HIPAA Notice of Privacy Practices

Effective Date: August 28, 2024

This notice describes how your Protected Health Information (PHI) may be used and disclosed and how you can access this information. Please review it carefully.

I. Our Commitment to Your Privacy

At Loving at Your Best Marriage and Couples Counseling, PC, we are committed to protecting the privacy of your Protected Health Information (PHI). PHI includes any information that can identify you and relates to your past, present, or future physical or mental health, the provision of healthcare to you, or the payment for such care. We are required by law to maintain the privacy of your PHI and to provide you with this notice of our legal duties and privacy practices.

II. How We May Use and Disclose Your Information

We may use and disclose your PHI without your prior consent for the following purposes:

Treatment: To coordinate and manage your healthcare, including sharing information with other healthcare providers involved in your care.

Payment: To bill and collect payment for services provided to you, including working with your insurance carrier.

Healthcare Operations: For activities necessary to support our operations, such as quality assessment and improvement, compliance reviews, and business management.

Certain other uses and disclosures may occur without your consent, including:

Legal Requirements: Disclosures required by law or in response to legal proceedings.

Preventing Harm: Disclosures to prevent a serious threat to your health and safety or the health and safety of others.

Public Health Activities: Disclosures for public health purposes, such as reporting diseases, injuries, or disabilities.

Other Specific Situations: Disclosures for research, military functions, or Workers' Compensation claims.

Insurance Reimbursement and Privacy:

In rare cases, your insurance carrier may request access to your general progress notes or require us to speak with their reviewer regarding your treatment. This is not intended to control your treatment but may affect your reimbursement. Such disclosures will only be made with your written consent, in compliance with strict HIPAA privacy laws. It's important to note that psychotherapy notes-detailed, personal reflections written by your therapist-are never shared.

III. Your Rights Regarding Your PHI

You have the following rights concerning your Protected Health Information:

Right to Access: You have the right to inspect and obtain copies of your PHI, with some exceptions.

Right to Request Restrictions: You may request that we limit how your PHI is used or disclosed. While we will consider your request, we are not legally required to agree to all restrictions.

Right to Confidential Communications: You have the right to request that we communicate with you about your PHI in a specific way or at a specific location.

Right to an Accounting of Disclosures: You have the right to receive a list of certain disclosures we have made of your PHI.

Right to Amend: If you believe there is an error in your PHI, you have the right to request a correction. We may deny your request in certain circumstances, but we will provide a written explanation.

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.

IV. Changes to This Notice

We reserve the right to change our privacy practices and this notice. Any changes will apply to all PHI we maintain, including PHI created or received before the changes. We will provide an updated notice to you if there are any significant changes.

V. Questions and Complaints

If you believe your privacy rights have been violated or have questions about this notice, you may file a complaint with our office or with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

VI. Contact Information

For questions, more information, or to file a complaint, please contact:

Loving at Your Best Marriage and Couples Counseling, PC
215 Park Avenue South 11th Floor
New York, NY 10003
Phone: (212) 725-7774
Email: travis@newyorktherapy.com

Purpose of This Form:

This form complements our HIPAA Notice of Privacy Practices. HIPAA is a federal law that protects your privacy and gives you rights regarding your Protected Health Information (PHI) used for treatment, payment, and healthcare operations. By signing this document, you acknowledge that this information has been provided to you and agree to its terms.

Confidentiality:

All information disclosed during sessions and written records are confidential and may not be shared without your written permission, except where required by law (e.g., suspected abuse, danger to self/others). Details are in the Notice of Privacy Practices.

When Disclosure Is Required by Law:

Disclosure is required in cases of suspected child, elder, or dependent adult abuse, or when a patient poses a danger to self or others.

When Disclosure May Be Required:

Disclosure may be required in legal proceedings. In couple and family therapy, confidentiality does not apply between partners or family members in joint sessions. Information will not be released to outside parties without authorization from all adult participants.

Emergencies:

In an emergency, if there is concern for your safety or the safety of others, your therapist may contact your emergency contact or appropriate authorities to ensure you receive proper care.

="caret-color:>

Health Insurance and Confidentiality:

To support your care and maximize the likelihood of insurance reimbursement, we may ask you to complete brief questionnaires before sessions. These help us provide the necessary documentation if you decide to submit for reimbursement, now or in the future. Reimbursement is an agreement between you and your insurance carrier, and while we assist with the required documentation, we are not responsible for the decisions made by your insurance company.

Please note that while psychotherapy notes are never shared, in rare instances an insurance carrier may request general progress notes, which are less detailed. For instance, an insurance carrier may require you to have us submit your progress notes for their review or may require you to grant permission for your psychotherapist to speak to their reviewer about your treatment. As out-of-network providers, this is not about controlling your treatment but may determine your reimbursement from the carrier. This is always your choice-such disclosures would only happen with your consent, following strict HIPAA privacy laws. While this is a rare situation, it is possible depending on your insurance carrier and policy.

As out-of-network providers, we share significantly less detailed information with insurance carriers compared to in-network providers, and always with your written permission.

Communication via HIPAA-Compliant Platforms:

All communication should occur through our HIPAA-compliant portals. Please avoid using email or text for communication with your therapist, as these methods are not secure.

Litigation Limitation:

Given the nature of therapy, you agree not to call on your therapist to testify in legal proceedings or to request psychotherapy notes.

Consultation:

Your therapist consults with other professionals but maintains your confidentiality. No identifying information is shared.

Telephone and Emergency Procedures:

Your therapist may not be immediately available by phone. In emergencies, contact emergency services or the crisis lines provided.

Payments and Insurance Reimbursement:

Payment is expected at the end of each session unless other arrangements are made. Insurance reimbursement is your responsibility. Understand that submitting claims may not always result in reimbursement and could affect future insurance eligibility.

Mediation and Arbitration:

Disputes will first be referred to mediation, then arbitration if necessary. Legal means may be used for overdue accounts.

The Process of Therapy/Evaluation:

Therapy involves effort and may cause discomfort as you work through issues. Results are not guaranteed. Your therapist will use various approaches to best meet your needs.

Discussion of Treatment Plan:

Your therapist will discuss your treatment plan, objectives, and potential outcomes with you. You have the right to ask questions or request information about other treatments.

Termination:

If your therapist believes they cannot help you, they will provide referrals. You may terminate therapy at any time but are encouraged to discuss your decision beforehand.

Dual Relationships:

Therapy never involves sexual or exploitative relationships. Dual relationships (e.g., knowing your therapist outside of therapy) will be discussed, and the therapist will address any discomfort or interference with treatment.

Cancellation:

Cancelling or rescheduling appointments requires 48 hours' notice. Missed sessions without notice will be charged in full.

Acknowledgment:

I have read and understood this Agreement and Office Policies and agree to the terms.

="caret-color:>

We understand that life can be unpredictable. However, because your appointment time is reserved just for you, we kindly ask that you provide at least 48 hours' notice if you need to reschedule or cancel. If you cancel or miss your appointment without providing 48 hours' notice, the full session fee will be charged to the credit card on file, and any deposit will not be refunded.

Group Therapy Cancellation Policy

Please note that the cancellation policy for group therapy differs. As a member of a group, you are responsible for the regular rate whether you attend or not. Your membership reserves a seat that cannot be filled in your absence, so it is not possible to cancel a group meeting without being responsible for the regular group rate.

Payment Disputes and Chargebacks

By signing this agreement, you agree not to dispute or initiate a chargeback with your credit card company for any fees charged in accordance with this cancellation policy. If you have any concerns about a charge, we encourage you to reach out to us directly so we can resolve the matter together. Our goal is always to find a solution that works for everyone.

By scheduling an appointment, you acknowledge that you have read, understand, and agree to this cancellation policy.

Consent to Participate in Telemental Health

I consent to participate in telemental health sessions with my therapist at Loving at Your Best Marriage and Couples Counseling as part of my psychotherapy. Telemental health involves the delivery of clinical care using technology to connect the practitioner and client in different locations.

Key Points of Understanding

Right to Withdraw:

I understand that I can withdraw my consent at any time without affecting my future care or benefits.

Risks and Benefits:

I acknowledge that telemental health has certain risks, including potential technology failures, breaches of confidentiality, and limitations in emergency response.

Confidentiality:

No online sessions will be recorded without mutual consent. All disclosed information and written records are confidential and protected by law, except where disclosure is legally required.

Privacy Laws:

The same privacy laws that protect my health information (PHI) apply to telemental health, with the exception of legal requirements such as mandatory reporting or threats to safety.

Appropriateness of Care:

If I experience suicidal or homicidal thoughts, psychotic symptoms, or a mental health crisis that cannot be resolved remotely, telemental health may be deemed inappropriate, and I will be recommended to seek a higher level of care.

Technical Difficulties:

If technical issues disrupt a session, I will attempt to reconnect. If reconnection is not possible within 10 minutes, I will contact my therapist at 646-699-4149 to reschedule.

Emergency Contact:

In an emergency, my therapist may need to contact my emergency contact or appropriate authorities.

Emergency Protocols

Location Information:

I agree to inform my therapist of my location at the start of each session in case of an emergency.

Emergency Contact Person:

I agree to provide and keep updated a contact person who may be reached in a life-threatening emergency. This person will only be contacted to go to my location or take me to the hospital if necessary.

Optional Treatment Enhancement

Digital Recording:

My therapist may request to use digital recordings during therapy sessions to enhance my treatment. These recordings may be reviewed in sessions to help identify behavior patterns and track progress. They may also be used for peer consultation, with my identity kept confidential.

Confidentiality and Ownership:

The recordings are the property of Loving at Your Best Marriage and Couples Counseling and will be stored securely on encrypted, HIPAA-compliant technology. They will be deleted when no longer needed. I may request a session to review the recordings as long as they are available.

Consent to Record:

I will always be asked for my consent before any recording, and I may decline. I may revoke my consent in writing at any time.

Acknowledgment

I have read and understand the information provided above. I have had the opportunity to discuss any questions with my therapist at Loving at Your Best Marriage and Couples Counseling, and all of my questions have been answered to my satisfaction.