RAWR LLC
MATTHEW SUTTON, LCSW, CSAC
HONOLULU, HI 96815
808-500-4240
PRACTICE POLICIES EFFECTIVE DATE: 8.23.2024
This policy will be updated as necessary to reflect new/updated insurance contracts, state and federal laws, ethical standards, updated best practices, and other standards of care.
MUTUAL RESPECT AND SAFE ENVIRONMENT
RAWR LLC is an inclusive and safe space. We uphold a zero-tolerance policy for harassment, stalking, derogatory/abusive/threatening language, vandalism or destruction of property, cyberattacks, and aggressive behavior directed towards any staff member, affiliate, or client. Clients engaging in such conduct may face termination of services and legal action.
___ Client initials
Summary: Please be kind to people, property, animals.
APPOINTMENTS AND CANCELLATIONS
Appointment length: Standard psychotherapy sessions are 53 minutes. A limited number of 45-minute sessions are available upon prior discussion.
Cancellation: Please cancel or reschedule at least 24 hours in advance to avoid fees1. 1 late cancellation or no-show within a rolling three-month period will not incur fees.
Cancellations within 24 hours will be billed directly to client at 50% of client’s hourly rate.
No-shows will be billed directly to client at 100% of client’s hourly rate.
3 consecutive no-shows will be considered a termination of services by the client.
Late arrivals: Managed on a case-by-case basis.
Therapist late cancellations and no-shows: Client account will be credited per rates above2.
This balanced policy is necessary because I have dedicated a specific time for client, and client has planned their day to include therapy.
1I reserve the right to waive fees based on individual circumstances.
2 Exceptions apply if I am addressing an urgent client need (e.g., imminent risk of suicide).
___ Client initials
Summary: I don’t like charging late fees so there is ample flexibility for emergencies and infrequent change of plans, but not for patterns. You won’t heal if I don't eat we don’t meet.
RATES, SELF-PAY, INSURANCE, PAYMENT
Rates
Psychiatric diagnostic evaluation (90 minutes, CPT code 90791): $225
Psychotherapy (60 minutes, CPT code 90837): $175
Psychotherapy (45 minutes, CPT code 90834): $130
Insurance
I am contracted with many, but not all, insurance providers. I will keep clients apprised of any known contract terminations with sufficient time to plan for transitioning to an in-network provider or self-pay.
If using insurance:
Client will be responsible for any copays, deductible and coinsurance determined by their insurance plan. Per insurance contracts, the fees cannot be waived or reduced.
I will submit claims on your behalf, billing insurance my rates as outlined above.
Clients will not receive balance billing to cover the difference between my billed rate and insurance reimbursement.
Clients will not be billed for any non-reimbursed charges for contracted services due to errors on my part, e.g., incomplete or late claim submission, failure to seek prior authorization, or a determination by their insurance plan that treatment is not medically necessary.
If a service in my scope of practice as an LCSW and/or CSAC with a current and valid CPT code is requested by client but is not an insurance-contracted service I will present the following two options:
Submit a prior authorization to the insurance for coverage of that CPT code. If prior authorization is granted, I will offer the service to that client and accept the insurance rate. If not granted I will proceed to step 2.
Conduct a market study to determine a reasonable cost for that service and provide a Good Faith Estimate so the client can decide if they wish to pursue treatment.
It will be my responsibility to track how many appointments insurance will cover in a given period of time. If benefits are exhausted and the client wishes to continue services, they will have the option to self-pay at a rate no more or less than their contracted insurance rate.
It is the client’s responsibility to inform me of any concurrent psychotherapy being received under their insurance. The client will be responsible for any non-reimbursed charges due to not sharing this information.
It is the client’s responsibility to ensure insurance information on file is up-to-date and to cooperate with any inquiries from their insurance company regarding treatment. If insurance will not provide reimbursement for covered services due to the client’s actions or inactions, the client will be responsible for incurred charges as allowable by their insurance contract or state and federal law.
___ Client initials
Summary: Insurance is unnecessarily complex so we both have to be diligent to avoid financial surprises.
Self-pay and payment
A limited number of sliding scale appointments are available for self-pay clients based on projected yearly income. Clients approved for sliding scale rates will be provided with the necessary information and policies. I will not decline a client based on absolute inability to pay.
Self-pay clients will receive a Good Faith Estimate of their total treatment cost before their first appointment. Clients have the right to dispute charges that exceed the Good Faith Estimate by $400 or more.
Self-pay clients paying my full hourly rate can request a superbill to submit to their insurance for reimbursement of services. A superbill will not be generated until payment in full is received. A superbill does not guarantee reimbursement, and no account adjustments will be made if reimbursement is denied, in part or whole.
The preferred method of payment is through the client portal for easier tracking.
Venmo, CashApp and Apple Pay are accepted, PayPal is not.
Copayments are due within 1 week of service.
Clients with a balance exceeding $1000 may be subject to suspension of services as applicable by state and federal law until balance is paid below $1000 or a payment plan is established.
Clients who do not respond to attempts to collect payment for services provided over 90 days ago are subject to their balance being sent to a third-party collection agency.
___ Client initials
Summary: The irony of social workers being therapists, the injustice of trauma and the cost of therapy is not lost on me. Therapy isn’t free but I make healing accessible by offering a discount.
MENTAL HEALTH CRISIS
Crises such as suicidal ideation, homicidal ideation, psychosis, altered mental status, unspecified psychiatric decompensation, and other behavioral health emergencies experienced by clients are an expected reality in the course of any psychotherapist’s career. If a client is experiencing a mental health crisis or behavioral health emergency outside of their appointment time, they are expected to call 988, 911, or check into an emergency department of their choice.
If I have knowledge or reasonable suspicion that a client is experiencing a mental health crisis or behavioral health emergency, I attempt to contact the client for assessment and support at my earliest availability, which could take up to 24 hours. If these attempts are not successful, I will contact their emergency contact. Depending on the information obtained or lack thereof, I may contact 911 to initiate a welfare check.
In the event a threat is made towards an identifiable person or people, I will make every effort to immediately warn the intended target(s) and law enforcement. Such efforts will be documented.
I encourage all clients to fill out a Mental Health Advance Directive found here: https://health.hawaii.gov/amhd/files/2013/06/AMHCD-Short-Form1.pdf
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Summary: I am legally and ethically bound to escalate care if I think there is imminent risk to self and/or others, and crisis services are the appropriate intervention for after hours crisis.
TELEPHONE ACCESSIBILITY AND GEOGRAPHIC COVERAGE
If clients need to contact me between sessions, please leave a message on my voicemail or via the client portal. I am often not immediately available; however, I will attempt to return calls within 24 hours.
Video appointments are highly preferable to phone appointments, and phone appointments are not reimbursable by insurance. Phone appointments per client request are offered at $150/hour and billed directly to client, pending a signed agreement they will self-pay.
There is no limit to number of asynchronous messages (e.g., text or email). However, if texting or emailing becomes excessive or is used inappropriately, this will be discussed in therapy.
I cannot provide psychotherapy to anyone outside of Hawaii due to each state’s unique laws and regulations.
___ Client initials
Summary: Telephonic work is suboptimal/expensive and clients have to be in Hawaii to receive services.
SOCIAL MEDIA AND DUAL RELATIONSHIPS
Due to the importance of client confidentiality and 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 adding clients as friends or contacts on these sites can compromise confidentiality and privacy. It may also blur the boundaries of our therapeutic relationship. If clients have questions about this, please bring them up when we meet, and we can discuss them further.
Due to the inherent power differential and personal nature of therapy, I do not provide services to known friends, family, family friends, family of friends, former coworkers, colleagues, or anyone with whom I have had a social connection. This can be reviewed upon a case-by-case basis, e.g., it may be appropriate for me to provide therapy to someone I recognize from a CrossFit class or periodically run into in public, while it would not be appropriate if I have attended monthly work meetings with them.
___ Client initials
Summary: I do not provide therapy to people I know and do not accept friend requests from clients.
ELECTRONIC COMMUNICATION
I cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If clients prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, I will do so. A client sending me a text will be considered consent to communicate via text messaging. While I may try to return messages in a timely manner, I cannot guarantee immediate responses and request that clients do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.
Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail is considered telemedicine by the State of California. Under the California Telemedicine Act of 1996, telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another.
If clients chose to use information technology for some or all of client treatment, they need to understand that:
Client retains the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which client would otherwise be entitled.
All existing confidentiality protections are equally applicable.
Client access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee.
Dissemination of any client identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without client consent.
There are potential risks, consequences, and benefits of telemedicine.
Potential benefits include, and are not limited to, improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel costs. Effective therapy is often facilitated when the therapist gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third person consultations, but also from direct visual and olfactory observations, information, and experiences.
Potential risks include, and are not limited to, the therapist's inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: client physical condition including deformities, apparent height and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression.
Potential consequences thus include the therapist not being aware of what he or she would consider important information, that client may not recognize as significant to present verbally the therapist.
___ Client initials
Summary: Hackers abound, so I run communication through HIPAA compliant platforms unless otherwise requested.
CLIENTS WITH GUARDIANS
If a client has a guardian, the guardian(s) may be legally entitled to some information about the client’s therapy. I will discuss with the client and their guardian(s) what information is appropriate to share.
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Summary: Guardians have access to information, but that does not mean I share everything.
TERMINATION
Ending therapeutic relationships, or termination, can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination process depends on the length and intensity of the treatment, as well as client’s response to termination. I will not terminate the therapeutic relationship without first discussing and exploring the reasons and readiness. If therapy is terminated before treatment is complete or client requests another therapist, I will provide client with a list of qualified therapists to continue treatment. Client may also choose someone on their own or from another referral source.
If a client terminates therapy with me in the course of an acute crisis that does not meet criteria for involuntary treatment, and I am unable to confirm continuity of care with a new provider, I will respect their self-determination. I will document client’s wishes and alert their PCP or psychiatrist, insurance plan, and Hawaii’s LCSW board. In such circumstances, the client will remain eligible to return for therapy at any point of their crisis episode, or after, if this would not be a duplication of services.
Should client fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued.
___ Client initials
Summary: Ending therapy can be hard or scary, although if done collaboratively and intentionally it is often a rewarding conclusion.