
Soul Purpose Counseling
Ashley PREMO Hinton, LPC, NCC
FORMS
PROFESSIONAL DISCLOSURE STATEMENT
Click to download PDF
Click to download PDF
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ADDITIONAL SERVICES & GENERAL DISCLOSURES
CONSULTATION. Clinical Consultation and Requests for written reports will be billed at a rate of $100 per hour with a one-hour minimum.
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COURT APPEARANCES. Fees for court appearances include preparation and travel time and are billed at a rate of $200 per hour. A retainer of $600 is due upfront and will be applied to any incurred court costs. Payment is expected at the time services are rendered. Court costs are generally not reimbursable.
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INSURANCE. Treatment services may be covered by using your insurance benefits. You are responsible for checking eligibility and benefit information. Deductibles and copayments are your responsibility.
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PAYMENTS. The fee for each session is due at the conclusion of each appointment. Accepted methods of payment include cash, personal checks, CashApp, PayPal, Venmo, and most major credit cards. You are obligated to pay your deductible or copayments, if applicable. You are responsible for verifying eligibility and benefits for behavioral health, mental health, and substance abuse services.
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PROVIDER TYPE. Ashley Hinton is fully licensed as a professional counselor in the state of Michigan, specializing in behavioral health services. As a Qualified Mental Health Professional Ashley Hinton is credentialed by many insurance panels and listed as an in-network provider.
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STATE OF MICHIGAN. Substance abuse evaluations (SOS-258) are $200 per assessment and must be paid before service is rendered. Read more about what documents are required in order to complete an accurate evaluation: Office of Hearings and Administrative Oversight (OHAO) Form Package.
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TELETHERAPY. When applicable, teletherapy may be utilized and billed at a regular session rate. Therapists utilizing teletherapy must use specialized software that is fully encrypted, offering a high level of security and privacy. SOFTWARE. Teletherapy software must be approved by the Health Insurance Portability and Accountability Act of 1996 [HIPAA]. This legislation ensures data privacy and security for safeguarding medical information, including therapy.