Notice of Privacy Practices

Notice of Privacy Practices

HIPPA Compliance

Notice of Privacy Practices in compliance with The Health Insurance Portability & Accountability Act of 1996 (HIPPA)

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED & DISCLOSED & HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. 

Protecting Your Privacy

Your privacy is of the utmost importance to me. The information I have about you will be held to the highest levels of confidentiality. I am required by law to give you a notice of my privacy practices & to maintain the privacy of your confidential information. This notice describes the information on my privacy practices. Unless you give me permission in writing, I will only disclose your information when I am ethically or legally required to do so. 

Confidential Information

This notice applies to the information & records I have about your counseling, mental health status, & the care of services you will receive during our work together. 

Use & Disclosure of Protected Health Information Without Authorization

The law permits me to use or disclose your health information without your written consent or authorization for the following purposes: 

Treatment: I may use health information about you to provide treatment & services. I may disclose your health information to counselors, supervisors, or administrators who are involved in your treatment. In addition, therapists may share relevant details about your treatment during peer consultation with other counselors & licensed professionals, exclusively for the purpose of enhancing your quality of care. 

Insurance: If you pursue treatment with in-network or out-of-network insurance reimbursement, I may be required to share elements of treatment with your insurance provider.

Other Circumstances: Additionally, I may use or disclose your health information for the following purposes without your consent or authorization, subject to all applicable legal requirements & limitations: 

• To avert a serious threat to health or safety. 

• As required or permitted by law (e.g. cooperation with law enforcement, court officials, or government agencies).

• As authorized by worker’s compensation laws or similar programs that provide benefits for work related injuries or illness. 

• If you are involved in a lawsuit or a dispute, I may disclose information about you in response to a court or administrative order. Subject to all applicable legal requirements, I may also disclose information about you in response to a subpoena. In the event that you file a lawsuit against me, your health information will no longer be considered confidential & may become part of the case. 

Use & Disclosure of Protected Health Information That Requires Your Authorization

Except as provided in the Notice of Privacy Practices, I will not disclose your health information without your written authorization. If you sign an authorization form, you may withdraw your authorization at any time, as long as your withdrawal is in writing. If you revoke your authorization, I will no longer use or disclose information about you for the reasons covered by your written authorization, but I cannot rescind any uses or disclosures that have been previously made with your permission. 

Your Rights Regarding Your Protected Health Information 

You have the following rights regarding the health information I maintain about you: 

• The Right to Inspect & Copy: You have the right to inspect & copy your health information, such as progress notes & billing records. You must submit a written request in order to inspect &/or copy your information. If you request a copy of the information, I may charge a fee for the cost of copying, postage, or other related expenses. I may only deny your request to inspect &/or copy in certain limited circumstances & with reasonable grounds. If you are denied access to your information, you may ask that the denial be reviewed. If such a review is required by law, I will select a mental health professional to review your request & our denial. I will immediately comply with the outcome of the review. 

• The Right to Amend: You have the right to request in writing that portions of your records be corrected when you feel information is incorrect or incomplete. I may deny your request if the information was not created by me or if I believe the information is currently accurate.

• The Right to an Accounting of Disclosures: You have a right to receive an accounting of disclosures of your health information made by me, except for disclosures such as treatments & certain other disclosures as provided for by law. To obtain an “accounting of disclosures”, you must submit your request in writing. It must state a time period which may not be longer than 5 years. Your request should indicate what form you would like the information provided (i.e. paper, e-mail), as I may charge you for the cost of providing you this information. I will notify you of the costs involved & you may choose to withdraw or modify your request at that time before any costs are incurred. 

• The Right to Request Restrictions: You have the right to request a restriction or limitations on how your health information is used or to whom your information is disclosed. I am not required to agree to such requests. 

• The Right to Request Confidential Communications: You have the right to request that I communicate with you about treatment matters in such a way (e.g. in writing) &/ or location (e.g. your work address). I will not ask you the reason for your request & I will attempt to accommodate all reasonable requests. 

• The Right to a Paper Copy of This Notice: You may request a paper copy of this notice at any time. Even if you have agreed to receive it electronically, you are still entitled to a paper copy. Contact me directly to request a copy & it is also available electronically on my professional website. 

Changes to This Notice

This notice went into effect on March 1, 2023.

I reserve the right to change my privacy practices for all health information that I maintain. Revised notices will be made available in the event of any changes. The revised notice will be effective for confidential information I already have about you as well as any information I receive in the future. 

Complaints & Communications to the Federal Government

If you believe your privacy rights have been violated, you have the right to file a complaint with the federal government by contacting the OCR Regional Manager, Office for Civil Rights, US Department of Health & Human Services (DHHS), 1301 Young St., Suite 1169, Dallas, Texas, 75202, (214) 767-4056. Information is also available on the DHHS website at http://www.hhs.gov/ocr/privacy/. You will not be penalized for filing a complaint with the federal government. 

Additional Protections of Your Privacy

In addition to being HIPPA compliant, I also comply with all federal & state legislation pertinent to health & mental services provisions regarding the practice of counseling, psychology, & related services. If you have any questions concerning your rights, please let me know!

RIGHT TO RECEIVE A GOOD FAITH ESTIMATE OF EXPECTED CHARGES UNDER 

THE NO SURPRISES ACT

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give individuals seeking services who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

-You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment and hospital fees.

-Your health care provider should give you a Good Faith Estimate in writing at least one business day before your medical service. You can also ask your health care provider for a Good Faith Estimate before you schedule a service and at any time during service.

-If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

-Make sure to save a copy or picture of your Good Faith Estimate for future reference.

For questions or more information, about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 512-522-4148.