Notice of Privacy Practices:
This notice describes how medical health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
This Notice was Updated 12/5/24
We are required by law to protect your health information and provide you with this Notice of our Privacy Practices.
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that provides privacy protections and patient rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations.
Your Protected Health Information. We refer to your mental, behavioral, medical and other health care information as “protected health information” or “PHI”. It may include information about your past, present or future physical or mental health or condition. PHI includes the past, present, or future payment for care. PHI information can be transmitted or maintained in any form or medium.
Confidentiality of Your PHI. Your PHI is confidential. We are required to maintain the confidentiality of your PHI by the following federal and Pennsylvania laws. Except as described in this Notice, it is our practice to obtain your authorization before we disclose your PHI to another person or party.
Notification of Data Breech. In the event your PHI is potentially affected by a data breach, we are required to notify you within 60 days of discovery.
Uses and Disclosures of Your PHI. HIPAA Privacy Regulations permit us to use and disclose your PHI for the following purposes in order to provide your treatment:
● For Treatment. It is necessary for us to use your PHI to care for you. In order to help you, our clinicians and staff need to use your PHI. This use includes the provision, coordination, or management of health care and related services by one or more health care providers. This includes consultation with other health care providers or the referral of a client from one provider to another.
● For Payment. We will use and disclose your PHI to obtain payment for our services. This includes any activities to obtain reimbursement for health care services that can include determination for eligibility or coverage, billing, claims management, collection activities, or utilization review.
● For Health Care Operations. We may use and disclose your PHI within the company to carry out our health care operations. For example, your PHI is used for: business management and general administrative duties; quality assessment and improvement activities; medical, legal, and accounting reviews; business planning and development; licensing and training. This information will then be used in an effort to improve the quality and effectiveness of the services we provide.
● Appointments and Services. We may contact you to provide appointment reminders, or information about treatment alternatives or other health related benefits that may be of interest to you. We will not sell your information or use it for marketing without your written permission.
● Family Members and Others Involved in Your Healthcare. Where a client is present and has the capacity to make health care decisions, health care providers may communicate with a client’s family members or other persons the client has involved in his or her health care or payment for care, so long as the client does not object. The PHI shared with your personal representative will be directly relevant to your personal representative’s involvement with your care or payment for services. For example, a family member is invited by the client and present in the treatment room with the client and healthcare provider when a disclosure is made, or a therapist may give information to a client’s spouse about warning signs that may signal a developing emergency. See 45 CFR 164.510(b).
● Uses and Disclosures of Your PHI Requiring Authorization. We may use or disclose PHI for purposes outside the reasons above when your appropriate authorization is abstained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances, we will obtain authorization from you before releasing this information. Please contact our office staff or your clinician to obtain a release of information form.
● Uses and Disclosure of Your PHI Not Requiring Consent or Authorization.
Exceptions to maintaining privacy occur under strictly limited circumstances. Under these circumstances, your PHI may be used or disclosed without your permission, consent, or authorization for the following purposes:
● To report abuse or neglect
● To avert serious threat to the health or safety of a person or the public
● In response to subpoenas and other requests to provide information for court or administrative proceedings
● In response to workers’ compensation claims
● Emergency situations based on professional judgment
Client Rights Regarding PHI. As a client you are entitled to client rights regarding your PHI as outlined below.
● Right to Request Restrictions. You have the right to request a limitation or a restriction on our use or disclosure of your PHI for treatment, payment or healthcare operations. You may also request that we limit the PHI we disclose to family members, friends or a personal representative who may be involved in your care. However, we are not required to agree to a restriction. If we agree to the requested restriction, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment. You may request a restriction by making your request in writing, including: (a) what PHI you want to limit; (b) whether you want us to limit our use, disclosure or both; and (c) to whom you want the limits to apply.
● Right to Request Confidential Communication. You have the right to request that confidential communications from us be sent to you in a certain way or at an alternative location. For example, you can ask that we only contact you at your home or by mail. We will accommodate reasonable requests. We may also condition this accommodation by asking you for specific information. Please make this request in writing specifying how or where you wish to be contacted.
● Right to Inspect and Copy. You have the right to inspect and obtain a copy of your PHI that is contained in our records and created by The Counseling Collective, LLC staff. However, you may not inspect or copy the following records: psychotherapy notes; or information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding. You may be denied access to your PHI if it was obtained from a person under a promise of confidentiality; or disclosure is likely to endanger the life and physical safety of you or another person. A decision to deny access may be reviewed. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other related costs.
● Right to Amend. If you believe the PHI that we have collected about you is incorrect, you have certain rights. If you are receiving mental health services, you have the right to submit a written statement qualifying or rebutting information in our records that you believe is erroneous or misleading. This statement will accompany any disclosure of your records. You also have the right under HIPAA Privacy Regulations to request an amendment to the PHI maintained in our records. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend PHI that: was not created by us (unless the person or entity that created the information is no longer available to make the amendment); the information is not part of the record kept by us; the PHI is not subject to inspection or copying; or the record is accurate and complete.
● Right to Receive an Accounting of Disclosures. You have the right to request an “accounting of disclosures”. This is a list of the disclosures we have made of PHI about you. We are not required to account for disclosures related to treatment, payment, or our health care operations; authorizations signed by you, or disclosures to you, to family members or your personal representative involved in your care, or for notification purposes.
● Right to a Paper Copy of this Notice. You have the right to receive a paper copy of this Notice upon request. To obtain a paper copy, contact our Security Officer at (717) 723-8040 or by email at Amanda@DiscoverCounselingCollective.com
GRIEVANCE PROCEDURES; RIGHT TO FILE A COMPLAINT
If you are not pleased with your care or feel your PHI was not kept confidential, you may officially file a grievance with us. Under The Counseling Collective, LLC grievance procedure, we will work with you to address your questions, concerns and complaints. HIPAA Privacy Regulations also entitle you to file a complaint with the U.S. Secretary of Health and Human Services. To file a complaint with us or learn more about the grievance process, you may contact our Security Officer via the contact information below. A complaint problem form will be provided to assist you. We will not retaliate against you for filing a complaint.
Security Officer: Amanda Ruiz MS LPC
Amanda@DiscoverCounselingCollective.com
1987 State Street, Suite 100, East Petersburg, PA 17520
Phone (717) 723-8040
Good Faith Estimate:
You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost. Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.
• You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
• If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1- 800-985-3059.