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therapist may occasionally find it helpful to consult other health and
mental health professionals about a case. During a consultation, the
therapist makes every effort to avoid revealing the identity of a client.
The other professionals are also legally bound to keep the information
confidential. The therapist is required to note all consultations in your
Clinical Record.
You should be aware that we share a waiting room and an office lease
with other mental health professionals. All of the mental health
professionals are bound by the same rules of confidentiality. Each mental health professional maintains a private
practice wherein separate business accounts and files, separate phones,
faxes, e-mail accounts, and have no formal business affiliations beyond a
shared lease-arrangement.
Disclosures required by health insurers or to collect overdue fees are
discussed below.
If a client threatens to harm himself/herself, therapists may be
obligated to seek hospitalization for him/her, or to contact family members
or others who can help provide protectionThere
are some situations where therapists are permitted or required to disclose
information without either your consent or authorization:
• If you are involved in a
court proceeding and a request is made for information concerning your
diagnosis and treatment, such information is protected by the
psychologist-client privilege law. Therapists cannot provide any
information without your (or your legal representative’s) written
authorization, or a court order. If you are involved or contemplating
litigation, you should consult with your attorney to determine whether a
court would be likely to order a disclosure of information.
• If a government agency is
requesting the information for health oversight activities, therapists are
required to provide it for them (eg. coroner or
medical examiner, Veterans Affairs, Workers Compensation claims, national
security purposes).
• If a client files a complaint
or lawsuit against a therapist, the therapist may disclose relevant
information regarding that client in order to defend themselves.
There are some situations in
which therapists are legally obligated to take actions, which are necessary
to attempt to protect others from harm and may require the therapist to
reveal some information about a client’s treatment. These situations are
unusual in practice.
If the therapist has reasonable
cause to suspect that a child has suffered harm as a result of child abuse
or neglect, the law requires that the therapist file a report with the
appropriate governmental agency, usually the Alaska Department of Health
and Social Services. Once such a report is filed, the therapist may be
required to provide additional information.
If a therapist has reasonable
cause to believe that a vulnerable adult suffers from abandonment,
exploitation, abuse, neglect, or self-neglect; or that a disabled person
has been abused, the law requires that the therapist file a report with the
Alaska Department of Administration. Once such a report is filed, the
therapist may be required to provide additional information.
If a client communicates an
immediate threat of serious physical harm to an identifiable victim, the
therapist may be required to take protective actions. These actions may
include notifying the potential victim, contacting the police, or seeking
hospitalization for the client.
If such a situation arises, the
therapist will make every effort to fully discuss it with you before taking
any action and will try to limit the disclosure to what is necessary.
While this written summary of exceptions
to confidentiality should prove helpful in informing you about potential
problems, it is important that you discuss any questions or concerns that
you may have now or in the future with your therapist. The laws governing
confidentiality can be quite complex. In situations where specific advice
is required, formal legal advice may be needed.
PROFESSIONAL RECORDS
The laws and standards of the
psychological profession require that the therapist keep Protected Health
Information about you in your Clinical Record. With an appropriate written
request, you [your legal representative] have the right to examine and/or
receive a copy of your records. Because these are professional records,
they can be misinterpreted and/or upsetting to untrained readers.
Your Clinical Record usually
includes information about your reasons for seeking therapy, a description
of the ways in which your problem impacts on your life, your diagnosis, the
goals set for treatment, progress towards those goals, medical and social history,
treatment history, any past treatment records received from other
providers, reports of any professional consultations, your billing records,
and any reports that have been sent to anyone, including reports to your
insurance carrier.
In addition, the therapist
usually keeps a record of the contents of sessions. These notes vary from
session to session, and are utilized to jog the therapist’s memory and
retain important information. They also contain particularly sensitive
information that you may reveal to the therapist.
CLIENT RIGHTS
HIPAA provides you with several
rights with regard to your clinical record and disclosures of protected
health information. These rights include requesting that the
therapist amend your records; requesting restrictions on what information
from your clinical record is disclosed to others; requesting an accounting
of most disclosures of protected health information that you have neither
consented to nor authorized; determining the location to which protected
information disclosures are sent; having any complaints you make about
policies and procedures recorded in your records; and the right to a paper
copy of this Agreement (HIPAA Rules and Regulations). A therapist
will discuss any of these rights with you.
HIPAA provides
you with several rights with regard to your Clinical Record and disclosures
of protected health information. These rights include requesting that the
therapist amend your record; requesting restrictions on what information
from your Clinical Record is disclosed to others; requesting an accounting
of most disclosures of protected health information that you have neither
consented to nor authorized; determining the location to which protected
information disclosures are sent; having any complaints you make about
policies and procedures recorded in your records; and the right to a paper
copy of this Agreement, the attached Notice form, am happy to discuss any
of these rights with you.
MINORS AND PARENTS
Clients under 18 years of age
who are not emancipated and their parents should be aware that the law may
allow parents to examine their child’s treatment records unless the
therapist decides that such access is likely to injure the child, or the
parent and the therapist agree otherwise. Because privacy in psychotherapy
is often crucial to successful progress, particularly with teenagers, a
therapist may sometimes request an agreement from parents that they consent
to give up their access to their child’s records. If the parents agree to
such an arrangement during treatment, the therapist will provide them only
with general information about the progress of the child’s treatment, and
his/her attendance at scheduled sessions, and with a summary of their
child’s treatment when requested. Any other communication would
require the child’s Authorization unless the therapist feels that the child
is in danger or is a danger to someone else. In such instances,
the therapist would notify the parents of such concern.
BILLING AND PAYMENTS
You will be expected to pay for
each session at the time it is held.
Payment can be with Check, Cash, or Mastercard/Visa. If you have insurance coverage, I will be
willing to assist you in accessing your benefits. It is important that you are aware of
your benefits before scheduling an appointment. I do work with a number of insurance
companies and/or managed care companies, and are listed on their Preferred
Provider lists. However it important
to notify me if you plan to utilize these benefits.
Payment schedules for other
professional services (requested records, letters, court-related
documents) will be agreed to when they are requested. In circumstances of
unusual financial hardship, the therapist may be willing to negotiate a fee
adjustment or payment installment plan.
If your account has not been
paid for more than 90 days and arrangements for payment have not been
agreed upon, some therapists utilize the option of using legal means to
secure the payment. This may involve hiring a collection agency or going
through small claims court which will requires the therapist to disclose
otherwise confidential information. In most collection situations, the only
information released regarding a client’s treatment is his/her name, the
nature of services provided, and the amount due.
INSURANCE REIMBURSEMENT
In order to set realistic
treatment goals and priorities, it is important to evaluate what resources
you have available to pay for your treatment. If you have a health
insurance policy, it will usually provide some coverage for mental health
treatment. The therapist often provides you with assistance in helping you
receive the benefits to which you are entitled; however, you (not your
insurance company) are responsible for full payment of fees. It is very
important that you find out exactly what mental health services your
insurance policy covers.
You should carefully read the
section in your insurance coverage booklet that describes mental health
services. If you have questions about the coverage, call your plan
administrator.
Due to the rising costs of
health care, insurance benefits have increasingly become more complex. It
is sometimes difficult to determine exactly how much mental health coverage
is available. "Managed Health Care" plans such as HMOs and PPOs often require authorization before they provide
reimbursement for mental health services. These plans are often limited to
short-term treatment approaches designed to work out specific problems that
interfere with a person’s usual level of functioning. It may be necessary
to seek approval for more therapy after a certain number of sessions.
While much can be accomplished
in short-term therapy, some clients feel that they need more services after
insurance benefits end. Some managed-care plans will not allow the
therapist to provide services to you once your benefits end.
You should also be aware that
your contract with your health insurance company requires that the
therapist provide it with information relevant to the services provided to
you. Often this includes a clinical diagnosis. Sometimes the therapist is
required to provide additional clinical information such as treatment plans
or summaries, or copies of your entire Clinical Record. In such situations,
you may request the therapist supply only the minimum information about you
that is necessary for the purpose requested.
This information will become
part of the insurance company files and will probably be stored in a
computer. Though all insurance companies claim to keep such information
confidential, the therapist has no control over what they do with it once
it is in their hands. In some cases, they may share the information with a
national medical information databank. You always have the right to pay for
psychological services yourself to avoid the problems described above in
relationship to insurance companies.
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