POLICY STATEMENT
Barry F. Moss, Ph.D.
Clinical Psychologist
5108 196th Street SW, Suite 102
Lynnwood, Washington 98036
425 / 778 - 4174
Washington State License #1658
Fees & Payments:
General Session Fees are $158.00 for a 50 minute session (standard rate); $110.00 for a 25 minute session; and $235.00
for an 80 minute session. However, because the very first 50 minute session
requires more out of session documentation time, the initial evaluation session is $225.00. Some
or all of the fees for psychological services may be covered by your health insurance.
It is important that you find out the details of your coverage. Payment
for the percentage of fees not covered by insurance is collected at the time of each session.
In order to devote maximal time to your therapy, please have your check made out in advance. At your preference, I will either bill the outstanding balance directly to your insurance company or send
the bill to you. Please remember that if your insurance company refuses to pay
for the outstanding balance, you are responsible for the remaining payment. There
will be a $25.00 service charge for all returned checks. A 2% fee will be added
to the outstanding balance of bills that are more than 60 days overdue from the date of the initial billing. Also, If your account has not been paid for more than 60 days and arrangements for payment have not been
agreed upon, I have the option of using legal means to secure the payment.
Telephone Consultation:
There is no charge for phone calls made to schedule/reschedule appointments or for the initial pre-therapy telephone
consultation. I try to return all calls within 24 hours during weekdays. Telephone consultations will be billed at the standard rate for the time spent. Telephone consultation time includes time spent talking with you directly or with
other professionals or individuals you have authorized me to speak with. Payment
for telephone consultation is due at the time of your next office visit. Please
note that I no longer provide emergency service access. If you feel you need
a therapist who has emergency access, I would be happy to suggest referral resources to help you find another therapist who
would provide these services.
Written Consultation:
All reports, letters, and email responses will be billed at the standard rate for the time spent (with the exception
of legal documents which is outlined below). Time spent includes time necessary
to review records to complete any written communication. A minimum retainer of
one hour advanced standard fee is required before work will commence on written materials.
Please be aware that the typical time to produce written materials is between two to three weeks or longer. Any written materials needed before two weeks will be billed at the legal services rate (below) regardless
of purpose or content. For practical purposes, email responses requiring therapeutic content will be saved for reading and discussion
at the next scheduled appointment time.
Legal Services:
If you become involved in legal proceedings that require my participation, you will be expected to pay for all of my
professional time, including preparation and transportation time and costs, even if I am called to testify by another party. Because of the difficulty of legal involvement, I charge $325 per hour for preparation
and attendance at any legal proceeding. This same hourly rate is required for
the completion of all written materials. A minimum retainer of two hours advanced
fee is required before work will commence on legal matters. Usually in legal circumstances you will be asked by an attorney to
sign a release of your treatment records for duplication. Charges for record
duplication are in accordance with RCW 70.02.010 which sets and updates the standard charges for Washington
State. As a psychologist,
I am required to maintain your records for a period of 8 years from the date of last treatment contact, after which records
can be destroyed.
Appointments:
Sessions are for 50 minutes and are usually scheduled once per week (progress is best when sessions occur on a regular
and predictable basis). Longer or more frequent sessions can be arranged by special
request. Please be aware that the time is yours.
If you are late, the session will not be extended and you will be charged the full standard fee. If you need to cancel or reschedule an appointment, I must receive at least 48 hours notice or I
will charge for the session. Charges for sessions which are not cancelled within
48 hours are not submitted to your insurance company but are provided directly to you.
If a true emergency occurs, please call and an exception to my cancellation policy will be discussed. Please be aware that if you schedule appointments during work hours, any work conflicts which arise will
not be considered sufficient reason for an exception to this cancellation policy.
Course of Treatment:
The first one to four sessions are used to assess your presenting problem. This
assessment is comprised of gathering pertinent information related to your concerns.
When necessary, this assessment may also involve the administration of psychological tests. Depending on your needs, therapy can be brief (six or less sessions) or may be extensive (six months or
more). My therapeutic orientation is eclectic, meaning that I utilize a variety
of treatment modalities (cognitive-behavioral, humanistic, systems, and dynamic). Psychotherapy
will also require your active participation. In order for the therapy to be most successful, you will have to work on treatment
strategies both during your sessions as well as at home. Psychotherapy can have
both benefits and risks. Because therapy often involves discussing unpleasant aspects of your life, you may, at times, experience
uncomfortable feelings such as sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, psychotherapy often leads to better relationships, solutions to specific problems, and
significant reductions in feelings of distress. However, participation in psychotherapy
does not guarantee a particular outcome.
Termination of
Therapy: At any point in therapy, you have the right to terminate treatment and to receive
a referral to another therapist. Please be aware that a therapist also has the
right to terminate therapy. The following are reasons why a therapist may choose
to terminate therapy: 1) If a therapist feels threatened in any way by a client; 2) If a therapist feels he or she is being treated abusively by a client; 3) If a therapist should lose objectively in treating a case; 4)
If a client repeatedly attempts to violate the boundaries of the therapeutic relationship;
5) If, as the facts of a case unfold, a therapist feels that it is in the client's best interests to be treated by
another professional who has specialized expertise in an area needed by that client; and/or,
6) If a therapist is not being paid for services.
Gifts:
Your progress in treatment is the greatest gift you can provide. Please
do not bring material gifts to this practitioner, even during the holiday season. Should
you feel so inclined, thank you cards, holiday cards, or a note updating me on your life are acceptable and welcome.
Ethics of Practice:
Please be advised that I am here to serve you. If you have any concerns
about the course of treatment, please discuss them with me. Should you feel that
I have been unethical, you may contact the Licensing Department in Olympia (P.O. Box 9649, Olympia, WA 98504).
Educational Background:
1983 B.A. in Psychology - University of California,
Santa Barbara
1987 M.A. in Clinical Psychology - The Ohio
State University
1991 Ph.D. in Clinical Psychology - The Ohio State University
My signature
below indicates that I have read, understand, and agree to the information on both sides of this policy statement. My signature also indicates that I have been given the option of obtaining a copy of the contents of this
policy statement.
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Client
Signature
Date
____________________________________________________
Printed Name
