DIRECTIONS to The Office

When you come in the Door,

if it is about time for your appointment, ring the bell in the corner next to the radio. It is labeled "Therapy Integration Practices" & "Couples Coaching"

Bring to first appointment

• Insurance Card
• Driver's License
• Paperwork, if you have done it. Otherwise, come about 10min early.
• Payment for first session. See Fee Agreement.

PAPERWORK-----You can save some time in your first session if you print out these forms & bring them with you already filled in.

• HCFA --(standard insurance billing form) The form is blocked off in sections & labeled, so you can more easily tell which person goes in which section.
  • INSURED (Line 1a,4,&7) This is the person who has the insurance benefit.
    • Line 1a--This number comes from the front of your insurance card--often the Social Security Number, though many of the insurance companies have started shifting to a different number as a security precaution against identity theft.
  • INSURANCE (Line 11,1,b,c,d, 13)
    • Line 11--The Group number can generally be found on the front of the insurance card-usually about 4-8 characters. Be careful not to confuse it with the Rx Group #.
    • Line 11d--If there is no Secondary (overlapping) Insurance, check NO & put a bix "X" through the "Other Insured" section. If you do have a Secondary Insurance, you will need to fill out the "Other Insured" section.
    • Line 13--to be signed by the Insured person. Often, if the spouse is on the insurance, they sign it for the Insured.
  • PATIENT (Line2,3,5,6,10, a,b,c,d)
    • Line10a--Unless you are coming in for therapy about an active L&I case, this is NO
  • OTHER INSURED (Line9a,b,c,d) This is about the Secondary Insurance, if there is one.
  LINE 12--Signature--by the Patient or Responsible person, & Date
• Fee Agreement (If you have filled out the HCFA, all you need to do on this one is put your name on the CLIENT line, look it over, & sign at the bottom
• PCP (Primary Care Provider) Notification (If you don't have a doctor, or don't want to have us inform your doctor, ignore this one, but make sure you make a note on the FEE Agreement/Permission/Doctor section, stating that you don't want to & why. We are required to ask, but you are not required to do it.
• History --This is a brief medical screening. If there is nothing to enter in one of the sections, just put "N/A" in that section & move on.
• Symptom Picture ---
  • Presenting PROBLEM--How are you describing the problem you are addressing with counseling.
  • Presenting SOLUTION --The outcome you want.
  • SYMPTOMS --For each category on the left, there are examples listed on the right.
    • If this situation fits your condition, circle it.
    • If there is a recent increase, put an up arrow by it.
    • If there is a recent decrease, put a down arrow by it.
    • Space is left for you to write in details/explanations
  • CONTEXT --
    • Circle the context areas affected
    • Timing / Situation--This behavior/condition tends to occur more when these conditions exist
    • Symptom History -- When did it start/ increase? Time periods of up/downs? How does this correlate with life changes?
  • DSM-IV & Clinical Formulation-- These sections are for the Therapist to fill out after appointment

PAYMENT OPTIONS

• Cash or Check at beginning of each session
• Major Credit/Debit card Online, through www.TxFusion.com. Go to the TxStore link in left navigation bar & select
  Payment for Therapy. Quantity = number of dollars. It is processed securely. You can also pay ahead online to still get the Cash Discount. If you have any questions, the HELP button has a tutorial under Store.
• Billing--This option generally does not get the Cash Discount, because the discount was designed partly to lessen our administrative load (by not having to do billing), while giving clients a break.