Pittsburgh PA and Nashville TN

(724) 919-4059

(724) 919-4059

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Elizabeth Krause, Ph.D.
Licensed Psychologist

Elizabeth Krause, Ph.D. Licensed PsychologistElizabeth Krause, Ph.D. Licensed PsychologistElizabeth Krause, Ph.D. Licensed Psychologist

Professional Guidance for Life's Transitions

Professional Guidance for Life's TransitionsProfessional Guidance for Life's TransitionsProfessional Guidance for Life's Transitions

Therapy Information

Using Insurance

initial paperwork

Using Insurance

  • If you are going to use your Insurance, Dr. Krause is in network with most Highmark/BCBS policies, most UPMC policies, and Medicare.


  • Dr Krause's insurance licensure is limited to Pennsylvania and Tennessee.


  • Services may be covered in full or in part by your health insurance or employee benefit plan. 


  • Please check your coverage carefully to understand if you have a 

  1. Deductible
  2. Copay
  3. Confirm that Dr. Krause is in your network
  4. Understand your out of network coverage options


out of pocket

initial paperwork

Using Insurance

  • If Dr. Krause is not in your insurance network, you can find out what your Out of Network benefits are.  


OR


  • If you don't have insurance or choose not to use insurance the 

      Fee For Service Rate is:


$250 for the Initial Appointment


$200 for each 45-50 minute session



  • Dr. Krause can provide a

      superbill to submit to 

your insurance for reimbursement.




initial paperwork

initial paperwork

initial paperwork

  • Please read the sections below so you have informed consent on 
  • In Person and Telehealth sessions,
  • Payment and Billing Information
  • No Surprise Billing
  • Confidentiality
  • Cancellation policy
  • When ready, you may proceed to the Getting Started Page.  You will be directed to my confidential scheduling portal to complete a brief clinical and insurance/financial information form (on the Getting Started page) and a Therapy Contract (on the Getting Started page).  
  • Once that is done, you will be able to schedule online telehealth sessions or schedule directly with me in Pittsburgh PA or Nashville TN.



In Person Session Agreement

INFORMED CONSENT FOR IN-PERSON SERVICES


Decision to Meet Face to Face

  • If there is a resurgence of the pandemic or if other health concerns arise, the use of telehealth may return. Telehealth reimbursement is dependent on insurance companies. 

Your Responsibility to Minimize Your Exposure

  • When we meet in person, take reasonable precautions and only keep your appointment if you are symptom free.  

My Commitment to Minimize Exposure

  • My practice has taken steps to reduce the risk of spreading germs within the office.
  • If I [or my staff] test positive for the coronavirus, I will notify you so that you can take appropriate precautions. 

Informed Consent

  • This agreement supplements the general informed consent/business agreement that we agreed to at the start of our work together.

Files coming soon.

Telehealth Agreement

INFORMED CONSENT CHECKLIST FOR TELEPSYCHOLOGICAL SERVICES

Prior to starting video-conferencing services:

  • There are potential benefits and risks of video-conferencing (e.g. limits to patient confidentiality) that differ from in-person sessions.  
  • Confidentiality still applies for telepsychology services, Nobody will record the session without the permission from the others person(s).
  • We agree to use the video-conferencing platform selected for our virtual sessions.
  • You need to have webcam or smartphone during the session.
  • It is important to be in a quiet, private space that is free of distractions during the session.
  • It is important to use a secure internet connection rather than public/free Wi-Fi.
  • If you need to cancel or change your tele-appointment, just let me know in advance by text or email.
  • I will contact you on the number you provide to restart the session or to reschedule it, in the event of technical problems.
  • You will provide at least one emergency contact and the closest ER to your location, in the event of a crisis situation.
  • It is your responsibility  to confirm with your insurance company that telehealth sessions will be reimbursed; if they are not reimbursed, you are responsible for full payment.
  • As your therapist, I may determine that due to certain circumstances, telepsychology is not clinically appropriate and I will offer in person sessions or make a referral to a therapist that might be a better clinical fit. 

Files coming soon.

Electronic Fees, Payment and Billing Agreement

Fees, Payments, and Billing

  • Payment for services is an important part of any professional relationship. This is even more true in therapy; one treatment goal is to make relationships and the duties and obligations they involve clear. You are responsible for seeing that my services are paid for.

Telephone consultations

  • Telephone consultations may be suitable or even needed at times in your therapy. 
  • If so, you will be charged your regular fee, prorated over the time needed. 
  • Insurance companies may or may not pay for telephone consultations. Please consult your insurance policy. 

Reports

  • You will be charged for time spent making reports that you request.  

Fees

  • Our agreed-upon fee-paying relationship will continue as long as services are provided to you.  You have a responsibility to pay for any services you receive before you end the relationship. I ask that your bills are paid within 5 days of receiving your statement.  
  • If you think you may have trouble paying your bills on time, please discuss this with me. If your unpaid balance becomes too high, I will notify you.  If it then remains unpaid, I will stop therapy with you. Fees that continue unpaid after this may be turned over to a collection service. 

Electronic Payment Communications Disclosure

  • Payment of fees is done electronically –  using a credit, debit or HSA card.  My secure platform, Jituzu can accept many forms of payment.

Please Be Aware of the Following:

  • I have a duty to uphold your confidentiality, which is why I use a HIPPA compliant and secure portal to make sure that your use of the above payment services is done as securely and privately as possible.
  • After using any of the above services to pay your fees, that service may send you receipts for payment by email or text message. These receipts will include my name, and would indicate that you have paid for a therapy session.
  • It is possible the receipt may be sent automatically, without first asking if you wish to receive the receipt. I am unable to control this in many cases, and am not able to control which email address or phone number your receipt is sent to.
  • So before using one of the above services to pay for your session(s), please think about these questions:
  • At which email address or phone numbers have I received these kinds of receipts before?
  • Are any of those addresses or phone numbers provided by my employer or school? If so, the employer or school will most likely be able to view the receipts that are sent to you.
  • Are there any other parties with access to these addresses or phone numbers that should not be seeing these receipts? Would there be any danger if such a person discovered them?
  • In addition to these possible emails or text messages, payments made by credit card will appear on your credit card statement as being made to me. Please consider who might have access to your statements before making payments by credit card.

Health Savings Accounts and Flexible Spending Accounts

  • If you are using a Health Savings Account (HSA) or Flexible Spending Account (FSA) payment card, please be aware that even if your payment goes through and is authorized at the time that I run your card, there is a possibility that your payment could later be denied. In the event of this happening, you are responsible for ensuring that full payment is made by other means. 

Health Insurance Coverage

  • Most health insurance plans will help you pay for therapy if I am in your network. Because health insurance is written by many different companies, I cannot confirm what your plan covers. Please read coverage for “Outpatient Psychotherapy” or under “Behavioral Health Treatment.” Or call your employer’s benefits office to find out what you need to know.
  • If your health insurance will pay part of the fee, I will help you with your insurance claim forms. However, please keep two things in mind:
  • 1. I have no role in deciding what your insurance covers. Your employer decided which, if any, services will be covered and how much you (and your therapist) will be paid. You are responsible for checking your insurance coverage, deductibles, payment rates, copayments, and so forth. Your insurance contract is between you and your company; it is not between your therapist and the insurance company.
  • 2. You—not your insurance company or any other person or company—are responsible for paying the fees we agree upon. 
  • If you belong to a health maintenance organization (HMO) or have another kind of health insurance with managed care (including PPO and PSO policies), decisions about what kind of care you need and how much of it you can receive may be reviewed by the plan. 
  • I will provide information about you to your insurance company only with your informed and written consent. The information will be sent electronically, by mail, or by fax.

Files coming soon.

No Surprises Billing

YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE  MEDICAL BILLS

(OMB Control Number: 0938-1401)

When you get treated by an out-of-network provider or pay fee for service, you are protected from surprise billing or balance billing.


What is Balance Billing/Surprise Billing?  

  • When you see a health care provider, you owe out-of-pocket costs,  such as a copayment, coinsurance, and/or a deductible. You may have to pay the entire bill if you see a provider that isn’t in your insurance network.
  • Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
  • “Surprise billing” is an unexpected balance bill.


You are not required to get care out-of-network. 

You can choose a provider in your plan’s network.


If you believe you’ve been wrongly billed, you may contact 1-877-881-6388 

Visit https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdffor more information about your rights under Federal law.

Files coming soon.

Confidentiality Agreement

  • It is your legal right that our sessions and the records about you be kept private. That is why you will be asked to sign a “release-of-records” form before your therapist can talk about you or send records about you to anyone else. In general, your therapist will tell no one what you talk about in therapy. In fact, he/she will not even reveal that you are receiving treatment.
  • In all but a few rare situations, your confidentiality (that is, your privacy) is protected by state law and by the rules of our professions. 


Here are the most common cases in which confidentiality is NOT protected:

  • 1. If you were sent to therapy by a court or an employer for evaluation or treatment, the court or employer expects a report from the therapist. If this is your situation, please talk with me before you talk about anything you do not want the court or your employer to know. 
  • 2. Are you suing someone or being sued? Are you being charged with a crime? If so, and you tell the court that you are seeing a therapist, the therapist may then be ordered to show the court your therapy records. Please consult your lawyer about these issues.   

            I do no accept patients who are in litigation and will be needing to use therapy notes as part to their court proceedings.   

      You must notify me if you hire an attorney and want to use therapy notes or testimonial in your case.  

I will make a referral to a forensic psychologist with legal and court expertise

  • 3. If you make a serious threat to harm yourself or another person, the law requires that I protect you or that other person. This usually means telling others about the threat. 
  • 4. Psychologists are state mandated to report driving impairments.
  • 5. If a therapist has reason to suspect, on the basis of his/her professional judgment, that a child is or has been abused, I am required to report my suspicions to the authority or government agency vested to conduct child-abuse investigations. I am required to make such reports even if I do not see the child in my professional capacity. Therapists are mandated to report suspected child abuse if anyone aged 14 or older tells the therapist that he or she committed child abuse, even if the child is no longer in danger. Therapists are also mandated to report suspected child abuse if anyone tells the therapist that he or she knows of any child who is currently being abused.


There are two situations in which your therapist might talk about part of your case with another therapist. 

  • First, when I am away from the office, a trusted collegue/therapist may “cover” for me.  If I have a covering therapist, he or she may need to know about you. Of course, this therapist is bound by the same laws and rules as your therapist to protect your confidentiality.
  • Second, sometimes therapists consult with other therapists or other professionals about their patients.  These consultants are also required to keep your information private. Your name will never be given to them, and they will be told only as much as they need to know to understand your situation.
  • Except for the situations described above, my staff will always maintain your privacy. I also ask you not to disclose the name or identity of any other patients being seen in my office.  My staff makes every effort to keep the names and records of clients private.  If we do couple therapy (where there is more than one client), and you want to have the records of this therapy sent to anyone, all of the adults present will have to sign a release.
  • An insurance company will sometimes ask for more information on symptoms, diagnoses, and treatment methods.  I  will let you know if this should occur and what the company has asked for. 
  • Please understand that I have no control over how these records are handled at the insurance company. My policy is to provide only as much information as the insurance company will need to pay your benefits.


Files coming soon.

Cancellation Agreement

About Your Appointments

  • Your first session will likely be for an hour. 
  • Subsequent sessions will be for either a 45 or 55-minutes, typically once a week at first.
  • When you cancel, please give me 24 hours notice. 
  • If you do not show up for an appointment or do not give 24 hour’s notice, you will be charged for the session. 
  • Your insurance will not cover this charge.

Files coming soon.

Privacy Policy

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. If you have any questions I will be happy to help you. 


A. Introduction

This notice will tell you about how I handle information about you. It tells how I use this information, how I share it with other professionals and organizations, and how you can see it. I want you to know all of this so that you can make the best decisions for yourself and your family. I am also required to tell you about this because of the privacy regulations of a federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Because this law and the laws of this state are very complicated and I don't want to make you read a lot that may not apply to you, I have simplified some parts. If you have any questions or want to know more about anything in this Notice, please ask me for more details. 


B. Medical information

Each time you visit us or any doctor's office, hospital, clinic, or any other healthcare provider information is collected about you and your physical and mental health. It may be information about your past, present or future health or conditions, or the treatment or other services you got from us or from others, or about payment for healthcare. The information collected from you is called, in the law, PHI which stands for Protected Health Information. This information goes into your medical or healthcare record or file at the office.


Your PHI may include:

  •  Your history. As a child, in school and at work, and marital and personal history.
  •  Reasons you came for treatment. Your problems, complaints, symptoms, needs, goals.
  •  Diagnoses. Diagnoses are the medical terms for your problems or symptoms.
  •  A treatment plan. These are the treatments and other services which I think will best help you.
  • Progress notes. Each time you come in I legally document how you are doing, what I observe about you, and what you tell me.
  •  Records I get from others who treated you or evaluated you.
  •  Psychological test scores, school records, etc.
  •  Information about medications you took or are taking.
  •  Legal matters
  •  Billing and insurance information


There may be other kinds of information that go into your healthcare record here.

I use this information for many purposes. For example, I may use it:

1. To plan your care and treatment.

2. To decide how well  treatments are working for you.

3. When I talk with other healthcare professionals with whom I have permission to consult such 

     as your family doctor or the professional who referred you to me.

4. To show that you actually received the services from us which I billed you or

     your health insurance company.

5. For clinical consultations.  


C. Privacy and the laws

The HIPAA law requires me to keep your PHI private and to give you this notice of my legal duties and privacy practices which is called the Notice of Privacy Practices or NPP. I will obey the rules of this notice as long as it is in effect but if it is changed, the rules of the new NPP will apply to all the PHI I keep. If the NPP is changed, I will post the new Notice in my office where everyone can see. You or anyone else can also get a copy at any time and it will be posted on my website.


D. How your protected health information can be used and shared:

When your information is read by me or others in this office that is called, in the law, use. If the information is shared with or sent to others outside this office, that is called, in the law, disclosure. Except in some special circumstances, when we use your PHI here or disclose it to others we share only the minimum necessary PHI needed for the purpose. The law gives you rights to know about your PHI , how it is used and to have a say in how it is disclosed and so I will tell you more about what we do with your information. We use and disclose PHI for several reasons. Mainly, we will use and disclose (share) it for routine purposes. For other uses we must tell you about them and have a written Authorization form unless the law lets or requires us to make the use or disclosure without your authorization. However, the law also says that we are allowed to make some uses and disclosures without your consent or authorization. 


Uses and disclosures of PHI in healthcare with your consent:

After you have read this Notice you will be asked to sign a separate Consent form to allow me to use and share your PHI. In almost all cases I intend to use your PHI here or share your PHI with other people or organizations to provide treatment to you, arrange for payment for my services, or some other business functions called health care operations. 


For treatment, payment, or health care operations.

I need information about you and your condition to provide care to you. You have to agree to let me collect the information and to use it and share it as necessary to care for you properly. Therefore you must sign the Consent form before I begin to treat you because if you do not agree and consent I cannot treat you. Generally, your PHI is disclosed for three purposes: treatment, obtaining payment, and what are called healthcare operations. 


For treatment

I use your medical information to provide you with psychological treatment or services. I may share or disclose your PHI to others who provide treatment to you. If you are being treated by a team I can share some of your PHI with them so that the services you receive will be coordinated. They will also enter their findings, the actions they took, and their plans into your record and so I all can decide what treatments work best for you and make up a Treatment Plan. I may refer you to other professionals or consultants for services I cannot offer such as special testing or treatments. When doing this I need to tell them some things about you and your conditions. I will get back their findings and opinions and those will go into your records here. If you receive treatment in the future from other professionals I can also share your PHI with them. These are some examples so that you can see how we use and disclose your PHI for treatment.


For payment

Information collected is used to bill you, your insurance, or others to be paid for the treatment I provide to you. My office  may contact your insurance company to check on exactly what your insurance covers.  In submitting billing, my office submits your diagnoses, what treatments you have received, and what I expect as I treat you. I will need to tell them about when we met, your progress, and other similar things.


Other uses in healthcare

Appointment Reminders.  Appointment reminders are an. optional service  to reschedule or remind you of appointments for treatment or other care. If you want my to call, text, or email to you only at your home or your work or prefer some other way to reach you, this can usually can arrange that. 


Business Associates. 

There are some jobs I hire other businesses to do for me. They are called our Business Associates in the law. Examples include a billing service who figures out, prints, and mails our bills. These business associates need to receive some of your PHI to do their jobs properly. To protect your privacy they have agreed in their contract with us to safeguard your information.


Uses and disclosures of PHI from mental health records Not requiring Consent or Authorization

The law lets us use and disclose some of your PHI without your consent or authorization in some cases.

When required by law 

*If you are involved in a lawsuit or legal proceeding and I receive a subpoena, discovery request, or other lawful process I may have to release some of your PHI. I will only do so after trying to tell you about the request, consulting your lawyer, or trying to get a court order to protect the information they requested. 

*I have to release (disclose) some information to the government agencies which check on us to see that we are obeying the privacy laws.

*For Law Enforcement Purposes

I may release medical information if asked to do so by a law enforcement official to investigate a crime or criminal.

*For public health activities

I might disclose some of your PHI to agencies which investigate diseases or injuries.

*For certain Insurance Company Requests 

You should also be aware that your contract with your health insurance company requires that I provide it with information relevant to the services that I provide to you. I am required to provide a clinical diagnosis. Sometimes I am required to provide additional clinical information such as treatment plans or summaries, or copies of your entire clinical record. By signing this Agreement, you agree that I can provide requested information to your carrier.

*For specific government functions

I may disclose PHI of military personnel and veterans to government benefit programs relating to eligibility and enrollment, to Workers' Compensation programs, to correctional facilities if you are an inmate, and for national security reasons. 

*To Prevent a Serious Threat to Health or Safety If I come to believe that there is a serious threat to your health or safety or that of another person or the public I can disclose some of your PHI. I will only do this to persons who can prevent the danger. Psychologists are state mandated to report driving impairments. 

*If it is an emergency - so I cannot ask if you disagree - I can share information if I believe that it is what you would have wanted and if I believe it will help you if I do share it. If I do share information, in an emergency, I will tell you as soon as I can. If you don't approve I will stop, as long as it is not against the law.


E. Your rights regarding your health information

1. You can ask me to communicate with you about your health and related issues in a particular way or at a certain place which is more private for you. For example, you can ask me to call you at home, and not at work to schedule or cancel an appointment

.2. You have the right to ask us to limit what I tell people involved in your care or the payment for your care, such as family members and friends.

3. You have the right to look at the health information we have about you such as your medical and billing records.

4. If you believe the information in your records is incorrect or missing important information, you can ask us to make some kinds of changes (called amending) to your health information. You have to make this request in writing. You must tell me the reasons you want to make the changes.

5. You have the right to a copy of this notice. If we change this NPP I will post the new version in the waiting area and you can always get a copy of the NPP.

6. You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint with the Secretary of the Department of Health and Human Services. All complaints must be in writing. Filing a complaint will not change the health care we provide to you in any way.

Copyright © 2024 Elizabeth Krause, Ph.D. - All Rights Reserved.

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