Policies, Forms, and Fees

Please click one of the anchored links below to be taken directly to your particular area of interest.

• Forms
• Confidentiality
• Insurance
• Contact Between Sessions
• Telephone, Email, and Emergency Procedures
• Disclaimer
• Fees
• 24-Hour Cancellation Policy

Forms

Below are links to download client forms.
To view and print these PDF forms, please Download Free Adobe Reader

Please complete and sign each form before your first visit.

• HIPPA Notice of Privacy Practices (Adobe PDF)
• Therapy Policies & Information (Adobe PDF)
• New Client History Information (Adobe PDF)

Please complete and sign if requested by Ms. Cunanan-Dwight

• Authorization to Release Patient Information (Adobe PDF)
• Adolescent History Information (Adobe PDF)

Confidentiality

The law protects the relationship between a client and a psychotherapist. All personal information discussed in therapy is completely confidential. Your personal information cannot be released to a third party without your written permission, except when disclosure is required by law.

Information Disclosure is Required if:

• Suspected child abuse or dependant adult or elder abuse.
  The therapist is required by law to report this to the appropriate authorities immediately.


• A client is threatening serious bodily harm to another person
  The therapist must notify the police and inform the intended victim.


• A client intends to harm himself or herself.
  The therapist will make every effort to enlist their cooperation in insuring their safety. If they do not cooperate, further measures may be taken without their permission in order to ensure their safety.

Please also refer to the Forms section re: HIPAA

Health Insurance and Confidentiality

Your insurance company may require disclosure of confidential information in order to process your claims. If you wish Ms. Cunanan-Dwight to provide information to your insurance company concerning your treatment, only the minimum necessary information will be communicated to the carrier. Upon your request, Ms. Cunanan-Dwight will release information to any agency/person that you specify.

Ms. Cunanan-Dwight has no control or knowledge about what insurance companies do with the information she provides or who may access that information. It is important to realize that there is a certain amount of risk to your confidentiality and privacy associated with submitting a mental health invoice for reimbursement.

Insurance

Ms. Cunanan-Dwight accepts some forms of HMO insurance and EAP plans. Many PPO plans will offer coverage or benefits even if she is outside of their network. If you are covered, your PPO plan will reimburse part or all of your fee. Please note that professional services are rendered and charged to the patient (for PPO plans) in the form of a "super-bill provided for you monthly or quarterly (and not to the insurance company) for either partial or full reimbursement.

Please be sure to verify your insurance coverage carefully. If you are utilizing HMO insurance to pay for your treatment, you will be responsible for any applicable deductibles and co-payments at the time of service.

Ms. Cunanan-Dwight can assist with specifics. Important questions to ask your carrier are:

• Do I have mental health benefits?
• What is my deductible and has it been met?
• How many sessions per calendar year does my plan cover?
• How much does my plan cover for an out-of-network provider?
• What is the coverage amount per therapy session?
• Is approval required from my primary care physician?

Contact Between Sessions

For established clients, Ms. Cunanan-Dwight is available Tuesdays-Saturdays. For non urgent matters, your call or email will be returned within 48 hours. For urgent matters, your call will be returned within 24 hours or less. Clients are also welcome to email with non-urgent matters, or to setup and confirm appointments. Please be aware that email communication is no guarantee of a secure or confidential communication medium. Psychotherapists are required to make a record of each client contact. Email communications are printed in full and become part of an established client's file.

Telephone, Email, and Emergency Procedures

In the event of a CRISIS or EMERGENCY - psychiatric or medical, such as suicidal or homicidal thoughts or actions, abuse of a child or adult, or other mental health emergency

CALL 911 immediately.

If you need to contact Ms. Cunanan-Dwight between sessions, you may contact her at (858) 525-2937. If she is unavailable or in session, your call will be returned as soon as possible. Ms. Dwight checks her messages a few times a day (between 9am-7pm), unless she is out of town. If an emergency situation arises, and you need to talk to someone immediately, you can call the crisis access line at 800-479-3339 or 911.

Email is not considered an appropriate communication form for crisis and emergency events and with your written consent at the beginning of treatment, it is solely utilized for brief questions, appointment setting and billing purposes.

Disclaimer

You acknowledge that the information on the Website is provided 'as is' for general information only. It is not intended to provide medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. Ms. Cunanan-Dwight makes no warranties of any kind regarding this Website, including but not limited to any warranty of accuracy, completeness, currency, reliability, merchantability or fitness for a particular purpose, or any warranty that these pages, or the computer server which makes them available, are free of viruses or other harmful elements, and such warranties are expressly disclaimed.

Fees

Initial Evaluation - May take up to three sessions depending on complexity.
First session - 90 minutes: $150.00

Subsequent sessions - 50 minutes: $120.00 (standard therapy hour)

Any 15 mins thereafter are billed at $30.00 each 15 mins

For clients who have financial hardships and cannot afford these fees, a flexible sliding scale is available . If this includes you, please let me know and we can review the sliding scale and arrive at a fee that is mutually agreeable.

Payment is due at the time of treatment unless other arrangements have been made with Ms. Cunanan-Dwight. (Accepts cash, personal or business checks, and Visa/Mastercard)

24-Hour Cancellation Policy

Since scheduling of an appointment involves the reservation of time specifically for you, a minimum of 24 hours notice is required for re-scheduling or canceling an appointment. The full fee will be charged for sessions missed without such notification. A nominal, lesser charge is issued for cancellations taking place less than 24 hours. Insurance companies do not reimburse for missed sessions.