Fees and Insurance

    • Call to set up an appointment
    • (530) 207-0126 or email to LauraShlien@gmail.com
    • Appointments available Monday through Friday, days and evenings, and Sundays by arrangement.
    • Fee is $120  per session.  There is a sliding scale. $75-120, based on income and individual circumstances. There are a limited number of openings for lower fees based on individual considerations and referrals.
    • Insurance accepted through  Anthem BC, UCDavis SHIP and Beacon Partnership.
    • Please note that each type of insurance has a different co-pay for which you are responsible at each session.  Different insurance companies also determine the length of the session. Below are sample insurance forms.  If you are unsure of your co-pay or whether your insurance will reimburse the cost of the sessions, go directly to the insurance website.  Your insurance card usually shows the co-pay amount after the letters PCP.  When you come to the first session, please bring your insurance card to be copied, as that is a requirement for obtaining insurance reimbursement.  You will also be asked to sign a release so that Laura Shlien can send your insurance information to a billing service.You will be asked to sign an  Informed Consent Agreement  agreeing to the terms for the appropriate insurance/method of payment at the beginning of the first session.
    • UCD SHIP users need to have a letter of referral  prior to the first session.  These can be obtained from UCD Student Services.           
    • The Informed Consent Terms

    •        Welcome to the Psychotherapy Practice of Laura Shlien Informed Consent Agreement                                    __ File Copy      __ Client Copy                                      Beginning Therapy ~The Therapeutic Process                                      The therapeutic process is a personal journey. The process is not a “quick fix” and is sometimes uncomfortable. Therapy is a joint effort.  Difficult questions may be asked. Your goals and the changes you want to make are what guide the therapeutic process.                                           Your signature on this document indicates you are voluntarily agreeing to treatment with    Laura Shlien, LMFT.Rights and Responsibilities                                                                                                  Clients have a right to confidential and private mental health care treatment and the confidentiality of their treatment record.  This includes your right to approve or refuse the release of information. Exceptions to this are:                                                                                                                                                           A. Your consent in writing;                                                                                                                                   B. A reasonable suspicion of past or present abuse to a child/elder/dependent adult;                           C. A clear and immediate danger to the client or another;                                                                   D. There is an order by a judge or a court action.                                                                                      Additionally, if you reveal that you are suicidal, I may determine it to be in your best interest to discuss this situation with other treatment professionals or people who could help you.

      Office Policies

      I do not provide letters or documentation for legal or evaluative purposes of: Custody evaluations, Worker’s Compensation, SSI, Fitness for Work, or Vocational Assessments, Academic Assessment, support animals,  or other issues. If requested I will verify in writing attendance only.   Any letter writing, required court appearances or consultations will be billed at $120/hr, and will be discussed with you prior to charges are created.

      I try to return calls promptly.  However, I am not available 24/7. If you are unable to reach me and are in crisis, immediately call Suicide Prevention & Crisis Services of Yolo County 24/7 [Davis] (530) 756-5000,(530) 756-7542, National Hopeline: (800) SUICIDE, or call 911.

      Contract for services, referrals and termination                                                               The first three sessions are for assessment.  Laura Shlien reserves the right to terminate therapy if  she believes the your needs are outside of her scope of competence of practice, if there are conflicts of interest, or if there is inadequate progress in reaching agreed upon goals.

      Attendance Policy

      If you “no show’ for an appointment, or cancel appointments for non essential reasons, or have multiple cancellations,   Laura Shlien reserves the right to change your appointment time, even if that leads to termination.  Schedules are agreed on for weekly meetings.  Special arrangements must be made for ‘drop in’ sessions.

       

      Client Signature_____________________________________________

                                        

                                                

       

                                                 Ending Therapy   TERMINATION POLICIES

      You are free to terminate therapy at any time, with 24 hour written notice.  When you decide to end therapy, it is best to have one or more sessions to provide  a positive ending of the therapeutic relationship, including a review of the experience of therapy.  Termination may include an assessment of the benefits achieved or referrals to other therapists.  Therapy sessions will be terminated if there is impairment due to substance use, and you will be charged the full insurance fee for the session.

       

      My goal is to provide you the most appropriate therapeutic interactions, designed to help you achieve and maintain a satisfying and productive life. You have a right and a responsibility to participate, to the degree possible, in:  1] understanding the mental and behavioral health issues;  2} developing mutually agreed upon treatment goals;  3]and following through on the agreed upon efforts to reach the agreed upon goals.

                                               Fee and Cancellation Policy:                                                                  

      This agreement is based on your insurance policy with ____________________________________. You will have a co-pay of __________________payable at the beginning of each session, by check or cash.  No other forms of payment are accepted.  A receipt is available on request.

                      Please note insurance reimbursement is for ­­­­­­a ____ minute session.      Note:   You are responsible or verifying and understanding the limits of your insurance coverage, as well as for any copayments and deductibles. If insurance claims are denied, you will be notified as soon as possible.  If your coverage has lapsed and Laura Shlien was not informed, you will be responsible for payment of the full insurance fee. If the claim is denied by the insurance company, you will have the option of discontinuing therapy services or taking responsibility for private payment of the full fee.                 If you have to miss a therapy session, please email, or otherwise give written notice, 24 hours in advance to cancel.  Sessions that are not cancelled in writing with 24 hour notice are subject to the full  fee of your insurance company, as insurance companies cannot be billed for missed sessions.  You have the option to reschedule within a calendar week, if our schedules allow.  

      In the event that Laura Shlien is unable to continue in her professional capacity I authorize the release of my contact information to professional colleagues and fiduciaries.

      My signature indicates I’ve read and accept the conditions of this informed consent.  I’ve received a copy of this form for my records, and understand the form is also on www.LauraShlienMFT.com.   Client Name Printed: _____________________________________________

      Address_________________________________________________________

      Telephone_______________________________________________________

      Email___________________________________________________________

      Client’s Signature____________________________________________  Date_____________

      Laura Shlien, LMFT, Signature _________________________                     Date____________

    •  For UCD SHIP only: To use the UCDavis Student Health Insurance Plan [SHIP] through Anthem Blue Cross,you must comply with  the following steps.
      •  Verify that the UC student health  is your only insurance plan; if you are a dependent on your family’s insurance, SHIP will not cover these sessions.
      • Bring a written referral from Student Insurance/Health & Counseling {CAPS} to the first session.
      •  Your agreed upon co-pay  fee of $15.00 payable at the beginning of each session by cash or check made payable to Laura Shlien, LMFT.

       

      Note:   You are responsible or verifying and understanding the limits of your insurance coverage, as well as for any co-payments and deductibles. If insurance claims are denied, you will be notified as soon as possible.  If your coverage has lapsed and Laura Shlien was not informed, you will be responsible for payment of the full fee of the insurance policy.  If the claim is denied by the insurance company, you will have the option of discontinuing therapy services or taking responsibility for private payment of the full fee.                

      If you have to miss a therapy session, please call 24 hours in advance to cancel.  Sessions that are not cancelled with 24 hour notice are subject to the full  fee of your insurance company, as insurance companies cannot be billed for missed sessions.  You have the option to reschedule within a week, if our schedules allow.  If we are unable to reschedule, you will be charged the full fee for the missed session.

      In the event that Laura Shlien is unable to continue in her professional capacity I authorize the release of my contact information to professional colleagues and   fiduciaries.

      My signature indicates I’ve read and accept the conditions of this informed consent.  I’ve received a copy of this form for my records, and understand the form is also on www.LauraShlienMFT.com.   Client Name Printed: _____________________________________________

      Address_______________________________________________

      Telephone_____________________________________________

      Email_________________________________________________

      Client’s Signature_______________________________________  Date_____________

      Laura Shlien, LMFT, Signature _________________________                     Date_____________


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