Welcome! This document outlines the policies and procedures for Asteria Counseling/April M. Jacobs, LPC, a private practice providing psychotherapy/counseling services in the state of Georgia. Please read this document carefully and sign the acknowledgment at the end, indicating your understanding and agreement.

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1. Confidentiality:

• All information shared during therapy sessions is confidential and protected by Georgia state law and the Health Insurance Portability and Accountability Act (HIPAA).

• Exceptions to confidentiality include:

  • Suspected child abuse or neglect (mandated reporting).

  • Suspected abuse or neglect of an elderly or disabled adult (mandated reporting).

  • If you pose a serious threat to yourself or others.

  • If there is a medical emergency.

  • If a court orders the release of your records.

  • If you provide written authorization for the release of information.

• Electronic communication (email, text) is not considered secure and should be limited to scheduling and administrative matters. Sensitive information shared through text/email is not considered secure or confidential, though every effort is made to protect text/email communications.

• Detailed information regarding HIPAA is provided in a separate notice of privacy practices.

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2. Appointments:

• Sessions are typically 55 minutes in length.

• Appointments will be scheduled at least 24 hrs in advance, except in cases of emergency/therapist discretion.

• Please arrive on time for your scheduled appointment. Late arrivals/sign-ins to telehealth will not result in extended session times. Therapist will wait for 15 minutes before counting the session as a no-show.

• If you need to cancel or reschedule an appointment, please provide at least 24 hours notice. Failure to provide 24 hours notice will result in a late cancellation fee of $100. No-shows will result in a $140 full session fee. 

• Consistent no-shows or late cancellations may result in the termination of services.

• Appointments are held in-person at The Corporate Center, 233 12th Street, Suite 802-A, Columbus, GA or via telehealth.

• Appointment reminders are a courtesy provided by Alma. Clients are encouraged to put their appointments into a personal calendar to avoid fees related to not receiving appointment reminders from Alma. 

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3. Fees and Payment:

• You may utilize self-pay or insurance for individual sessions. The self-pay fee for a 55-minute Individual/KAP/GAC session is $140. 

• Couples/Relational therapy is $165 for a 55-minute session and is only offered as self-pay.

• Payment is due at the time of service unless otherwise arranged with therapist.

• Accepted forms of payment include credit/debit card processed through Alma.

• I accept Aetna, Cigna and Evernorth, Meritain Health, Nippon, Optum, Oscar Health, Oxford, Quest Behavioral Health, United Medical Resources (UMR), UnitedHealthcare UHC | UBH insurances. I am out of network with other insurances, but I can provide a super bill. Client is responsible for co-pays, deductibles, and any non-covered services.

• Fees are subject to change with 30 days notice.

• Acceptance of insurance is subject to change with 90 days notice.

• Admin fees are charged in per 15-minute increments for $35. Admin fees may be charged for any service outside of a scheduled therapy session and accompanying documentation for that session. Examples of admin fee charges could include, but are not limited to: writing ESA/social security letters, WPATH letters, filling out forms/evaluations from other providers, conferring with other providers for continuity of care, etc. If a service you request requires an admin fee, you will be notified before the service is performed and invoiced. Insurance does not cover administrative fees.

• Clients are required to have an active card on file at all times. 

• Clients are encouraged to pay the session fee at the time of service. However, payment arrangements may be made at the therapist's discretion. Clients are not allowed to accrue more than 3 session fees at any one time. 

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4. Communication:

• For scheduling or administrative matters, please contact me via text or email. 706-940-2276 or april@asteriacounseling.com

• For urgent or crisis situations, please contact the Georgia Crisis & Access Line (GCAL) at 1-800-715-4225, or dial 988.

• I will make every effort to return phone calls and emails within 48 business hours, unless I am on personal leave. You will be notified if I’m on personal leave.

• I do not provide 24/7 crisis support.

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5. AI and Tech Disclaimers:

• Clinical Notes: With your written consent, I use secure, HIPAA-compliant AI to streamline administrative notes. Your data is fully encrypted and never used to train public models. 

• Marketing: I may brainstorm social media content, streamline a blog post for the website or schedule emails/blogs/social media using AI, but never for clinical advice or client communications. 

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5b. Client AI Use

• Between Sessions: Feel free to use AI to organize thoughts, brain dump, schedule tasks or search for coping strategies, but it is never a substitute for therapy or crisis support (dial 988 for emergencies).

• In Sessions: You are welcome to bring AI-generated writing or prompts to unpack together, but third-party AI recording bots are not permitted (without prior written consent) to protect privacy.

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6. Termination of Services:

• Therapy may be terminated by either the client or the therapist.

• Reasons for termination by the therapist may include:

  • Failure to attend sessions.

  • Failure to pay fees.

  • Client's needs exceed the therapist's scope of practice.

  • Client poses a threat to the therapist or others.

• If termination is initiated by the therapist, referrals to other mental health professionals will be provided.

• The client has the right to terminate therapy at any time. Client is encouraged to discuss their decision to terminate with the therapist.

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7. Professional Boundaries:

• The therapeutic relationship is professional and confidential.

• Personal social media contact with clients is prohibited. Clients are invited to follow Asteria Counseling on Facebook, TikTok, and Instagram, but are under no obligation to do so. No personal messaging or information exchange through social media messaging is permitted. 

• Living and working in a tight-knit community means our paths might occasionally cross outside the office. While I do not enter into secondary roles like personal friendships or business ventures with clients, some overlap can happen naturally. When it does, we will talk through it together to ensure your confidentiality, comfort, and best interests always come first. 

• Gift acceptance is at the therapist’s discretion, and large or expensive gifts will not be accepted.

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8. Records:

• Clinical records are maintained according to Georgia state law and HIPAA regulations.

• Clients have the right to access their records, subject to certain limitations.

• Requests for records should be made in writing. Therapist will provide records within 5 business days.

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9. Telehealth Policies (If Applicable):

• Telehealth sessions will be conducted via doxy.me or Alma’s generated telehealth link.

• Clients are responsible for ensuring a private and secure location for telehealth sessions.

• Clients are responsible for ensuring a stable internet connection and functioning technology.

• In case of technical difficulties, the session may be rescheduled or conducted via phone.

• Telehealth services will only be provided to clients physically located within the state of Georgia during the session.

• Emergency contact information for client location must be provided prior to telehealth services.

• Telehealth is not permitted if you are driving or in a moving vehicle with others. 

 

10. Your Rights and Protections Against Surprise Billing (No Surprises Act)

As part of this practice’s commitment to transparency and informed consent, I want to inform you of your rights under the No Surprises Act, which went into effect on January 1, 2022.

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If you are uninsured or electing not to use insurance (i.e., self-pay), you have the right to receive a Good Faith Estimate that outlines the expected costs of your mental health care services. This estimate is provided so you can make informed decisions about your treatment without unexpected financial obligations.

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Key Points:

• You will receive a written Good Faith Estimate upon request.

• The estimate will include the anticipated cost of services you may receive, based on the frequency and type of care discussed in our initial consultation.

• If you receive a bill that is $400 or more above the Good Faith Estimate, you have the right to dispute the charges.

• This policy applies to in-person and telehealth sessions alike.

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Please note: If you are using insurance to pay for services, billing protections under the No Surprises Act may not apply in the same way, as your costs are determined by your insurance provider’s policies and contracted rates. If insurance denies coverage or if you’re out of pocket expense is later determined to be higher than Alma initially estimated, you are responsible for those costs.

For questions or more information about your rights under the No Surprises Act, visit: www.cms.gov/nosurprises or call 1-800-985-3059.