Privacy Policy

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY. 

Your health record contains personal information about you and your health.  This information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law, including the Health Insurance Portability and Accountability Act (“HIPAA”), regulations promulgated under HIPAA including the HIPAA Privacy and Security Rules, and the APA Code of Ethics.  It also describes your rights regarding how you may gain access to and control your PHI.

We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices.  We reserve the right to change the terms of our Notice of Privacy Practices at any time.  Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on our website, sending a copy to you in the mail upon request or providing one to you at your next appointment.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT THE PATIENT

For Treatment.  Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with clinical supervisors or other treatment team members.  We may disclose PHI to any other consultant only with your authorization.

For Payment.  We may use and disclose PHI so that we can receive payment for the treatment services provided to you.  This will only be done with your authorization. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities.  If it becomes necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purposes of collection. 

Required by Law.  Under the law, we must disclose your PHI to you upon your request.  In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.

Without Authorization.  Following is a list of the categories of uses and disclosures permitted by HIPAA without an authorization.  Applicable law and ethical standards permit us to disclose information about you without your authorization only in a limited number of situations. 

As an unlicensed psychotherapist in this state providing mental health services, it is our practice to adhere to more stringent privacy requirements for disclosures without an authorization.  The following language addresses these categories to the extent consistent with the APA Code of Ethics and HIPAA.

Child Abuse or Neglect. We may disclose your PHI to a state or local agency that is authorized by law to receive reports of child abuse or neglect. 

Judicial and Administrative Proceedings. We may disclose your PHI pursuant to a subpoena (with your written consent), court order, administrative order or similar process.

Deceased Patients.  We may disclose PHI regarding deceased patients as mandated by state law, or to a family member or friend that was involved in your care or payment for care prior to death, based on your prior consent. A release of information regarding deceased patients may be limited to an executor or administrator of a deceased person’s estate or the person identified as next-of-kin.  PHI of persons that have been deceased for more than fifty (50) years is not protected under HIPAA.

Medical Emergencies.  We may use or disclose your PHI in a medical emergency situation to medical personnel only in order to prevent serious harm. Our staff will try to provide you a copy of this notice as soon as reasonably practicable after the resolution of the emergency.

Family Involvement in Care. We may disclose information to close family members or friends directly involved in your treatment based on your consent or as necessary to prevent serious harm.

Health Oversight.  If required, we may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance to the program (such as third-party payors based on your prior consent) and peer review organizations performing utilization and quality control.

Law Enforcement. We may disclose PHI to a law enforcement official as required by law, in compliance with a subpoena (with your written consent), court order, administrative order or similar document, for the purpose of identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, in connection with the reporting of a crime in an emergency, or in connection with a crime on the premises.

Specialized Government Functions.  We may review requests from U.S. military command authorities if you have served as a member of the armed forces, authorized officials for national security and intelligence reasons and to the Department of State for medical suitability determinations, and disclose your PHI based on your written consent, mandatory disclosure laws and the need to prevent serious harm.

Public Health.  If required, we may use or disclose your PHI for mandatory public health activities to a public health authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, or if directed by a public health authority, to a government agency that is collaborating with that public health authority.

Public Safety. We may disclose your PHI if necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.  If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.

Research.   PHI may only be disclosed after a special approval process or with your authorization.

Verbal Permission. We may also use or disclose your information to family members that are directly involved in your treatment with your verbal permission.

With Authorization.   Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked at any time, except to the extent that we have already made a use or disclosure based upon your authorization.  The following uses and disclosures will be made only with your written authorization: (i) most uses and disclosures of psychotherapy notes which are separated from the rest of your medical records or (ii) other uses and disclosures not described in this Notice of Privacy Practices.

YOUR RIGHTS REGARDING YOUR PHI

You have the following rights regarding PHI we maintain about you. 

•        Right of Access to Inspect and Copy.  You have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that is maintained in a “designated record set”. A designated record set contains mental health/medical and billing records and any other records that are used to make decisions about your care.  Your right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you or if the information is contained in separately maintained psychotherapy notes.  We may charge a reasonable, cost-based fee for copies. If your records are maintained electronically, you may also request an electronic copy of your PHI.  You may also request that a copy of your PHI be provided to another person.

•        Right to Amend.  If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information although we are not required to agree to the amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy.

•        Right to an Accounting of Disclosures.  You have the right to request an accounting of certain of the disclosures that we make of your PHI.  We may charge you a reasonable fee if you request more than one accounting in any 12-month period.

•        Breach Notification. If there is a breach of unsecured PHI concerning you, we may be required to notify you of this breach, including what happened and what you can do to protect yourself.

•        Right to a Copy of this Notice.  You have the right to a copy of this notice.

COMPLAINTS

If you believe we have violated your privacy rights, you have the right to file a complaint in writing with the Colorado Department of Regulatory Agencies Division of Professions and Occupations at 1560 Broadway, Suite 1350, Denver, CO 8020.  We will not retaliate against you for filing a complaint. 

No Surprise Act

YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS

(OMB Control Number: 0938-1401)

The purpose of this document is to let you know about your protections under federal and state law from unexpected medical bills.

IMPORTANT: You can choose to get care from a provider or facility in your health plan’s network, which may cost you less than if you get care from a provider or facility that is out-of-network. You should never be required to sign a form giving up your rights and protections against surprise billing or balance billing.

If you’d like assistance with this document, ask your provider or a patient advocate. Take a picture and/or keep a copy of this form for your records.

You are getting this notice to inform you of your rights if your provider or facility isn’t in your health plan’s network, which means the provider or facility doesn’t have an agreement with your plan.

*If your provider is in your health plan’s network, this form does not apply to you, but this information is important for you to understand.

Balance billing: When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill to see a provider or visit a health care facility that isn’t in your health plan’s network. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay, and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

Surprise billing: “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care, such as if you have an emergency or if you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing and surprise billing for:

Emergency services: If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments or coinsurance). You cannot be balance-billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balance-billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center: When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. The most these providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance-bill you and may not ask you to give up your protections not to be balance-billed.

If you get other services at these in-network facilities, out-of-network providers cannot balance-bill you unless you give written consent and give up your protections under the law.

You are never required to give up your protection from balance-billing. You also are not required to get out-of-network care. You can choose a provider or facility in your plan’s network.

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As of January 1, 2020, Colorado law prohibits out-of-network providers from sending balance bills to consumers if the provider provides emergency services or covered nonemergency services to a covered person at an in-network facility (C.R.S. 12-30-113)

When balance billing isn’t allowed, you also have the following protections:

1. You are only responsible for paying your share of the cost (copayments, coinsurance, and/or deductibles you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

2. Your health plan generally must:

a. Cover emergency services without requiring you to get approval for services in advance,

b. Cover emergency services by out-of-network providers,

c. Base what you owe the provider or facility on what it would pay an in-network provider or facility and show that amount in your explanation of benefits,

d. Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you have been wrongly billed, you may contact:

Colorado Department of Regulatory Agencies, Division of Insurance

https://doi.colorado.gov/for-consumers/file-a-complaint

Department of Health and Human Services - No Surprises Act

https://www.cms.gov/nosurprises/consumers

For more information about your rights under federal law, visit https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf

For more information about your rights under Colorado state law, visit https://doi.colorado.cov/insurance-products/health-insurance/health-insurance-initiatives/out-of-network-health-care