We offer a range of telehealth services after in-person initial assessment, including individual counseling. Our telehealth services are designed to provide the same level of care and support as our in-person sessions.

You can contact us through our website’s contact form, email us at info@empowerhelp.com, or text/call us at 330-770-4870. Our office is located at 89 N. Main St, Poland, OH 44514.

Our office hours are Monday- Friday and Saturday BY APPOINTMENT ONLY. Please complete a contact inquiry form on the home page or call/text 330-770-4870 to schedule.

Please see our Insurance and rates tab for more information. We DO NOT accept Medicare at this time and DO NOT complete disability paperwork.

🧾 Your Right to a Good Faith Estimate

You have the right to receive a Good Faith Estimate explaining how much your mental health care will cost if you are uninsured or choose not to use insurance.

Under federal law, health care providers must give clients who are self-pay an estimate of the expected charges for therapy services before services are provided.

You have the right to:

• Ask for a Good Faith Estimate before scheduling services
• Receive a written estimate of the expected cost of therapy services
• Dispute a bill if the actual charges are $400 or more than your Good Faith Estimate
• Request an updated estimate at any time during treatment

Because therapy is individualized, the total number of sessions needed cannot be predicted in advance. Your estimate will be based on typical treatment frequency and your provider’s session fee.

If you would like to receive a Good Faith Estimate, please ask the front desk or your therapist.

For more information about your rights, visit: www.cms.gov/nosurprises

PRACTICE POLICIES

APPOINTMENTS AND CANCELLATIONS

Please remember to cancel or reschedule 24 hours in advance. You will be responsible for a 25$ cancellation fee for appointments cancelled day off as well as no show appointments.

Cancellations and re-scheduled session will be subject to a 25$ charge if NOT RECEIVED BEFORE DAY OF SESSION. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late for a session, you may lose some of that session time.

NO-SHOW/ LATE CANCELLATION POLICY

At Empower, we are committed to providing exceptional care and ensuring therapeutic progress for all our clients. To maintain the integrity of our practice and respect the time of our therapists and clients, we have established a policy regarding no-show and late-cancellation appointments. A no-show is defined as missing a scheduled appointment without prior notice, while a late cancellation occurs when an appointment is canceled with less than 24 hours’ notice. Missed appointments hinder therapeutic progress and take away valuable time that could have been used to support another client in need.

If a client has THREE or more no-show or late-cancellation appointments, Empower reserves the right to refer the client to another practice for continued care. This policy is in place to ensure that every client receives the consistency necessary for therapeutic progress and helps us maintain availability for others seeking support.

If you need to cancel or reschedule an appointment, we kindly ask for at least 24 hours’ notice. We understand that emergencies happen, and we encourage you to communicate with us as soon as possible so we can work together to find a solution.

OUTSTANDING BALANCE POLICY

At Empower, we are committed to providing transparent and fair policies to ensure that all clients receive uninterrupted and high-quality care. To maintain this commitment, we have established the following policy regarding outstanding balances:

1. Payment Responsibility: All balances are due immediately upon notification. Clients are responsible for timely payment of all fees and charges related to their services. IT IS THE CLIENTS RESPONSIBILITY TO KNOW AND UNDERSTAND THEIR INSURANCE COVERAGE, INCLUDING DEDUCTIBLES, COPAYS, ETC. No collected payments will be refunded due to lack of knowledge of personal insurance coverage.
2. Impact on Scheduled Appointments:
   If a balance remains unpaid, any upcoming scheduled appointments will be canceled until the balance is resolved.
3. Future Scheduling:
   No new appointments will be scheduled for clients with an outstanding balance. Scheduling will resume only after full payment of the balance.
4. Payment Methods:
   Empower accepts cash, checks, and major credit cards. A $30 fee will apply for any returned checks. Payments can also be made securely through the client portal.

By signing below, I acknowledge that I have read and understand the Outstanding Balance Policy and agree to abide by its terms.

TELEPHONE ACCESSIBILITY

If you need to contact your therapist between sessions, please send a message via text, or reach out via email. Just as we encourage work life balance to our clients, we also practice this skill. We are often not immediately available; however, we will attempt to return your contact within 48 hours. Please note that Face- to-face sessions are highly preferable to telehealth. However, in the event that you are out of town, sick or need additional support, telehealth sessions are available. If a true emergency situation arises, please call 911 or any local emergency room.

SOCIAL MEDIA AND TELECOMMUNICATION

Due to the importance of your confidentiality and the importance of minimizing dual relationships, we do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). We believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meeting with your therapist.

ELECTRONIC COMMUNICATION

Empower cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, we will do so. While Empower may try to return messages in a timely manner, we cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.

Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail is considered telemedicine by the State of Ohio. If you and your therapist chose to use information technology for some or all of your treatment, you need to understand that: (1) You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled. (2) All existing confidentiality protections are equally applicable. (3) Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee. (4) Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent. (5) There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel costs.

MINORS

If you are a minor, your parents may be legally entitled to some information about your therapy. Your therapist will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately kept confidential.

TERMINATION

Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. Empower may terminate treatment after appropriate discussion with you and a termination process if it is determined that the psychotherapy is not being effectively used, inconsistent attendance or if you are in default on payment. Empower will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, Empower will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.

Should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued.

Empower uses Advanced Billing Services for all of our billing needs. Any questions regarding insurance, billing, or claims can be directed to Brooke Seidel at brooke@advancedbillingserv.com. Alternatively, you can call her at (701) 221-9810.