Service Agreement & Billing Terms

1. Services Provided

Aseya Lukina, LCSW, provides individual psychotherapy with a specialization in Eye Movement Desensitization and Reprocessing (EMDR). Services are delivered via HIPAA-compliant telehealth platform and are available to clients located in states where Aseya holds licensure or is authorized to practice.

Therapy services are not emergency or crisis services. If you are in crisis or experiencing a psychiatric emergency, please call 988 (Suicide & Crisis Lifeline) or go to your nearest emergency room.

2. Session Fees

Fees are set within the above range based on clinical complexity and session length. The exact fee will be confirmed during your consultation.

3. Sliding Scale & Financial Hardship

I am committed to making therapy accessible. A limited number of sliding scale slots are available for clients who demonstrate financial need. The sliding scale fee is determined during the initial consultation based on household income and financial circumstances.

To inquire about sliding scale availability, please mention it during your free consultation or in your initial contact message.

4. Insurance & Reimbursement

My practice operates on an out-of-network (OON) basis. This means I do not bill insurance companies directly. However:

• A detailed superbill (itemized receipt with CPT codes, diagnosis codes, and NPI number) is provided after each session.
• Many insurance plans (including PPO plans from Aetna, BCBS, Cigna, United Healthcare, and others) offer OON reimbursement — typically 50–80% of the "reasonable and customary" rate.
• You can submit superbills directly to your insurer for reimbursement. My team can assist you in understanding this process.
• HSA and FSA funds may be used to pay for therapy sessions.

I cannot guarantee reimbursement from your insurance plan. Contact your insurer to verify your OON mental health benefits before beginning treatment.

5. Payment Terms

Payment is due at the time of service. Accepted payment methods include:

• Major credit and debit cards (Visa, Mastercard, American Express, Discover)
• Health Savings Account (HSA) cards
• Flexible Spending Account (FSA) cards
• ACH bank transfer (arrangements made in advance)

A valid credit card is required on file to book and hold your appointment slot. Your card will be charged following each session unless an alternative payment arrangement has been made.

6. Cancellation & Late Cancellation Policy

24-hour advance notice is required for all cancellations and rescheduling requests.

• Cancellations with ≥ 24 hours notice: No charge. The session slot is released.
• Late cancellations (less than 24 hours notice): 50% of the session fee is charged.
• No-shows (no notice): The full session fee is charged.
• Emergencies and medical situations: Handled with understanding on a case-by-case basis. Please communicate as soon as possible.

Repeated late cancellations or no-shows may result in termination of the therapeutic relationship at my discretion.

7. Confidentiality & HIPAA

All information shared in therapy is strictly confidential, protected under HIPAA (Health Insurance Portability and Accountability Act) and applicable state laws. Information will not be shared with any third party without your written consent, except in the following legally mandated exceptions:

• Imminent risk of harm to yourself or others
• Suspicion of child abuse, elder abuse, or dependent adult abuse
• Court order requiring disclosure

Telehealth sessions are conducted via a HIPAA-compliant platform. You are responsible for ensuring your own session environment is private and secure.

8. Telehealth Requirements

To participate in telehealth sessions, you must:

• Be physically located in a state where I am licensed to practice at the time of each session.
• Have access to a device with a functioning camera and microphone.
• Have a stable internet connection adequate for video calling.
• Be in a private, confidential space where you will not be interrupted or overheard.

If you are no longer located in an eligible state, please notify me immediately. Providing sessions across state lines may violate licensure law and could result in suspension of services.

9. Termination of Services

Either party may terminate the therapeutic relationship at any time. I will provide a referral to another therapist upon request. In cases where termination is initiated by me (e.g., repeated no-shows, scope of care mismatch, ethical concerns), at least two weeks' notice will be given when clinically appropriate.

10. Contact & Questions

If you have any questions about these terms or need clarification before booking, please reach out: