Overview
 
Core Therapy Services, LLC (CTS) is an independent agency providing Applied Behavior Analysis (ABA), Psychotherapy/Counseling, Educational Services, Music Therapy, Social Skills Groups, Camps, Staff Training and Transition Programming. Our services are offered to children, adults, families, schools, agencies and organizations and are provided by CTS employees and subcontactors who are credentialed/licensed and/or supervised as required by the licensing/certification board for the scope of practice for the service being delivered. CTS may subcontract for services that are deemed necessary for programming and will make the contracting agency aware of the credentials of any subcontractors utilized. All employees and subcontractors are verified for work through E-Verify and must complete a background check prior to providing services.  CTS strives to exceed standards set forth by the contracting company/agency regulations and as a provider that accepts third party payment, is required to maintain high levels of compliance.
 
Payment for Services
 
Core Therapy Services, LLC is an independent agency. We will consult with your insurance company to determine if your health benefits will cover the costs of services and will collect payment directly from your insurance company if we are in-network, less your co-pay. Core Therapy Services will submit insurance claims directly to your insurance company for reimbursement of out-of-network services if we are not in-network with your insurance company. You are ultimately responsible for the payment of services and any applicable co-pays. We are not able to bill 3rd Party Payors for missed sessions or sessions cancelled prior to our 24-hour cancellation window and the consumer will be directly billed. There may be an additional travel fee for your location, which will be discussed with you prior to initiation of services.
 
Invoices are sent once your Explanation of Benefits (EOB) is received or, at the end of the month for private pay services. See APPENDIX A for our private pay fee schedule. Your prompt payment is appreciated. A 10% late fee charge may be applied for late payments.
 
Appointment Scheduling/Attendance/Cancellation:
 
Services are provided at a frequency that will best meet the presenting needs.

• If you cannot attend a session, you agree to notify the therapist at least 24 hours in advance whenever possible.
• You understand that you can be charged for any session cancelled with less than 24-hour notice.
• You understand that late arrival and/or late pickup in excess of 15 minutes will be charged at the current private pay rate.
• You understand that if you are utilizing insurance for a scheduled session and are late or end session earlier than scheduled with less than 24-hour notice, there may a charge for the assigned therapist's time. 
• Your therapist reserves the right to transfer/terminate services at any time, for any reason they consider therapeutically appropriate.

 
There are policies/procedures in place allowing for exceptions to the above policy. Please discuss any concerns or special circumstances you may have with your therapist. Please note that exceptions to the above attendance policy do not necessarily relieve responsibility for payment of those sessions.
 
Confidentiality
 
State law requires that information provided to mental and behavioral health practitioners remain confidential, and Core Therapy Services, LLC makes every effort to ensure confidentiality is maintained with respect to all aspects of treatment. As a consumer, you agree to the following exceptions to confidentiality, in which case information may be disclosed to the appropriate authorities/agencies/individuals serviced:

• If your interventionist has reason to believe there may be risk that the agency/organization and/or the individual being serviced are in danger of harm.
• If your interventionist has reason to believe that the individual serviced and/or the contracting agency/organization is involved in or have knowledge of abuse or neglect of a child; or abuse, neglect, or exploitation of a person who is elderly or has a disability.
• Ordered disclosure by state or federal courts.

 
In addition, Core Therapy Services, LLC requires disclosure of information in the following circumstances:

• A signed release form granting permission to designated third parties to receive information (as needed).
• Discussion of the case with the interventionist’s clinical supervisor.
• In the case of minors: parents/legal guardians have access to their child’s records, unless emancipated.

 
Confidentiality With Regard To Minors:
 
The parents or legal guardians of Core Therapy Services, LLC clients under the age of 18 have the right to access their child’s records. The exception to this is in the case of an emancipated minor. A minor is emancipated if he or she is on active duty with the armed services, is married, or is 16 years of age or older and resides separate and apart from his/her parents, managing conservator, or guardian and manages his/her own financial affairs. Your child’s therapist will discuss with you the limitations, procedures, and implications with regard to your child’s records and progress.
 
Emergency Services
 
Core Therapy Services, LLC is not an emergency or crisis center. If at any time you experience an emergency or crisis needing immediate attention. Please call 911.
 
Termination of Services
 
Core Therapy Services, LLC reserves the right to terminate services with discretion. Reasons for termination include, but are not limited to: untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in recommended services, the individual’s needs are outside of the company’s scope of competence or practice, or the individual is not making adequate progress. The Organization and/or the family has the right to terminate services at your discretion. Upon either party’s decision to terminate therapy.
 
Grievance/Complaint
 
You have the right to file a confidential grievance if you have an unresolved concern regarding services provided, or any issue involving any representative of Core Therapy Services, LLC. Any grievance should be in written form and addressed to:
 
Core Therapy Services, LLC
Executive Director
PO Box 170062
Atlanta, GA 30317
 
Consent to Services
 
I have read the Core Therapy Services, LLC Service Agreement and have asked any questions that I needed to and understand the Core Therapy Services, LLC Service Agreement. I understand the limits to confidentiality required by law. I understand the cost of services provided. I understand my rights and responsibilities as a consumer of services and Core Therapy Services, LLC’s responsibilities to the agency/organization and to your family. I agree to undertake services with Core Therapy Services, LLC. I know I can end services at any time I wish and that I can refuse any requests or suggestions made.