Billing and Insurance at the Glass Box LLC
Telephone Consult
As our first contact, I will schedule you a complementary 15-30 minute phone consultation. This is an opportunity for us to connect about the issues that you are struggling with, give you information about myself, and us to determine whether working together is the best fit for your needs. I can answer any questions that you may have about counseling and/or the process. If we agree to work together, I will get some information from you, send you paperwork electronically, and set up your first appointment. 15-30 minute initial telephone consult — free
Initial Appointment
During your first appointment I will review your completed intake paperwork prior to our session, and work with you to ensure that I have an appropriate understanding of some of your history and what brings you into counseling. I will answer any questions that you have to the best of my ability. We will also use this appointment to create some initial goals for care and to set up our mutual expectations for treatment.
60 minute initial individual assessment appointment — $175 ( this includes any scales and diagnostic tools used to assess and clarify diagnosis.
Follow Up Appointments
Follow up appointments are also typically 45-60-minute appointments, if you feel you need more than 60 minutes, please inform me prior to our appointment so I can book your session accordingly. During return appointments we will work together on your goals and I will support you through the process. We will regularly check in about the progress of care and make adjustments as needed to ensure that we are working effectively together.
Telehealth Appointments:
All services are provided via Telehealth, predominantly using video platforms. We will use a HIPPA compliant platform to protect your privacy, and you will receive the link prior to your scheduled appointment. Completing the Informed Consent form acknowledges your understanding of the risks and benefits associated with telehealth, and acceptance of the risk that may be associated with this format of care.
These sessions are billed the same as in person services delivered above
Session Fees for Individual Services 2026
$175 for 1-3 sessions for diagnostic assessment
$135 per 53-minute session
$163 per 75-minute session
$225 per 90-minute session
● Fees can be paid in cash, by check, or using a debit/credit card via billing platform. Checks can be made out to The Glass Box LLC.
● At times a session runs several minutes over. In such a case, it is presumed that the additional time will be prorated (*see below)
● Fees are subject to annual increases. If this occurs, I will notify you in person or in writing, and we can discuss any concerns you may have.
Missed Appointment Fees:
● I charge a $100 fee for missed appointments that are not cancelled or rescheduled with less than a 48-hour advance notice. When appointments are missed due to an emergency situation, such as sudden illness, serious accident, or similar extenuating circumstance, and I am informed of the situation, no fee will be assessed.
After one emergency cancellation, the fee waiver will require third-party verification of each emergency.
● The missed appointments policies apply the same to all clients and all methods of payment. Please anticipate this policy being discussed in a consistent and straightforward manner when an appointment is missed without notice.
Reduced Session Fees:
● I maintain space for a few clients whose motivation and need are higher than their ability to pay the $135 session rate. Please request this consideration only if paying the standard fee would be an obstacle to the affordability of food, housing, and/or transportation, and documentation of income may be required.
● Reduced session fees also apply to the formula used to calculate prorated services such as extended sessions, missed appointment fees, or Special Fees (see below).
Special Fees for work performed outside of our sessions:
● If consultation services, documentation, or other forms of communication beyond usual therapy notes are required and/or requested, you agree to my prorating billing policy (see below*) for completing those services (i.e., report writing, faxing, communicating by phone, etc.) Attorney Subpoenas will be ignored, only judicial subpoenas ( signed by a judge will be addressed)
● If you become involved in legal proceedings that require my participation, you will be expected to pay for my professional time and services even if I have been called to testify by another party. Because of the difficulty of legal involvement and the interruption to my regular practice, I charge $250 (or twice the amount of a regular session fee, when applicable) per hour for preparation and attendance at any legal proceeding and charge hotel fee, travel costs etc on top of the hourly fee. I will provide regular invoices for work performed on behalf of your legal proceeding and expect to be paid upon receipt unless otherwise agreed upon.
*Determination of Prorated Fees*:
● Prorated fees accumulate at 10-minute intervals, based upon a $135/53-minute fee structure. This works out to $26 for up to 1-10 minutes, $52 for 11-20 minutes, $78 for 21-30 minutes, and so on. (135 divided by 53 = 2.6, which is multiplied by the number of minutes rounded up to 10)
● Balances: I do not permit clients to carry a balance of more than one session and if you are unable to pay this balance, we will discuss whether it makes sense to pause your care or develop another strategy so that you can avoid incurring additional debt. Please let me know if any problem arises during the course of therapy regarding your ability to make timely payments.
Fees for Phone Calls and Emails:
● If you need to contact me between sessions about a clinical matter, please leave a message for me at 419-308-8253. I check my messages each day and will respond in 24-48 business hours. HIPPA secured email is deanacouch.lpcc@protonmail.com and applies as the same to 24-48 business hours unless I am on vacation.
● Phone consultations of five minutes or less are typically free. However, if we spend more than five minutes in a week on the phone, if you leave more than five minutes' worth of phone messages in a week, or if I spend more than five minutes reading and responding to emails or coordinating your care, I will bill you on a prorated basis for that time.
Employee Assistance Program (EAP) Benefits:
● I am in network with some but these are limited slots available and based on availability of open EAP slots.
Health Insurance:
● I am not a contracted provider for any health insurance plans.
● Although I do submit claims to health insurance companies via a third-party system HEADWAY, GROW THERAPY, TELADOC et al, upon request, I will provide you coded billing receipts to use for your own claims. I would be considered an "out-of-network" provider that you will be working with if you do not verify with your insurance company through the third party EHR/Billing portals. The coverage you receive is entirely dependent upon the plan that you have. I recommend you contacting your insurance company directly to determine your specific coverage. Some questions that may be helpful in this conversation include:
● Do I have mental health insurance benefits that cover psychotherapy?
● Does my policy cover an out of network Licensed Professional Clinical Counselor or Licensed Professional Counselor? If so, what percentage is covered or what is the coverage amount per therapy session?
● What is my deductible and has it been met and what is and do I have a copay also?
● Are my medical and mental health/behavioral health deductibles separate?
● How many sessions per year does my health insurance cover?
● Does the diagnosis matter? Are some diagnoses covered and others not?
● What paperwork or forms do I need to submit for sessions to be covered?
● Is approval required from my primary care physician?
● I will complete necessary portions of health claim forms that you may be required to submit. I cannot guarantee reimbursement.
● Your health insurance carrier or benefits provider will require disclosure of confidential information in order to process claims. This is likely to include diagnosis, the date and length of our appointments, and what services were provided. Please be aware that submitting a mental health invoice for reimbursement carries some risk to confidentiality, privacy, or future eligibility to obtain health or life insurance.
The Glass Box Counseling does not provide 24 hour coverage nor does it provide crisis services- if in mental health crisis call 988 /911 or go to your nearest Emergency Room / Center.
No Surprises Act - Effective 1/1/2022
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. Under the law, health care providers need to give patients who don’t have insurance, or who are not using insurance, an estimate of the expected charges for medical services, which includes mental health care.
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You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, which includes mental health care.
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You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
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If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
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Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit CMS website or call our office at 419-308-8253.