Young Single Adult’s Life Sign Up

Financial Policy

The cost for participating in the Men's Life Group is $240 a month. This will be paid monthly, regardless of attendance.

You can cancel any time. We require 48 hours notice to cancel your monthly payments. If we have less than 48 hours notice we will not be able to cancel your next payment. When monthly payments are cancelled participant can no longer attend the chosen Life Group.

If payment is declined on the card we have on file the participant will no longer be able to attend the chosen Life Group until the payment method is updated and your account is in good standing with Taylor Lyman.

Participant may attend as many groups per week they desire without additional cost.

Third Party Billing

We do not work with insurance. If you have an arrangement with your ecclesiastical leader for financial help please email us at billing@taylorlyman.com to work out those arrangements.

Attendance

It is recommended that the participant attends at least one group per week. The participant is allowed to attend more frequently if they desire. There is no additional cost for additional groups attended. There will be no refunds if participant does not attend group.

Counseling Policies and Processes:

Entering into a therapeutic relationship with a counseling professional requires an establishment of trust. When you begin therapy, you are committing your time, money and emotional energy and it is important to fully understand what that commitment will entail. Included below is a summary of the policies and processes that guide your work through this process

1. Professional Background:

I am currently working on becoming fully licensed in Marriage and Family Therapy with the Utah Division of Occupational & Professional Licensing, which allows me to practice counseling independently in Utah. I have worked in the counseling field since 2013 and my scope of practice includes sexual addiction counseling/coaching for individuals and counseling/coaching for sexual issues with adolescents. I also work with clients needing grief counseling, divorce and divorce adjustment issues depression/anxiety and spirituality. Additionally, I finished certification requirements to become an Associate Sexual Addiction Therapist with the International Institute for Trauma and Addiction Professionals and have finished an externship in Emotionally Focused Therapy. I worked in the medical field for many years as a Spanish Medical Interpreter at Vanderbilt Medical Center. I have been a clinician with Life Changing Services since 2013 running multiple groups sessions for adolescent young men, young single adult men and older/married men.

2. Appointments

Since clients are seen by appointment only, unless an emergency requires an immediate appointment, this appointment time is reserved specifically for you. If it is necessary for you to cancel an appointment, notice of cancellation must be made at least 24 hours prior to your scheduled appointment time or you will be billed or charged for the set appointment fee. If a third party is paying for your therapy and you no show or do not cancel 24 hours prior to your appointment, you (the client) will be responsible for the full fee through credit card. If arrangements have been made for an alternate fee and you no show or do not cancel 24 hours prior to your appointment, you will be responsible for the full fee. Cancellation of a scheduled appointment will be done via email or text.

If you are experiencing a mental health emergency and cannot reach us, please go directly to your nearest emergency room for assistance or call the Utah Crisis Line at 801-587-3000, or the National Help Line at 1-800-273-8255.

3. Fees and Payments for Counseling Services:

Fees for counseling services are $150 for a 50-minute session with individuals and couples. All fees are due at time of service and will be charged via credit/debit card. Health insurance is NOT accepted as part of our practice, only private pay. Payment for special circumstances such as services rendered for court-ordered appearances/consulting will be $1,500 per day. Gifts cannot be accepted.

4. Confidentiality:

Utah State laws and ethical requirements of the State Boards indicate that what we discuss in our private counseling sessions is privileged communication, meaning that you as the client control the release of this information to a third party. There are several limits to confidentiality that involve the required release of information in order to keep you and/or others safe from harm. These limits include: clear and imminent danger to self or others; suspected child or elder abuse; a direct court order by a judge ordering me to release records or appear in court to testify. If it would benefit you in your counseling progress, you may be asked to sign a release of information to allow further discussion of pertinent information with your primary healthcare professional or other key providers in your life (ie: a psychiatrist or a previous counselor).

5. HIPAA Notice of Privacy Practices:

Included with this initial introductory paperwork, you should have received a copy of the HIPAA document. I am required by law to provide this to you and to secure your signature. If you should have any questions about this document, please do not hesitate to ask me for clarification.

6. Benefits and Risks of Counseling:

Counseling can be of great benefit to a client who fully commits to being open and honest in the counseling relationship. It requires the client to come to the table with their own personal goals for counseling. I cannot create change in your life; you are the change agent in your own life. I cannot guarantee a specific outcome from our time together. Clients are ultimately responsible for their own growth and direction in counseling. Counseling also has risks that may include the experience of intense and unwanted feelings, including sadness, fear, anger, guilt or anxiety. It is important to remember that these feelings may be natural and normal and are an important part of the counseling process. Other risks of counseling may include: facing unpleasant thoughts and beliefs, increased awareness of feelings, values and experiences, and recalling unpleasant life events. I am available to discuss any of your problems or possible side effects of our work together. Also, during our counseling sessions, we may discuss additional resources or activities that added to counseling may help further your change and growth. These may include referrals to a PCP for medication evaluation, directions for a specific activity plan of exercise, referrals to a nutritionist, etc. Wellness comes from whole body health that should include an emphasis on mind, body and spirit. After we have met to discuss your concerns, we will create a plan that is individualized to your own goals and desires for counseling outcomes.

7. Private Practice:

Please feel free to discuss with me any of the policies and processes outlined above. It is important that you clearly understand your rights and responsibilities when entering into a counseling relationship.

8. Online Counseling / Coaching:

It is my (the client’s) understanding that as a client of Taylor Lyman, LLC., there is a possibility that my Service Provider may live in a different state than I do. I understand that some states’ professional boards require the client to visit the service provider in their home state. I have worked hard to find a quality service provider for my needs, but I/we do not live and work in the same state. I am not in a position to travel regularly or move my family to the same state as my service provider. I understand that I may be meeting with my service provider primarily via confidential webcam services or phone calls because of the distance and I am okay with that. If it ever becomes an issue, I would like to evoke my “Client Determination” rights and I would like my case to be treated as if I am visiting with my service provider in person in their office in their state of licensure. I do not want distance to disrupt the opportunity for quality services when we have access to such effective technology.

Billing Contact

If you have any questions you can each our billing department at 801-692-3628 or email billing@taylorlyman.com

Notice of Therapists’ Policies and Procedures To Protect the Privacy of Your Health Information

THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

We are required by a federal law known as the Health Insurance Portability and Accountability Act (HIPAA) to give you this Notice. This notice will tell you about the ways in which we may disclose health information about you and will describe your rights and our obligations regarding the use and disclosure of that information.

PLEASE REVIEW IT CAREFULLY.

I. Preamble:

The Licensed Professional Counselors Licensing law provides extremely strong privileged communication protections for conversations between your therapist and you in the context of your established professional relationship with your therapist. There is a difference between privileged conversations and documentation in your mental health records. Records are kept documenting your care as required by law, professional standards, and other review procedures. HIPAA very clearly defines what kind of information is to be included in your “designated medical record” as well as some material, known as “Psychotherapy Notes” which is not accessible to insurance companies and other third-party reviewers and in some cases, not to the patient himself/herself.

HIPAA provides privacy protections about your personal health information, which is called “protected health information” which could personally identify you. PHI consists of three components: treatment, payment and health care operations.

TREATMENT refers to activities in which I provide, coordinate or manage your mental health care or other services related to your mental health care. Examples include a therapy session, talking to your physician about medications or other medical conditions, or talking with your child’s teacher about observable behaviors in the classroom.

PAYMENT refers to the reimbursement I receive for providing your mental health care. If you have insurance coverage, filing with your insurance for payment of therapy sessions is an example of this type of sharing of PHI information. Please note, I do not accept insurance.

HEALTH CARE OPERATIONS are activities related to the business and quality performance of my therapy practice. Insurance companies can request documentation reviews to assure my work with you is “medically necessary.” USE applies only to activities within my office such as sharing, employing, applying, utilizing, examining and analyzing information that identifies you.

DISCLOSURE applies to activities outside of my office such as releasing, transferring, or providing access to information about you to other parties.

II. Uses and Disclosures of Protected Health Information Requiring Authorization

Tennessee requires authorization and consent for treatment, payment and healthcare operations. When beginning therapy with me, you will sign this general consent to care and authorization to conduct payment and health care operations, authorizing me to provide treatment and to conduct administrative steps associated with your care. I may use or disclose PHI for purposes outside of treatment, payment and health care operations only when you sign an additional authorization for release of information. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures that you identify in writing. I will also need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes I have made about our conversations during a private, group, joint, or family counseling session, which I have kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI.

You may, in writing, revoke all such authorizations to disclose protected health information at any time provided each revocation is in writing. You cannot revoke an authorization for an activity already done that you instructed me to do or if the authorization was obtained as a condition for obtaining insurance and Tennessee law provides the insurer the right to contest the claim under the policy.

III. Uses and Disclosures with Neither Consent or Authorization

I may use or disclose PHI without your consent or authorization in the following circumstances:

• Child Abuse: If I have reasonable cause to believe or suspect abuse of a child or children, I am required by law to report this abuse to authorities.
• Elder or Domestic Abuse: If I have reasonable cause to believe that an older adult is in need of protective services (regarding abuse, neglect, exploitation or abandonment), I must report this to the local protective services agency.
• Health Oversight Activities: If the licensing board of professional counselors in TN were to audit activities in my practice, I would be required to release information for quality review purposes.
• Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is for me to directly appear to report on the therapy I have provided, or the records I maintain documenting these therapy meetings are requested, such information is privileged under state law and I will not release the information without your written consent or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. You will be informed in advance if this is the case.
• Serious Threat to Health or Safety: There are two types of threats to safety: threats toward you or threats toward others. If you express a serious threat to yourself, or intent to kill or seriously injure an identified person, and I determine that you are likely to carry out the threat, I must take reasonable measures to prevent harm. Reasonable measures may include directly advising the potential victim of the threat or intent.
• Worker’s Compensation: If you file a worker’s compensation claim, I will be required to file periodic reports with your employer which shall include, where pertinent, history diagnosis, treatment and prognosis.

IV. Clients Rights and Therapist’s Duties:

Client’s Rights:

• Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, I am not required to agree to a restriction you request.
• Right to Receive Confidential Communications by Alternative Means and at Alternative Locations: You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you should provide permission for me to leave a voice message at your home or provide an alternative way to reach you if you are worried about sharing your PHI with those at your home residence. Additionally, if you do not want your bills sent to your home address, you can provide an alternative billing address.
• Right to Inspect and Copy: You have the right to inspect and/or copy your protected health information in my mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. I may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. On your request, I will discuss with you the details of the request and the denial process. as the PHI is maintained in the record. I may deny your request. At your request, I will discuss with you the details of the amendment process.
• Right to an Accounting: You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in Section III of this notice). At your request, I will discuss with you the details of the accounting process.
• Right to a Paper Copy: You have the right to obtain a paper copy of the notice from me upon request, even if you have agreed to receive the notice electronically.
• Right to Revoke Authorization: You have the right to revoke your authorization of protected health information except to the extent that action has already been taken based on that authorization.

Therapist’s Duties:

• I am required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI.
• I reserve the right to change the privacy policies and practices described in this notice. Unless I notify you of such changes, however, I am required to abide by the terms currently in effect.
• If I revise my policies and procedures, I will present you with a revised copy when you present for a session.

V. Questions and Complaints:

Ben H. Smith is the appointed “privacy officer” for Ben Smith Counseling per HIPAA regulations. If you have any concerns of any sort that your counselor may have somehow compromised your privacy rights, please do not hesitate to speak with him immediately about this matter. You will always find him willing to talk with you about preserving the privacy of your protected mental health information. You may also send a written complaint to the Secretary of the U. S. Department of Health and Human Services.

VII: Effective Date, Restrictions and Changes to Privacy Policy

This notice will go into effect 9/1/2018. I reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that I maintain. I will provide you with a revised notice when you present at this office.

I acknowledge that I have received a copy of the HIPAA Notice of Privacy Practices. I understand that after I have read the notice, I may address any questions to my therapist.

I acknowledge that I have received a copy of the Counseling Policies and Processes. By signing below, I acknowledge having read, understood, and agreed to these policies and processes, including the financial agreement and issues of confidentiality.

I give consent to contact my identified emergency contact in the event of a psychiatric emergency situation.

I give consent to be contacted by my therapist by phone and email and that it is acceptable to leave a voice message for me on the number provided.

I give consent to Taylor Lyman, LLC., to provide clinical treatment in the context of the counseling relationship.