Jodi Howell Nagy, Ph.D.

Please correct the errors described below.

Jodi Nagy, Ph.D. 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 comments and questions are always welcome. CREDENTIALS: I am a licensed psychologist in the state of Washington. I earned a master’s degree in marriage and family therapy from Indiana State University (ISU) in 1994, and a doctoral degree, also from ISU, in counseling psychology in 1998. I strive to uphold the highest professional and ethical standards at all times. PROCESS OF THERAPY: I view therapy as a collaborative process wherein my clients and I establish a working relationship based on trust, respect, genuine regard, and healthy boundaries. It is through this process, that my clients typically come to feel safe to open up and work through uncomfortable thoughts, feelings, and/or conflicts. I, in turn provide my clients with the skills, knowledge, and awareness to arrive at their own solutions and achieve their desired goals. I have a great deal of faith in the therapy process and people’s inherent capacity to make desired changes in themselves and their lives. APPOINTMENTS: Appointments are usually 50 minutes in length and your appointment begins 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 $75.00 for the time reserved for you. Please be aware that most insurance companies will not pay for missed sessions, making you responsible for the charge. This office does not give reminder calls for appointments. It is your responsibility to remember and keep track of your appointments. PHONE MESSAGES: My office staff is available to take your phone calls, Monday through Thursday, from 9:00 am to 5:00 pm. The office staff hours on Fridays are 9:00 am to 3:00 pm. Our answering machine will record your messages when we are not in the office. We will try to return your calls as promptly as possible. BILLING AND PAYMENTS: You will be expected to pay for each session at the time it is held, unless we agree otherwise or unless you have insurance coverage. If you have insurance coverage, you are expected to pay your co-pay at the time of each appointment. The co-pay for mental health is often different from that for other medical visits. If you are uncertain about your co-pay, I encourage you to contact your insurer. Until you know for certain what your co-pay is, I would ask that you pay 20% of my fee at the time of each appointment. Bills are sent out monthly and detail the dates of visits, the type of service provided, whether your insurance has been billed for that visit, and all payments made into your account. If you have any questions about your bill, please direct them to our billing department or to me. Clients are responsible for their accounts, and are expected to pay their bill when due, whether medical insurance pays for a portion or not, including charges for evaluations, reports, letter, etc. 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 may be added to any balance not paid within 60 days after the charge was incurred. When 90 days have passed without a payment or prior arrangements with me, accounts may be sent for collections and the client may be responsible for any additional legal and/or collection agency charges. 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 benefits, 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. EMERGENCY CALLS: An answering service takes all emergency calls during non-business hours. This service will attempt to locate me in the event of an emergency, and will contact the on-call psychologist if I am not available. After-hours calls are typically charged a fee base on a prorated amount for the length of the call. You may also call the crisis line at: 253-759-6700 (Pierce County) or 206-461-3222 (King County). 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 Jodi Howell Nagy, Ph.D. to render psychological services.

* 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.

Your message will be encrypted and can only be read by Jodi Howell Nagy, Ph.D..