Sliding Fee Scales, Pro-Bono Agreement, Payment Plans & Good-Faith Estimates

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Simple Legal Rights(For Comprehensive, Legal Agreement)​

Definitions

1. The following terms are defined to ensure clarity and mutual understanding between Cuyahoga Valley Mindful Health & Wellness LLC (hereby referred to as "the Company,") and the Client:

2. “Body Members”: Individuals directly engaged in the Company Operations, either employed or contracted by the Company, including licensed counselors, licensed marriage/family therapists, licensed social workers, licensed clinical mental health supervisors, as defined under Ohio Rev. Code § 4757.01, as well as life coaches, athletic coaches, OHSAA-affiliated athletic consultants, and administrative staff. Also, any individual affiliated with direct engagement under accepted vote by the Board of Directors and/or CEO in Company Operations, including legal consultants, accountants, billing consultants, insurance affiliates, debt-collectors, and board members engaged in the provision of administrative duties, wellness services, consultation services, medical services, or legal oversight. 

3. “Consultation Services”: Non-medical, non-psychological services offered by the Company, specifically life coaching and athletic coaching, which do not involve the diagnosis, treatment, or management of medical or mental health conditions as defined by applicable state and federal laws.

4. “Medical Services”: Psychotherapy services rendered through the Company are provided by licensed professionals under clinical supervision, unless otherwise noted, involving the diagnosis, treatment, or management of mental health conditions in accordance with the Ohio Revised Code and federal regulations, including HIPAA (42 U.S.C. § 1320d et seq.).

5. “Client": Any individual entering into this agreement to receive clinical mental health psychotherapy, life coaching, or athletic coaching services from the Company.

6. “Household Income”: The aggregate gross income of all members of the Client’s household, as reported in the most recent federal tax return, used to determine eligibility for sliding scale fees or pro-bono services in a fair and equitable manner without discrimination.

7. “Good Faith Estimate”: A written estimate of anticipated service costs provided to the Client pursuant to the No Surprises Act (42 U.S.C. § 300gg-19a), delivered within 1-3 business days of scheduling with the Company.

8. Psychotherapy Services

9. Scope and Supervision

10. The Company offers psychotherapy services for individuals, families, and couples addressing mental health conditions including, but not limited to, anxiety, depression, trauma, autism spectrum disorders, and relational conflicts. These services are provided by Eric Riesterer, Licensed Professional Counselor (LPC), under the direct supervision of Wendy Nathan, Licensed Professional Clinical Counselor with Supervision Designation (LPCC-S), in compliance with the Ohio Counselor, Social Worker, and Marriage & Family Therapist Board (Ohio Rev. Code § 4757).

11. Regulatory Compliance: All psychotherapy services adhere to the Health Insurance Portability and Accountability Act (HIPAA) (45 C.F.R. Parts 160 and 164), ensuring the confidentiality and security of protected health information (PHI).

12. Informed Consent: Prior to commencing services, the Client must execute an informed consent agreement detailing the scope of treatment, potential risks (e.g., emotional distress), benefits (e.g., symptom reduction), and the Client’s rights under Ohio law.

13. Confidentiality: Psychotherapy sessions are confidential except as required by law, including mandatory reporting obligations under Ohio Rev. Code § 2151.421 (child abuse) and § 5101.63 (elder abuse), or where there is an imminent risk of harm to the Client or others.

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16. Client Rights and Grievances

17. The Client retains the following rights:

18. To receive respectful, non-discriminatory treatment consistent with 42 U.S.C. § 18116 (Section 1557 of the Affordable Care Act).

19. To submit grievances regarding service delivery to Patient Rights Officer Wendy Nathan, LPCC-S, via phone (419-377-3057) or email (WNathanWellness@gmail.com) without fear of retaliation or termination of services.

20. To receive a written response to any grievance within 5 business days, including a proposed resolution or escalation plan.

21. Referrals and Level-of-Care Adjustments

22. Should outpatient psychotherapy prove inadequate, the Company shall facilitate referrals to appropriate higher levels of care, including:

23. Intensive outpatient programs (IOP);

24. Inpatient psychiatric facilities;

25. Psychiatric care for medication management; or

26. Substance abuse detoxification programs.

27. Additional integrative services (e.g., marriage counseling, spiritual/pastoral counseling, dance and movement therapy, holistic wellness) may be accessed through the Company's referral network. Clients transitioning to a higher level of care may resume outpatient services with the Company upon stabilization.

28. Life Coaching Services

29. Scope and Limitations

30. Life coaching is a non-clinical consultation service aimed at fostering personal growth, goal attainment, stress management, and life transitions. It is expressly not a medical or psychological service and does not involve diagnosing or treating conditions under the Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR) or International Classification of Diseases (ICD-11).

31. Non-Medical Disclaimer: Life coaches, regardless of any concurrent licensure, do not act in a medical or psychological capacity during these consultation sessions.

32. Service Exclusivity: Clients may not concurrently receive life coaching and psychotherapy from the Company. Transition to psychotherapy is permitted if life coaching is deemed insufficient upon discharge and LOC assessment by the Company during clinical biopsychosocial assessment. Clients are encouraged to work alongside clinical therapists while engaged in Wellness Consultation Services through the Company via our referral network.

33. Medical Recommendations: Clients are advised to consult a licensed medical professional (e.g., general practitioner, M.D., or D.O.) to assess whether psychotherapy or medical intervention is warranted.

34.  Confidentiality and Mandated Reporting

35. Limited Confidentiality: Life coaching may occur in non-traditional settings (e.g., public venues), where privacy cannot be guaranteed to the same extent as HIPAA-protected psychotherapy. Clients requesting confidentiality will be accommodated to the extent feasible, but no legal privilege applies.

36. Mandated Reporting: Life coaches are mandated reporters under Ohio law and must report suspected abuse or neglect (Ohio Rev. Code § 2151.421) or imminent threats to safety to appropriate authorities (e.g., 911, Department of Jobs and Family Services).

37. Home-Visit Provisions: Home-visit coaching is discretionary and subject to coach approval. Coaches may decline such requests if safety or liability concerns arise, offering alternative session locations instead.

38.  Referrals and Recommendations

39. The Company provides referrals to external mental health or medical professionals upon request. For physical or psychological concerns (e.g., diet, injuries, eating disorders), Clients should consult licensed specialists (e.g., dieticians, physicians, or programs like the Emily Program). Emergency resources (e.g., 911) are recommended as needed.

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42. Athletic Coaching Services

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44. Scope and Limitations

45. Athletic coaching is a consultation service provided by the Company for runners and athletes, offering customized training plans based on empirical training methodologies such as Dr. Jack Daniels’ VDOT Method, Dr. Thomas Schwartz’s “Tinman Method,” Dr. Jay Johnson's University of Boulder Colorado Method, and Tony Holler’s “Feed the Cats.” It is not a medical or psychological intervention.

46. Initial Assessment: All Clients must complete a consultation to evaluate fitness levels and goals prior to program enrollment.

47. Non-Medical Nature: Coaches do not diagnose or treat medical conditions, and participation assumes Client responsibility for health-related risks and appropriate disclosure for adequate assessment of wellness consultation service appropriateness between Client and the Company.

48.  Liability and Intellectual Property

49. Liability Waiver: The Company disclaims liability for injuries, health complications, or damages arising from athletic coaching or Client failure to seek proper medical clearance. Clients must communicate limitations to coaches to mitigate risks to physical and/or mental health.

50. Intellectual Property: All training plans, materials, and consultation content provided by the Company in any setting are proprietary to Cuyahoga Valley Mindful Health & Wellness LLC, protected under the U.S. Copyright Act (17 U.S.C. §§ 101-1332.) Unauthorized utilization, reproduction or distribution may result in civil action, including injunctive relief and damages.

51. Outcome Disclaimer: The Company does not guarantee specific health or performance outcomes from athletic programs, though benefits to physical and mental well-being may occur.

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55. Financial Policies

56. Standard Fees and Payment Terms

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58. Psychotherapy:

59. Standard counseling session (1 hour): $120

60. Parent psychotherapy (without patient): $100

61. Biopsychosocial assessment: $150

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63. Life Coaching: $45/hour

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65. Athletic Coaching:

66. Couch to 5K (16 weeks): $250

67. First Marathon (26 weeks): $350

68. Endurance Athletic Development (52 weeks): $850

69. Sprint/Middle-Distance/Distance Camps (12-20 weeks): $300-$400

70. Race Plan Consultation (1 hour): $45

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72. Payment is due at the time of service unless a notarized and written payment plan is executed with the Company's Legal Counsel and Accounting Services.

73.  Sliding Scales and Pro-Bono Services

74. Sliding Scales:

75. Psychotherapy: $45-$70/hour, contingent on household income.

76. Life Coaching: $25-$45/hour, contingent on household income.

77. Athletic Coaching: 10-20% program discount, contingent on household income.

78. Eligibility requires submission of the most recent federal tax return or equivalent documentation.

79. Pro-Bono Services:

80. Offered to Clients demonstrating severe financial hardship (e.g., unemployment, medical necessity), subject to availability.

81. Requires written application and supporting documentation (e.g., proof of income loss).

82.  Good Faith Estimates and Refunds

83. Good Faith Estimate: Delivered within 1-3 business days of scheduling, detailing anticipated costs per the No Surprises Act.

84. Refund Policy:

85. Athletic coaching programs: Full refund to the Client within 4 weeks of purchase; partial refunds (less 10% administrative fee) thereafter, subject to documented injury or hardship.

86. Psychotherapy and life coaching: Refundable after service delivery on a case-by-case basis as within first 3 months of initial intake assessment (psychotherapy) or initial consult (life coaching consultation services) determined by level-of-care change needs, lacking fit between the Company and Client, and/or sub-standard improvements for consultation service, mental health service, comprehensive wellness service, diagnostic and/or treatment plan consideration. Refunds must be approved by Client, Provider/Consultant and Patient Rights Officer.

87. Collections: Unpaid balances owed to the Company by the Client may be referred to a third-party collector, with non-PHI data disclosed per the Company's privacy policy.

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1. Compliance and Supervision

2. Psychotherapy: Governed by HIPAA and supervised by Wendy Nathan, LPCC-S, per Ohio Rev. Code § 4757.

3. Consultation Services: Life and athletic coaching are non-clinical and may be terminated by the Company at its discretion with written notice. Life coaching and athletic coaching services are consultation services and do not guarantee improvements in physical or mental health, nor do consultation services guarantee accurate assessment to medical or mental health conditions.​​​

4. Liability Limitations

5. The Company is not liable for injuries, damages, or losses arising from Client participation in consultation services or failure to seek medical advice.

6. Intellectual Property

7. All Company materials are protected under federal intellectual property laws. Infringement may result in legal remedies, including monetary damages and equitable relief, U.S. Copyright Act (17 U.S.C. §§ 101-1332.)

8. Disability Accommodations

9. Requests for accommodations to receive your deserved respectful, non-discriminatory treatment consistent with 42 U.S.C. § 18116 (Section 1557 of the Affordable Care Act) & the Americans with Disabilities Act (42 U.S.C. §§ 12101 et seq.) must be submitted via the Company's chat function (your accommodations requests are routed directly to our legal partners via the chat function) with copies emailed to wnathanwellness@gmail.com and cvmindfulhealthandwellness@outlook.com. All Disability Accommodation Requests will be reviewed and answered by Legal Counsel within 5 business days under your deserved rights in Ohio.