Barry S. Anton, Ph. D., ABPP

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Barry Anton, Ph.D., ABPP Welcome to my office at Rainier Behavioral Health. I look forward to working with you. The following information is designed to help our work go as smoothly as possible. Your questions and comments are always welcome. APPOINTMENTS: Appointments begin at our agreed upon time, not when you arrive. Your appointment is held exclusively for you. It is important to be on time because your appointment cannot be extended beyond the scheduled time since other people may have reserved that time. If you are unable to keep your appointment for any reason, you must give at least 24 hours advance notice to cancel; otherwise you will be charged the $75.00 for the time reserved for you. Please be aware that most insurance companies will not reimburse for missed psychotherapy sessions, making you responsible for the entire fee. Similarly, if I fail to give you 24 hours notice because I cannot keep an appointment, your next session will be at no charge. It is your responsibility to remember and keep track of your appointments. The laws of the State of Washington require that I obtain a signed Office Policy Agreement from the custodial parent before I render psychological services to a child or adolescent. If you are not the legal custodial parent, please notify me of this before signing this agreement. GUARANTEES AND PROMISES: When you request treatment or an evaluation for yourself or for another person for whom you are responsible, be assured that I shall do my best to perform all services in a professionally competent manner. My training at Colorado State University (Ph.D. in Psychology), and Harvard University (Internship in Clinical Psychology and Post Doctoral Fellowship) have prepared me to work with adults, children and adolescents in a variety of ways. I will endeavor to explain to you the kinds of treatments that are typically used, approaches to assessments and length and course of treatment for the issues or problems discussed. In this regard, I encourage you to raise questions about the nature and course of treatment at any point during our work together. There are no guarantees that the results of any evaluation or therapy will conform to your every expectation. I make no promises to determine any particular diagnosis or to reach any particular conclusion from an evaluation. Effective psychotherapy can at times be confusing and emotionally painful. Effective treatment and accurate assessment depend to a significant degree on your openness, your commitment to change, and our collaboration. Much of the responsibility for a successful outcome is yours. ETHICS AND PROFESSIONAL STANDARDS: As a Fellow of the American Psychological Association, and as a Psychologist licensed by the Board of Psychological Examiners, I work to uphold the highest ethical and professional standards at all times. The Board of Psychology Examiners in Olympia (360) 753-9772 is also available to respond to your questions or concerns. EMERGENCY CALLS: An answering service takes all emergency calls during non-business hours and will attempt to locate me in the event of an emergency. Some crisis situations can best be handled before they become emergencies. Whenever possible, do not wait until the last minute to try to contact me. Evaluation for behavioral/emotional problems are different than those that involve formalized psycho educational testing in that I do not write a formal report for the former. If you wish a formal written report of the evaluation then I will charge for the time required to write this report. Fees for reports, letters, review of materials, and phone calls will be charged on a pro-rated basis according to time actually required. BILLING AND PAYMENTS: In families in which divorced parents are each legally responsible for a portion of the child’s bill, the custodial parent will be considered solely responsible for the entire bill. We will not determine which portion belongs to which parent, nor will we directly bill the non-custodial parent. I expect that you will pay the portion of the bill that insurance does not pay (co-payment) at each session. Patients or their legal guardians are responsible for their accounts and are expected to pay their bill when due, whether medical insurance pays for a portion of the bill or not. This includes charges for evaluations, printed materials, reports, letters, consultations, and telephone calls. Balances which accumulate can begin to look very intimidating and may, in fact, interfere with the therapeutic process. I understand that this is an expensive treatment and we are prepared to arrange an extended payment plan. This entails a written agreement to pay a fixed amount each month until the balance is paid. If regular payments stop, the balance will be considered delinquent, and the finance charges and collection procedures detailed below may be instituted. A finance charge of 1% per month will be added to any balance not paid within 60 days after the charges were incurred. When 90 days have passed without a payment or prior arrangement with me, accounts may be sent for collection and the patient or legal guardian may be responsible for any additional legal and/or collection agency charges. Bills are sent out monthly and detail the dates of visits, the type of services provided, whether your insurance company has been billed for that visit, and all payments made to your account. If you have any questions about you bill, please ask our bookkeeper or me. INSURANCE: I am a contracted provider for many, but not all, insurance companies. You should be sure to check with your insurer and my intake office to learn whether I am a provider for your plan. You should also learn whether you need a referral or preauthorization in order to be eligible for your mental health benefit, whether you have a separate annual deductible for mental health, and whether your mental health benefit has a maximum yearly number of visits or a maximum yearly dollar amount. My billing department will submit claims to insurance companies that I am contracted with. In order for this to occur you must complete the insurance portion of the “Patient Information” form that was given to you with this office policy; you also need to provide a copy of your insurance card. CHANGES TO THIS OFFICE POLICY: From time to time I may change the business policies described in this document; I will attempt to notify you of changes. INFORMED CONSENT: I hereby authorize Barry S. Anton, Ph.D. to render psychological services. This authorization constitutes informed consent without exception. I have read and understand the Office Policy Statement and have received a copy of this Office Policy for myself. ** My electronic signature acknowledges that I have read and agree to the terms of the before mentioned office policy. ***

* I acknowledge I have read the financial policy above and that I am responsible for all charges regardless of any insurance coverage I have. I understand that delinquent accounts may be assigned to a credit reporting collection agency and agree to pay for all legal costs and expenses including reasonable attorney fees. By signing this Acknowledgement, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.

Please note: Rainier Behavioral Health does not provide disability evaluations or court related evaluations.

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