Terms & Policies

    • Initial Assessment and Intake: $280

    • Individual Therapy (60 min): $225

    • Individual Therapy (45 min): $195

    • Couples Therapy: $215

    • Family Therapy: $215 

    • 60- Minutes Session with a Post-Graduate Level- Counselor in Training (Out of Pocket Only): $185

    • 60- Minute Session with a Graduate Level Intern (Out of Pocket Only): $120

  • Limited evening and weekend hours are available. At this time we also offer virtual appointments, phone appointments, and appointments via chat for your convenience.

  • Insurance carriers will not pay for late cancellations or missed appointments. Once an appointment is scheduled,that time is reserved specifically for you. Cancellations must be made at least 24 hours in  advance. Although 24 hours is the minimum, if you need to cancel or reschedule please give as much notice as possible. You may notify our office of cancellation by phone or email to your provider. Late cancellations (fewer than 24 hours before the appointment) will incur a fee of $60.00.

    Insurance carriers will not pay for shortened appointment times due to tardiness. Please arrive before your scheduled appointment time. Please notify your therapist as soon as possible if you are going to be late for your appointment. Tardiness of over 5 minutes from your scheduled appointment time, over 3 or more separate sessions may result in termination of services or additional charges.

  • Please note that it is your responsibility as a client to check with your insurance provider to ensure you will be covered with Marriage and Family Focus LLC practice. You are responsible for reaching out to your insurance provider for co-pays and whether or not your insurance will cover virtual appointments.

    1. Medical Records Requests: $15.00 per request and $0.25 per page that is printed

    2. Case Management: $50.00 (prorated per 15 min.)

      • Please Note: Case Management includes indirect services provided outside session times such as writing letters, consultations made at your request (for which a written authorization for disclosure of confidential information is required), coordinating adjunct and Court Advocacy services, and compiling forms or reports (this include preparing testimony and documents for court if subpoenaed by the court).

    3. On occasion you may request that we testify or be present in court proceedings on your behalf.  If the therapist is subpoenaed in court, the client is held liable for paying $1,200 per day to Marriage and Family Focus, LLC. The client is also liable for payment of the hourly rate of the therapist from our arrival at the courthouse to completion of testimony. Any preparation necessary is subject to the $50 per hour Case Management fee. 

    4. Phone Consultations: (11-60 min.) $50.00 (prorated per 15 min.)

    • Late cancellations/Missed Appointment – fewer than 24 hours notice prior to appointment $60.00

    • Non-sufficient funds (bounced) check $40.00

    • Past-due accounts – over 30 days $25.00 per month

    • Checks returned due to insufficient funds will incur a fee of $45.00

  • Amounts past due by more than 30 days will incur a late fee each month of $25.00. If your account has not been paid for more than 45 days and arrangements for payment have not been agreed upon, Marriage and Family Focus, LLC may resort to legal means to secure payment. This may involve hiring a collection agency, an attorney or going through small claims court. If such legal action is necessary, you will be responsible for those costs.

  • THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

    l. IT IS MY LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI)

    By law I am required to ensure that your PHI is kept private. The PHI constitutes information created or noted by me that can be used to identify you. It contains data about your past, present or future health or condition, the provision of health care services to you, or the payment for such health care. I am required to provide you with this Notice about my privacy procedures. This Notice must explain when, why and how I would use and/or disclose your PHI. Use of PHI means when I share, apply, utilize, examine or analyze information within my practice, PHI is disclosed when I release, transfer, give or otherwise reveal it to a third party outside my practice. With some exceptions, I may not use or disclose more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is made; however, I am always legally required to follow the privacy practices described in this Notice.

    Please note that I reserve the right to change the terms of this Notice and my privacy policies at any time.

    Any changes will apply to PHI already on file with me. Before I make any important changes to my policies, I will immediately change this Notice and post a new copy of it in my office. You may also request a copy of this Notice from me or you can view a copy of it in my office.

    ll. HOW I WILL USE AND DISCLOSE YOUR PHI.

    I will use and disclose your PHI for different reasons. Some of the uses or disclosures will require your prior written authorization; other, however, will not. Below you will find the different categories of my uses and disclosures, with some examples.

    Uses and Disclosures Related to Treatment, Payment or Health Care Operations Do Not Require Your Prior Written Consent. I may use and disclose your PHI without your consent for the following reasons:

    For treatment, I may disclose your PHI to physicians, psychiatrists, psychologists and other licensed healthcare providers who provide you with health care services or are otherwise involved in your care.

    Examples: If a psychiatrist is treating you, I may disclose your PHI to her/him to coordinate your care. For health care operations. I may disclose your PHI to facilitate the efficient and correct operation of my practice.

    Examples: Quality control-I might use your PHI in the evaluation of the quality of health care services that you have received or to evaluate the performance of the health care professionals who provided you with these services. I may also provide your PHI to my attorneys, accountants, consultants and others to make sure that I follow applicable laws.

    To obtain payment for treatment. I may use and disclose your PHI to bill and collect payment for the treatment and services I provide to you.

    Example: I might send your PHI to your insurance company or health plan to get payment for the health care services that I have provided to you. I could also provide your PHI to business associates, such as billing companies, claim processing companies and others that process health care claims for my office.

    Other disclosures. 

    Examples: Your consent isn't required if you need emergency treatment provided that I attempt to get your consent after treatment is rendered. If I try to get your consent, but you are unable to communicate with me (for example, if you are unconscious or in severe pain), but I think that you would consent to such treatment if you could, I may disclose your PHI.

    B. Certain Other Uses and Disclosure Do Not Require Your Consent. I may use and/or disclose your PHI without your consent or authorization for the following reasons:

    When disclosure is required by federal, state or local law; judicial, board or administrative proceedings; or law enforcement.

    Example: I may make a disclosure to the appropriate officials when a law requires me to report information to government agencies, law enforcement personnel and/or in an administrative proceeding. If disclosure is compelled by a party to a proceeding before a court or an administrative agency pursuant to its lawful authority.

    If disclosure is required by a search warrant lawfully issued by a governmental law enforcement agency. If disclosure is compelled by the client or the client's representative pursuant to corresponding federal statutes of regulations, such as the Privacy Rule that requires this Notice.

    To avoid harm. I may provide PHI to law enforcement personnel or persons able to prevent or mitigate a serious threat to the health and safety of a person or the public.

    If disclosure is compelled or permitted by the fact that you are in such mental or emotional conditions as to be dangerous to yourself or the person or property of others, and if I determine that disclosure is necessary to prevent the threatened danger.

    If disclosure is mandated by the Wisconsin Child Abuse and Neglect Reporting law. For example, if I have a reasonable suspicion of child abuse or neglect.

    If disclosure is mandated by the Wisconsin Elder/Dependent Adult Abuse Reporting law. For example, if I have a reasonable suspicion of elder abuse or dependent adult abuse.

    If disclosure is compelled or permitted by the fact that you tell me of a serious/imminent threat of physical violence by you against a reasonably identifiable victim or victims.

    For public health activities. Examples: In the event of your death, if a disclosure is permitted or compelled, I may need to give the county coroner information about you.

    For health oversight activities.

    Example: I may be required to provide information to assist the government during an investigation or inspection of a health care organization or provider. Also, when compelled by U.S. Secretary of Health and Human Services to investigate or assess my compliance with HIPAA regulations.

    For specific government functions.

    Example: I may disclose PHI of military personnel and veterans under certain circumstances. Also, I may disclose PHI in the interests of national security, such as protecting the President of the United States or assisting with intelligence operations.

    For research purpose. In certain circumstances, I may provide PHI in order to conduct medical research.

    For Workers' Compensation purposes. I may provide PHI in order to comply with Worker's Compensation laws.

    Appointment reminders and health related benefits or services.

    Examples: I may use PHI to provide appointment reminders. I may use PHI to give you information about alternative treatment options or other health care services or benefits I offer. Also, I am permitted to contact you, without your prior authorization, to provide appointment reminders or information about alternatives or other health-related benefits and services that may be of interest to you.

    If an arbitrator or arbitration panel compels disclosure, when arbitration is lawfully requested by either party, pursuant to subpoena duces tectum (e.g. a subpoena for mental health records) or any other provision authorizing disclosure in a proceeding before an arbitrator or arbitration panel.

    If disclosure is required or permitted to a health oversight agency for oversight activities authorized by law. 

    If disclosure is otherwise specifically required by law.

    Certain Uses and Disclosures Require You to Have the Opportunity to Object.

    Disclosure to family, friends, friends’ others. I may provide your PHI to a family member, friend or other individual who you indicate is involved in your care or responsible for the payment for your health care, unless you object in whole or in part. Retroactive consent may be obtained in emergency situations.

    Other Uses and Disclosures Require Your Prior Written Authorization. In any other situation not described in Sections IllA, 111B and IllC above, I will request your written authorization before using or disclosing any of your PHI. Even if you have signed an authorization to disclose your PHI, you may later revoke that authorization, in writing, to stop any future uses and disclosures (if I haven't taken any action subsequent to the original authorization) of your PHI by me.

    Ill. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI

    These are your rights with respect to your PHI:

    The Right to See and Get Copies of your PHI. In general, you have the right to see your PHI that is in my possession. Or to get copies of it; however, you must request it in writing. If I do not have your PHI, but I know who does, I will advise you how you can get it. You will receive a response from me within 30 days of my receiving your written request. Under certain circumstances, I may feel I must deny your request, but if I do, I will give you, in writing the reasons for the denial. I will also explain your right to have my denial reviewed. If you ask for copies of your PHI, I will charge you not more than $.45 per page. I may see fit to provide you with a summary or explanation of the PHI, but only if you agree to it, as well as to the cost, in advance.

    The Right to Request Limits on Uses and Disclosure of Your PHI. You have the right to ask that I limit how I use and disclosure your PHI. While I will consider your request, I am not legally bound to agree. If I do agree to your request, I will put those limits in writing and abide by them except in emergency situations. You do not have the right to limit the uses and disclosures that I am legally required or permitted to make.

    The Right to Choose How I Send Your PHI to You. It is your right to ask that your PHI be sent to you at an alternate address (for example, sending information to your work address rather than your home address) or by an alternative method (for example, via email instead of by regular mail). I am obliged to agree to your request providing that I can give you the PHI, in the format you requested, without undue inconvenience.

    The Right to Get a List of the Disclosures I have Made. You are entitled to a list of disclosures of your PHI that I have made. The list will not include uses or disclosures to which you have already consented, i.e. those for treatment, payment or health care operations, sent directly to you or to your family; neither will the list include disclosures made for national security purposes, to corrections or law enforcement personnel or disclosures made before April 15, 2003, disclosure records will be held for six years.I will respond to your request for an accounting of disclosure within 60 days of receiving your request. The list I give you will include disclosures made in the previous six years (the first six-year period being 2003-2009) unless you indicate a shorter period. The list will include the date of the disclosure, to who PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. I will provide the list to you at no cost, unless you make more than one request in the same year, in which case I will charge you a reasonable sum based on a set fee for each additional request.

    The Right to Amend Your PHI. If you believe that there is some error in your PHI or that important information has been omitted, it is your right to request that I correct the existing information or add the missing information. Your request and the reason for the request must be made in writing. You will receive a response within 60 days of my receipt of your request. I may deny your request, in writing, if I find that: the PHI is (a) correct and complete, (b) forbidden to be disclosed, (c) not part of my records, or (d) written by someone other than me.

    My denial must be in writing and must state the reasons for the denial. It must also explain your right to file a written statement objecting to the denial. If you do not file a written objection, you still have the right to ask that your request and my denial be attached to any future disclosures of your PHI. If I approved your request, I will make the change(s) to your PHI. Additionally, I will tell you that the changes have been made and I will advise all others who need to know about the change(s) to you PHI.

    The Right to Get This Notice by Email. You have the right to get this notice by email. You have the right to request a paper copy of it, as well.

    IV. HOW TO COMPLAIN ABOUT MY PRIVACY PRACTICES

    If, in your opinion, I may have violated your privacy rights, or if you object to a decision I made about access to your PHI, you are entitled to file a complaint with the person listed in Section VI below. You may also send a written complaint to the Secretary of the Department of Health and Human Services at 200 Independence Avenue S.W., Washington, D.C. 20201. If you file a complaint about my privacy practices, I will take no retaliatory action against you.

    V. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT MY PRIVACY PRACTICES

    If you have any questions about this notice or any complaints about my privacy practices or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact Betty Rygiewicz, RN, MS, LMFT at The Family center, 8025 Excelsior Drive, Madison, WI 53717- 2902, Phone: 608-663-6154.