Practice Policy, Client Information and Concerns

I am Jun-chih Gisela Lin, Ph.D., ABPP, owner psychologist and the provider of Gisela Lin Counseling and Consultation Services PLLC. The following are the practice policies of the practice of Gisela Lin Counseling and Consultation Services, PLLC and Dr. Jun-chih Gisela Lin. Please contact Dr. Lin at any time with questions or concerns regarding these policies.

Counseling/Therapy Services:

I, Jun-chih Gisela Lin, Ph.D., ABPP am a licensed psychologist in Texas and a board-certified counseling psychologist. I provide counseling/therapy for adults and adolescents using a wide array of approaches including, but not limited to cognitive behavioral therapy, systemic therapy and relaxation techniques. I use a multicultural counseling framework and take on multiple helping roles when working with my clients. I believe counseling/therapy is a journey and a joint venture that empowers clients to increase their self-efficacy. The primary goal of counseling/therapy is to assist clients in developing effective coping strategies and in improving their overall functioning and problem-solving abilities in multiple areas of their lives. Specific counseling interventions and any possible side effects will be discussed during your sessions. The counseling/therapy duration and frequency will be determined on an individual basis. Progress and results may vary from individual to individual, and no specific result is guaranteed.

You, as a client, have the right to access information contained in your counseling/therapy records, and it will be provided once we have discussed your request and any possible consequences associated with reviewing the material.

Confidentiality:

The ethical principles of the American Psychological Association state that “Psychologists have a primary obligation to respect the confidentiality of information obtained from persons in the course of their work as psychologists. They reveal confidential information to others only with the consent of the person or the person’s legal representative, except in those unusual circumstances in which not doing so would result in clear danger to the person or others. Where appropriate, psychologists inform clients of the legal limits of confidentiality.”

Specific exemptions to the requirement of confidentiality include those for threats of suicide, homicide, damage to other’s property, and ongoing cases of abuse of a minor child, elderly, or an incapacitated adult. The law specifically requires that a mental health professional break confidentiality to ensure the safety of the person at risk.

Ethics:

I, Jun-chih Gisela Lin, Ph.D., ABPP subscribe to the ethical principles of the American Psychological Association and adhere to all laws regulating the practice of psychology in the state of Texas.

Crisis and Emergency:

This practice does not provide 24-hour crisis counseling. You understand that in case of crisis, if you cannot reach Dr. Lin at 979-314-9698, if you live in Brazos County Texas, you can call the MHMR hotline 979-822-6467 or call your local MHMR number, or call 988 Suicide and Crisis Lifeline, or call the National Suicide Prevention Lifeline 1-800-273-TALK (8255). If you have a life-threatening emergency, you should call 911, or go to the nearest hospital emergency room.

Fee Policy:

1. Individual or Couples counseling ($250 for the initial session per hour and $200 for each additional session per hour, crisis appointment $250 per hour, letters $30 per 10 minutes)
2. Consultation outside of the office ($500 per hour plus expenses)
3. Limited appointments on a sliding fee scale are available
4. Other services upon request and fees will be discussed

The practice and Dr. Lin accept cash, check, and credit card payment. The practice will provide you a receipt for your reimbursement and you can submit a claim to your insurance. The practice will submit insurance claims for you if you have Blue Cross Blue Shield of Texas, Baylor Scott & White Health Plan, Cigna, ComPsych, Medicare, and Aetna health insurance as the practice and Dr. Lin are in their network, and you will only need to pay the amount designated as “patient responsibility” (deductible, co-pay and/or co-insurance amounts). In cases where payment of the above fees would create a financial hardship, the practice will be happy to discuss a payment agreement with you. It is customary to pay professional fees at the time of service.

Dr. Lin also uses Headway and is in network for Aetna, Oxford, United Healthcare, Oscar Health, Cigna, Blue Cross Blue Shield of Texas, and Blue Cross Blue Shield of Massachusetts through Headway. If you are one of the clients through Headway, Headway will manage the payment. They will submit the claims for you and collect copay from you directly.

If you are uninsured or if you have insurance but choose to self-pay, you will be provided with a good faith estimate (GFE). GFE is a financial document that shows the expected charges for healthcare services provided. GFE is not a bill.

Cancellation:

With the exception of unforeseen emergencies, cancellations are expected 48 hours in advance; otherwise you will be billed for your missed session. Requests for changing appointment times should be discussed in advance. It is your responsibility to contact Dr. Lin to reschedule any missed appointments. For an existing current client with a single appointment, please contact Dr. Lin to reschedule a missed appointment within 60 days. After 60 days, the counseling relationship will be terminated.

Confidentiality Agreement:

The following statements explain confidentiality as it applies to discussions between psychologist and client and the limits on the confidentiality of disclosures made to a psychologist by Texas State Law. The information is important to you, so please read it carefully.

What Is Protected

In general, your identity as a client, as well as the disclosures that you make to my practice and me (Dr. Jun-chih Gisela Lin) in the course of our work, is private and protected. This means that I do not reveal to others that you are a client of mine, nor do I share anything that you say during our work with anyone else. If you would ever like me to reveal your status as a client, or you would like me to share mental health information, you will be asked to sign an agreement waiving your right to confidentiality. Because certain information that I maintain in your file may need to be interpreted to be properly understood, it is my policy only to release relevant information from files to qualified mental health professionals. In the event that you would like information from your file released to a third party, other than another mental health professional, my policy is to provide a summary of the treatment information contained in your file. If coordination of care is needed, I may share relevant information with other health or mental health care professionals. I may also consult with other mental health professionals to better serve you without revealing any identifying information. In the event of my unexpected incapacity or death, my designee will help you make a transition to another professional upon request.

What Is Not Protected

There are certain situations in which disclosures made to my practice and me cannot be kept strictly private due to state law. These situations include:

If you indicate that you are in serious and immediate risk of harming yourself or someone else, I cannot maintain your privacy. The most typical situation is when the threat of suicide is such that I cannot be assured of your safety once you leave the session. It is important to note that this does not apply to talking about thoughts of harming yourself that you may be experiencing. However, in the event that you intend to act on your thoughts to kill or harm yourself, I am required to act to protect you, even if that involves breaching confidentiality. Life is more important than the right to privacy.

If you indicate that you are involved in the abuse of a minor child, an elderly adult, or a disabled person, I am required to file a report about these activities with the Office of Human Protective Services. Once I file the report, I am unable to safeguard the privacy of the information the Office of Human Protective Services has.

If you are involved in a court proceeding, the court may use the power of subpoena to gain access to information that you have shared with me. Although it is my policy to limit my involvement in legal proceedings as much as possible, under court order, I may be required, by law, to provide written or verbal testimony to the court.

If you indicate that you were sexually violated by another licensed mental health professional in Texas, I am required to report this information to the district attorney in the county in which the incident took place, as well as to the licensing board governing that person’s license. Please note: this does not apply to disclosure of sexual misconduct by anyone other than a licensed mental health professional in Texas from whom you were receiving treatment.

If you have a temporary psychosis or are incapacitated, I may share your information with your family, friends, or others involved in your care for coordination of care if I believe doing so is in your best interests.

If you submit your payment with a check or credit card that is not yours, you are giving permission to use the payment for the purpose stated. If your fees for services are being paid by a third party such as your health insurance company, third party payers often ask for treatment information (e.g., diagnosis, type and place of service rendered, dates of services, treatment plan) as part of their review of services. In general, the third-party payers have their own policies and procedures for safeguarding your privacy. However, once I release the information to the third party, I cannot control what the third party does with the information.

Be assured that your right to confidentiality is very important to me. It is a rare situation that would require me to breach confidentiality, and I will make every effort to use care and discretion while meeting my legal and ethical obligations.

HIPAA Notice of Privacy Practices:

During or before the first session, Dr. Lin will answer any questions you might have regarding the HIPAA Notice of Privacy Practices. The notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Please let Dr. Lin know if you have any questions. By signing consent to therapy and signing the Informed Consent for Treatment and Financial Responsibility Agreement, you acknowledge you have read the Practice Policy of Gisela Lin Counseling and Consultation Services PLLC and Jun-chih Gisela Lin, Ph.D., ABPP.

Client Information and Concerns

Names and ages of any children:

Parent or Guardian if minor or appointed by court

Emergency contact

Please list all medications that you take on a regular basis. Please also list all non-prescription medications, herbs, supplements that you are taking.

Please describe any previous counseling or psychiatric treatment (including any behavioral health hospitalization).

Checklist of Concerns

Please check the symptoms or concerns that are currently problems for you, or if they are related to your visit. Please check those that are a priority for your visit. If you think a symptom applies to your family history, please indicate which relatives.

Clinical Symptoms

Situational Concerns