Practice Policy for Psychotherapy

Provider Information

Name: Danielle Falesnik

Email: df@destinofortuna.com

Phone number: (920) 666-6963

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Appointments and Cancellations

Appointments are scheduled in advance, at a cadence we agree on, based on your goals, treatment needs, and our mutual availability. Payments for each appointment will be made through Headway by debit or credit card or ACH transfer.

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You may cancel appointments in advance without charge, as long as I receive notice far enough in advance. For appointment no-shows or last-minute cancellations, you may be charged a fee. The standard no-show or late cancellation fee is $100. A late cancellation fee is assessed for any service canceled within 24 hours of the scheduled appointment and will be at the provider's discretion to assess a full or partial late-cancelation fee.

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Cost of Billable Services

Individuals who pay out-of-pocket for services will be automatically granted an out-of-pocket fee discount. Below is the full billable cost for common CPT codes used in billing insurance. For the out-of-pocket fee scale, please see out-of-pocket cost. These amounts do not always reflect what the insurance payer will pay and are often reduced after being billed.

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• CPT Code 90791 (Psychiatric Diagnostic Evaluation): $169 per session. This code is generally used for an initial assessment and includes a comprehensive evaluation of the patient's mental health status.

• CPT Code 90837 (Psychotherapy, 60 minutes): $150 per session. This code is used for longer therapy sessions, lasting 53 minutes or more.

• CPT Code 90834 (Psychotherapy, 45 minutes): $120 per session. This code applies to sessions lasting 38 to 52 minutes.

• CPT Code 90832 (Psychotherapy, 30 minutes): $90 per session. This code is for sessions lasting 16 to 37 minutes.

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Out of Pocket Cost (Private Pay Fees)

• Psychiatric Diagnostic Evaluation: $130 per session.

• Psychotherapy, 60 minutes (Over 53 Minutes): $130 per session.

• Psychotherapy, 45 minutes (38-52 Minutes): $100 per session.

• Psychotherapy, 30 minutes (16-37 Minutes): $60 per session.

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Telehealth and Electronic Communication

All sessions are conducted online through a secure and encrypted telehealth platform. By agreeing to this policy, you are agreeing to electronic communication including but not limited to email, SMS, Zoom/Telehealth, and other secure messaging platforms. Additionally, sessions will preview a transcript and may appear as Closed Captioning during your session. If you wish to revoke consent for any of these you may do so, however, it may limit your ability to participate in telehealth sessions. Please discuss this with your provider if you have any questions.

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Availability and After-Hours Emergencies

Providers check for voicemail messages during normal business hours. Messages left outside of normal hours of operation will be picked up the next business day. If you are experiencing suicidal or homicidal thoughts, are in crisis, or need immediate help, please call 911 or go to the nearest emergency department.

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Contacting Me

I am often not immediately available by telephone. I do not answer my phone when I am with clients or otherwise unavailable. At these times, you may leave a message on my confidential voicemail and I will return your call once I’ve reviewed your chart, but it may take a day or two for non-urgent matters. I will make every attempt to inform you in advance of planned absences, and provide you with the name and phone number of the mental health professional covering my practice. If I need to cancel an appointment at the last-minute, I will reach out as soon as possible and reschedule, or have a member of my staff connect with you.

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Discharge Process

There are several reasons why we may eventually end our professional relationship. You may decide you would prefer to work with a different provider. I may reach the conclusion you would be better served working with someone else. Regardless of the case, I will first discuss with you the reasons for discharging, and if you request, provide you with a list of other qualified providers. I will also extend the discharge process length if necessary based on your treatment needs, including continuing to provide emergency support for a time-limited period after you have been notified of the end of our treatment relationship.

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Please note that ongoing failure to pay for treatment, attend sessions, or communicate with me in a respectful and timely manner can also result in discharge from my practice. In these instances, to ensure you have continued access to care, I will still make every reasonable effort to get in touch with you and provide referrals to a new provider before I consider our relationship ended.

Updated 7/11/24