the right to know, upon request and in advance of treatment, whether the health care provider or health care facility accepts the Medicare assignment rate.
- A patient has the right to receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.
- A patient has the right to receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have the charges explained.
- A patient has the right to impartial access to medical treatment or accommodations, regardless of race, national origin, religion, handicap, or source of payment.
- A patient has the right to treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
- A patient has the right to know if medical treatment is for purposes of experimental research and to give his or her consent or refusal to participate in such experimental research.
- A patient has the right to express grievances regarding any violation of his or her rights, as stated in Florida law, through the grievance procedure of the health care provider or health care facility which served him or her and to the appropriate state licensing agency.
- A patient is responsible for providing to the health care provider, to the best of his or her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to his or her health.
- A patient is responsible for reporting unexpected changes in his or her condition to the health care provider.
- A patient is responsible for reporting to the health care provider whether he or she comprehends a contemplated course of action and what is expected of him or her.
- A patient is responsible for following the treatment plan recommended by the health care provider.
- A patient is responsible for keeping appointments and, when he or she is unable to do so for any reason, for notifying the health care provider or health care facility.
- A patient is responsible for his or her actions if he or she refuses treatment or does not follow the health care provider’s instructions.
- A patient is responsible for assuring that the financial obligations of his or her health care are fulfilled as promptly as possible.
- A patient is responsible for following health care facility rules and regulations affecting patient care and conduct.
Seasons Psychotherapy Associates LLC provides outpatient behavioral health services (commonly described as counseling or therapy) through a Medicaid-enrolled professional who authorizes services within the purview of the treating practitioner’s credentials and state law on behalf of the client. Select clinicians from Seasons Psychotherapy Associates LLC are Licensed Practitioners of the Healing Arts (LPHA) certified and licensed by the state of Florida. They practice in a group setting under the Seasons Psychotherapy Associates LLC administrative umbrella.
Neither Seasons Psychotherapy Associates LLC nor its individually licensed clinicians provide services at a higher level of care than outpatient mental health services. If a referral is needed for a service that Seasons Psychotherapy Associates LLC deems medically necessary but cannot provide, a referral to another provider will be made. This may include services such as intensive outpatient, partial hospitalization, inpatient services, or emergency medical services of any kind.
Eligibility of Services
A Florida State Medicaid Managed Care beneficiary requiring medically necessary behavioral health therapy services shall be eligible to receive services through Seasons Psychotherapy Associates LLC and its Licensed Practitioners of the Healing Arts (LPHAs). On rare occasions we may have a short waiting list for clients to receive services, we endeavor to not have waiting lists and provide services as quickly as possible to our clients.
Recipients of services may discontinue services at any time, as well as seek out services elsewhere at their discretion. Likewise, Seasons Psychotherapy Associates LLC and its Licensed Practitioners of the Healing Arts reserve the right to discontinue services for non-compliance with treatment recommendations, failure to attend more than three scheduled appointments, or disrespectful or unsafe behaviors in our facilities or towards our staff. Every effort will be made to provide a discharged client with an appropriate referral for treatment.
You will not be financially responsible for a service rendered that the Florida Medicaid program denies for payment. If you elect to participate in services that are outside of the services offered through outpatient behavioral health services, then you will be responsible for arranging payment for those services prior to delivery. Our administrative team will work to obtain necessary information needed to process your claims, including a referral from your primary care physician. It is your responsibility to ensure that any participant requirements set forth by Medicaid or private insurance are met prior to receiving service
A $2,000 legal retainer fee (per day, per staff person) will be charged should we be asked to testify in any type of court proceeding. Including but not limited to any type of court trials (including divorce or custody cases), depositions, mediations, etc. You agree to pay this fee even if another attorney, without your authorization, subpoenas any of our staff regarding your records.
This fee must be paid prior to our appearance in court and will be billed to your credit card if one is on file, or payment must be submitted in full by credit or debit card, check, or cashier’s check. Failure to pay this fee will result in our normal collection procedures. Unless specifically contracted to do so, in writing prior to your first appointment, Seasons Psychotherapy Associates LLC clinical staff will not make custody recommendations regarding children, even if we have provided therapy services to all parties involved in a divorce.
Seasons Psychotherapy Associates LLC strictly prohibits audio or video recording of any therapy or testing session without all parties’ expressed written consent. By agreeing to receive services from Seasons Psychotherapy Associates, you also agree to pay a fee of $2,000 for each session in which you record all or part of the session without our clinician’s expressed written consent.
Children under the age of 14 may not be left unattended in our waiting areas. If our therapists realize that a minor is unaccompanied, they will terminate the session and apply the no-show fee. Additionally, children under 14 that are receiving therapy, are required to have a parent or guardian on site at all times. You may wait in your car if you would prefer, but please do not leave the parking lot.
Hurricane and inclement weather days: Cancellation/No Show fee is only waived if the school districts surrounding the office are closed for the day.
Unless specifically prohibited by a third-party payer (insurance company, government program, etc.) all clients will be charged a $150 fee per therapy hour that they fail to show up for, cancel with less than 24 hours’ notice, show up more than 15 minutes late, or leave more than 15 minutes early due to our inability to properly bill insurance for the time you reserved that cannot be recouped. Monday appointments are required to be canceled/rescheduled by the Friday prior to the appointment, by no later than the same time the appointment is scheduled for (a 10:00am appointment on Monday must be canceled no later than 10:00am the Friday before).
This fee is charged regardless of the reason for your no show, later arrival, late cancellation (including illness, family emergency, vehicle difficulties, etc.). This fee will be charged to your credit card on file, if required, within 24 hours and is not covered by your insurance provider or EAP. To cancel an appointment, you can text or secure message (through the client portal) your therapist and cancel. You may also call our main phone number; our answering service will send your therapist a message that you called to cancel with the time that you called. You may also email your clinician directly. In the event you do not have a valid credit card on file, an invoice will be mailed to the address we have on file for you.
We are unable to charge those clients who have Medicaid a no-show or cancellation fee; however, Seasons does reserve the right to discharge any client if the client has 3 or more no-show or late cancellation incidents.
We wish we did not have to have a cancellation / no show fee. Unlike other healthcare providers, we only schedule one client at a time. We thank you for understanding that this policy allows us to keep our doors open and provide the quality mental health services you deserve from dedicated and hard-working professionals.
Copays, coinsurance and session fees for non-insurance clients are due at the time services are rendered. The credit or debit card you have placed on file, if required, will be charged either the day the service was performed or the following day. In the event that your card is declined, our office will continue to attempt to process your card (including partial amounts) at our discretion for up to 180 days after your appointment. We are not responsible for fees associated with a client’s bank account, including overdraft fees, or delayed processing of your credit card. We must have a credit card on file in order to provide services (unless the client has Medicaid).
In the event a client contests a valid charge resulting in a reversal of chargeback initiated by their card issuer, Seasons Psychotherapy Associates will assess the client’s account $50 to cover the cost charged by our credit card processor and the additional labor involved with collecting their outstanding balance.
Failure to pay any fees within 60 days of the date of service will result in your private information being turned over to the law firm or collection agency of our choice for collection actions, including the possible filing of a public lawsuit for collections. This may result in the disclosure of some aspects of your private health information. Fees associated with collections will be added to the balance you owe to our practice.
To facilitate communication, we require all clients to provide us with a valid home address, telephone number and email that we may use to contact you. We encourage you to avoid providing contact information associated with your employment to help protect your privacy, as Seasons Psychotherapy Associates LLC is not liable for breaches of privacy associated with the contact information you provide.
Email communication will be sent through encrypted email whenever possible, but some exceptions, such as our appointment reminder system, do not have this option.
Seasons Psychotherapy offers a HIPAA compliant client portal that makes it easy to leave your psychotherapist secure messages, schedule or reschedule appointments, and send any documents that you may want to share with your psychotherapist. This can be done straight from your phone or computer.
We prefer using email and texting only to arrange or modify appointments. Please do not email or text us content related to your therapy sessions, as email and texting is not completely secure or confidential.
By agreeing to receive services from Seasons Psychotherapy Associates, you give our clinical and administrative personnel authorization to contact you for scheduling and billing purposes at the addresses and phone numbers provided. By signing our consent to treat document, you also acknowledge and give permission for Seasons Psychotherapy Associates LLC to include private health information in these communications.
Our team wishes to be sensitive to your confidentiality in public settings. If we encounter you in public, we will do our best to avoid contact or conversation with you and encourage you to do the same. At no point will we discuss the details of your mental health treatment outside of our offices.
All of Seasons Psychotherapy Associates LLC’s staff and clinicians are prohibited from engaging in anything besides a therapeutic relationship with our clients. This includes, but is not limited to, accepting relationship requests on social media, exchanging gifts, entering into business or personal relationships with clients, or similar activities with close or immediate family members of clients.
Neither Seasons Psychotherapy Associates LLC’s clinicians or our subcontractors provide on call, after hours, or emergency services. We are solely an outpatient mental health office providing services by appointment only. In the event of a medical emergency (including side effects from prescribed medications) or an emergency involving a threat to your safety or the safety of others, please call 911, go to your nearest emergency room or contact Henderson Behavioral Health at 954-463-0911 for independent mobile assessment services.
Our clinicians do not travel to see clients or make house calls. All meetings with our clinicians must take place in our established place of business or via telehealth, unless previously scheduled to occur at another location and approved by Seasons Psychotherapy Associates LLC’s practice manager.
All treatment and psychotherapy sessions are voluntary. You can accept treatment or decline treatment at any time. Your treatment will be collaborative between you and Seasons Psychotherapist Associates LLC’s clinician who will determine the best treatment plan for you. You also have the right to make your treatment wishes known, if you are unable to make your own decisions a Mental Health Advance Directive allows you to designate a person to act for you if you are unable to make your own decisions, so that your wishes can be carried out.
Please let our intake staff know if you have already executed a Mental Health Advance Directive. If so, this information will be included in your medical record in case of an emergency. If you have not executed a Mental Health Advance Directive and would like more information, our staff can assist you with understanding and executing a Mental Health Advance Directive.