Policies

Fees: The fee for an initial assessment (intake session) is $200.  A standard 45 minute psychotherapy session is $165.00. For clients preferring more time or seeking EMDR treatment, I offer either a 60 minute session for $200, or a 90 minute session for $275.00. 

Insurance: I am an in network provider with Aetna, so if you have that insurance I will bill them directly.  If you have another kind of insurance, you can receive partial reimbursement for your visits with me as an "out of network" provider.  You must pay upfront for the services, but then I provide you with documentation to submit to your insurance for reimbursement.  Check with your insurance company for information on the rate at which they will reimburse you for out of network care.

Payment: I accept cash, check, and credit/debit cards (this includes HSA cards). Payment is due at the time of service.  For more information on my fees and policies, see General Policies tab below.

Abigail Spencer, LCSW

1200 28th St., Suite 200B ~ Boulder, CO 80303 ~ 720-340-8060

PRACTICE POLICIES

APPOINTMENTS

Psychotherapy sessions can be 45, 60, or 90 minutes long, depending on client needs and preferences. Client and therapist decide collaboratively on a default session length which is then scheduled in advance.

I offer the option of either in person or telehealth sessions, arranged in advance. In person sessions may be changed to telehealth as late as the morning of the session if inclement weather or illness make it unwise to meet in person. If a client wants to change an in person session to telehealth, that is always an option, though advance notice of such change is requested and appreciated.

Missed appointments, canceled appointments, and rescheduled appointments will be subject to a fee (see below) IF NOT RECEIVED AT LEAST 24 HOURS IN ADVANCE. This is necessary because I have limited availability and that time was held exclusively for you. Sessions cannot be extended due to lateness.

MINORS

I do not see minors in my practice. I will give you a list of referrals if you are under 18.

FEES

Psychotherapy: The fee for an initial intake session is $200. A 45 minute session is $165.00, 60 minutes is $200, and 90 minutes is $275.

For sessions cancelled or rescheduled with AT LEAST 24 HOURS NOTICE, there is no charge for rescheduling. The fee for a missed or late cancelled appointment is the full cost of the scheduled session.

Payment is due at the time of service. I accept cash, check, and credit/debit cards (this includes HSA cards). I require all clients to provide a credit/debit card to be kept on file so that if cash or check payment is not provided at the time of service, I can charge the card.

If you are unable to pay a fee or balance you owe, you will not be able to schedule another appointment with me until the balance is paid.

If you end therapy with an unpaid balance and do not make arrangements to settle the bill, your account may be turned over to a collection agency. Any costs incurred in the collection are your responsibility. A $10.00 service charge will be charged for any checks returned for any reason for special handling.

INSURANCE

I am in network with only one insurance company: Aetna.

If I am out of network with your insurance company, you may still be able to receive partial coverage of my services. If you would like to go this route, I will give you a statement which you can submit directly to your insurance company.

Please note: If you have Medicaid insurance, I am not allowed to see you out of network.

OTHER SERVICES

Telephone conversations of a clinical nature, either with the client or to coordinate care with other providers, will be charged at my hourly rate for psychotherapy ($200) in 15 minute increments. Written reports or letters will also be charged at the psychotherapy rate as well. Court appearances and preparation of legal testimony/materials are charged at $500/hr, and require 4-hour minimum. If the court appearance is rescheduled or cancelled I will bill for the time reserved for the appearance.

EMERGENCIES

This practice is not a 24 hour crisis intervention agency. In case of an emergency you should call 911 or go to the nearest hospital emergency room.

TELEPHONE ACCESSIBILITY

If you need to contact me between sessions, please leave a message on my voicemail. I am often not immediately available; however, I will attempt to return your call within 24 hours during the business week. Telehealth sessions (secure videoconference) are always an option.

ELECTRONIC COMMUNICATION

I cannot ensure the confidentiality of any form of communication through electronic media, including text messages.  I request that you do not email or text to discuss therapeutic content. My preferred mode of communication with clients is through the secure messaging capability in my client portal, as this is compliant with HIPAA privacy laws.  You may also call me and leave a confidential voicemail. While I try to return messages in a timely manner, I cannot guarantee immediate response. I do not provide crisis services.

SOCIAL MEDIA AND TELECOMMUNICATION

Due to the importance of your confidentiality and the importance of minimizing dual relationships, I do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.

TERMINATION

Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. I reserve the right to terminate treatment after discussion with you if I determine that the psychotherapy is not being effectively used or if you are in default on payment. I will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or if you request another therapist, I will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.

Should you fail to schedule an appointment or communicate with me for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued.

General Information 

The therapeutic relationship is unique in that it is a highly personal and at the same time, a contractual agreement. Given this, it is important for us to reach a clear understanding about how our relationship will work, and what each of us can expect. This consent will provide a clear framework for our work together. Feel free to discuss any of this with me. Please read and indicate that you have reviewed this information and agree to it by filling in the checkbox at the end of this document.

The Therapeutic Process 

You have taken a very positive step by deciding to seek therapy. The outcome of your treatment depends largely on your willingness to engage in this process, which may, at times, result in considerable discomfort. Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. There are no miracle cures. I cannot promise that your behavior or circumstance will change. I can promise to support you and do my very best to understand you and repeating patterns, as well as to help you clarify what it is that you want for yourself.

Other Reminders

• You are entitled to receive information about the methods of clinical work, the techniques used, the duration of clinical work (if known), and the fee structure.

• You may seek a second opinion from another licensed or registered mental health professional or you may terminate our work at any time.

• In a professional relationship sexual intimacy is inappropriate and should be reported to the Board that licenses, registers, or certifies the licensee, registrant or certificate holder.

Confidentiality 

The session content and all relevant materials to the client’s treatment will be held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons. Limitations of such client held privilege of confidentiality exist and are itemized below:

1. If a client threatens or attempts to commit suicide or otherwise conducts him/her self in a manner in which there is a substantial risk of incurring serious bodily harm.

2. If a client threatens grave bodily harm or death to another person.

3. If the therapist has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.

4. Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.

5. Suspected neglect of the parties named in items #3 and # 4.

6. If a court of law issues a legitimate subpoena for information stated on the subpoena.

7. If a client is in therapy or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney.

Occasionally I may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name.

If we see each other accidentally outside of the therapy office, I will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to me, and I do not wish to jeopardize your privacy. However, if you acknowledge me first, I will be more than happy to speak briefly with you, but feel it appropriate not to engage in any lengthy discussions in public or outside of the therapy office.

About the therapist

Education and Licensure:

MSW from Smith College School for Social Work, 2006

BA from Princeton University, 2003

Colorado licensed clinical social worker (LCSW) since 2010, license #1618

Regulatory Requirements relevant to LCSW:

•A Licensed Clinical Social Worker (LCSW) must hold a masters degree in their profession and have two years of post-masters supervision.

•The practice of licensed clinical social workers is regulated by the Mental Health Licensing Section of the Division of Registrations of the Colorado Department of Regulatory Agencies.

•The Board of Social Work Examiners can be reached at: 1560 Broadway, Suite 1340, Denver, CO 80202, (303) 894-7760.

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. MY PLEDGE REGARDING HEALTH INFORMATION: I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.

• Give you this notice of my legal duties and privacy practices with respect to health information.

• Follow the terms of the notice that is currently in effect.

• I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.

For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your person health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

1. Psychotherapy Notes. I do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is: a. For my use in treating you. b. For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy. c. For my use in defending myself in legal proceedings instituted by you. d. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA. e. Required by law and the use or disclosure is limited to the requirements of such law. f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes. g. Required by a coroner who is performing duties authorized by law. h. Required to help avert a serious threat to the health and safety of others.

2. Marketing Purposes. As a psychotherapist, I will not use or disclose your PHI for marketing purposes.

3. Sale of PHI. As a psychotherapist, I will not sell your PHI in the regular course of my business.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:

1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.

2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.

3. For health oversight activities, including audits and investigations.

4. For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.

5. For law enforcement purposes, including reporting crimes occurring on my premises.

6. To coroners or medical examiners, when such individuals are performing duties authorized by law.

7. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.

8. Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.

9. For workers' compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers' compensation laws.

10. Appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

1. Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.

2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

3. The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.

4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost based fee for doing so.

5. The Right to Get a List of the Disclosures I Have Made.You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost based fee for each additional request.

6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.

7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on 9/23/19.

Acknowledgement of Receipt of Privacy Notice

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By checking the box below, you are acknowledging that you have received a copy of HIPAA Notice of Privacy Practices.

Pursuant to the No Surprises Act (HR133, Title 45 Section 149.610), this form is used to provide a current or prospective client with a “Good Faith Estimate” (GFE) of expected charges for services to be provided.  

You are entitled to receive a personal/customized “Good Faith Estimate” of what the charges could be for psychotherapy services provided to you. While it is not possible for a psychotherapist to know, in advance, how many psychotherapy sessions may be necessary or appropriate for a given person, this form provides an estimate of the cost of services provided. Your total cost of services will depend upon the number of psychotherapy sessions you attend, your individual circumstances, and the type and amount of services that are provided to you. This estimate is not a contract and does not obligate you to obtain any services from the provider(s) listed, nor does it include any services that may be recommended during treatment to you that are not identified here. 

This Good Faith Estimate is not intended to serve as a recommendation for treatment or a prediction that you may need to attend a specified number of psychotherapy visits. The number of visits that are appropriate in your case, and the estimated cost for those services, depends on your needs and what you agree to in consultation with your therapist. You are entitled to disagree with any recommendations made to you concerning your treatment and you may discontinue treatment at any time. 

The fee for a 45 minute psychotherapy visit (in person or via telehealth) is $150. The fee for an intake (initial assessment) session or a 60 min psychotherapy session (in person or via telehealth) is $180. The fee for a 90 min session is $250. Most clients will attend one psychotherapy visit per week, but the frequency of psychotherapy visits that are appropriate in your case may be more or less than once per week, depending upon your needs. 

Based on this per visit fee cited above, the following are expected charges of psychotherapy services:

For 45 min. sessions every other week: 

-13 weeks of service (approx. 3 months): $900 

-26 weeks of service (approx. 6 months): $1,950 

-39 weeks of service (approx. 9 months): $2,550 

-52 weeks of service (approx. 12 months): $3,900

For 60 min. sessions every other week: 

-13 weeks of service (approx. 3 months): $1,080 

-26 weeks of service (approx. 6 months): $2,340 

-39 weeks of service (approx. 9 months): $3,060 

-52 weeks of service (approx. 12 months): $4,680

For 90 min. sessions every other week: 

-13 weeks of service (approx. 3 months): $1,750 

-26 weeks of service (approx. 6 months): $3,250 

-39 weeks of service (approx. 9 months): $5,000 

-52 weeks of service (approx. 12 months): $6,500

For weekly 45 min. sessions: 

-13 weeks of service (approx. 3 months): $1,950 

-26 weeks of service (approx. 6 months): $3,900 

-39 weeks of service (approx. 9 months): $5,850 

-52 weeks of service (approx. 12 months): $7,800

For weekly 60 min. sessions: 

-13 weeks of service (approx. 3 months): $2,340 

-26 weeks of service (approx. 6 months): $4,680 

-39 weeks of service (approx. 9 months): $7,020 

-52 weeks of service (approx. 12 months): $9,360

For weekly 90 min. sessions: 

-13 weeks of service (approx. 3 months): $3,250 

-26 weeks of service (approx. 6 months): $6,500 

-39 weeks of service (approx. 9 months): $9,750 

-52 weeks of service (approx. 12 months): $13,000

For twice a week 45 min. sessions: 

-13 weeks of service (approx. 3 months): $3,900 

-26 weeks of service (approx. 6 months): $7,800 

-39 weeks of service (approx. 9 months): $11,700 

-52 weeks of service (approx. 12 months): $15,600

For twice a week 60 min. sessions: 

-13 weeks of service (approx. 3 months): $4,680 

-26 weeks of service (approx. 6 months): $9,360 

-39 weeks of service (approx. 9 months): $14,040 

-52 weeks of service (approx. 12 months): $18,720

You have a right to dispute a bill if the actual amount charged to you substantially exceeds the estimated charges stated in your Good Faith Estimate (which means $400 or more beyond the estimated charges). Initiating the dispute process will not adversely affect the quality of services rendered to you. You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you, you will have to pay the higher amount. To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call HHS at (800) 368-1019. Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.

You are encouraged to speak with your provider at any time about any questions you may have regarding your treatment plan, or the information provided to you in this Good Faith Estimate.