Jill Gaumer, LCSW
Counseling & Mediation
Office Policies and Procedures
SESSIONS AND FEES: My usual fee is $85 per session. Sessions
normally last 50 minutes, but can be longer or shorter depending on the
circumstances. Fees are paid at either the beginning or the end of the
TELEPHONE COVERAGE AND CONTACTING ME: I return calls as quickly as possible
as I like to be available to clients. I do not, however, want to use the
telephone for treatment issues. Please limit calls to information exchange
or critical issues. You may also e-mail me at
When I am out of town or on vacation, I will have another therapist on call
for urgent needs
EMERGENCIES: CALL 911 or go to the nearest hospital emergency room.
CONFIDENTIALITY: A key aspect of counseling/psychotherapy is the development
of a trusting relationship between the client and the therapist. Also, I am
bound by the Clinical Social Work Federation and the licensing board to
maintain client confidentiality. Therefore, information between the client
and therapist is kept in strict confidence. You may review your record with
your therapist upon written request.
Exceptions to confidentiality:
If there is a suspicion of abuse or neglect of a child,
whether current or past, there is a Duty to Report this to the Department
of Social Services. This is true for both suspected victim and abuser.
If a client threatens to do harm to another person, there
is a Duty to Warn that potential victim.
If a client is determined to be at high risk of harming
him/herself, or of harming another person, the Duty to Protect takes
precedence over confidentiality.
If there is a suspicion of abuse or neglect of an elderly
person, there is a Duty to Report this to the Department of Social
Court Orders override the rules of confidentiality.
Health insurance companies generally require a diagnosis
and can require a review of their case records.
PAYMENT AND RESPONSIBILITY: You may pay privately or you may
choose to use your health insurance or your Employee Assistance Program (EAP).
I accept many of the major plans.
If you are using your insurance coverage for psychotherapy is often very
different than coverage for medical visits to a physician. To insure that
you are aware of what type of coverage you have, I suggest that you verify
your benefits for outpatient coverage by calling your insurance carrier.
Here are some questions you should ask your insurance company.
Is your coverage active at the time of your session?
Do you have a deductible?
Do you have a co-pay?
What is the maximum amount they will pay in a year?
What is the maximum number of sessions in a year?
If you have your own coverage and are covered by a spouse’s insurance,
how does this affect the payment?
It is the insurance company’s job to explain your benefits to you. Be aware
that most insurance carriers do not pay the entire fee.
KEEPING APPOINTMENTS: It is important to keep your agreement to come to
counseling on a regular schedule. I try to accommodate people’s work and
home life schedules. However, last minute cancellations are disruptive to
all. This time has been reserved for you. Additionally, insurance companies
will not pay for any missed sessions.
Appointments cancelled with less than 24 hours notice and missed
appointments are charged at $35. Payment must be made before additional
sessions can be scheduled.
Please review the following and sign that you have read and agree:
I understand and agree that, regardless of my insurance status, I am
personally responsible for any balance on this account. I understand that I
will be responsible for any legal fees or other fees incurred in the
collection of payment on this account. I have completed the above
information and certify that this information is true and correct to the
best of my knowledge.