Child Abuse

Child abuse and/or neglect, which include but are not limited to domestic violence in the presence of a child, child on child sexual acting out/abuse, physical abuse, etc. If you reveal information about child abuse or child neglect, the therapist is required by law to report this to the appropriate authority.

Vulnerable Adult Abuse

Vulnerable adult abuse or neglect. If information is revealed aboutvulnerable adult or elder abuse, the therapist is required by law to report this to the appropriateauthority.

Privacy and Confidentiality

Anything said in therapy is confidential and may not be revealedto a third party without written authorization, except for the following limitations:

Policies - Insurance & Confidentiality

Privacy and HIPAA

Foggy Morning Therapy strives at all times to maintain the highest degree of integrity in its interactions with patients and the delivery of quality health care. We will always strive to maintain compliance with all applicable laws, rules, regulations, and requirements related to the practice of medicine and the handling of patient information, including HIPAA regulations. The protection of an individual's health information privacy and the security of their electronic protected health information ("ePHI") are critical concerns to this Practice and the trust our patients place in our treatment of their medical issues. The HIPAA Privacy Regulations require healthcare providers to furnish patients with a written notice of their policies and procedures regarding the use and disclosure of protected health information. This Notice of Privacy Practices is the starting point under HIPAA. It describes how the Practice will handle confidential patient information in accordance with HIPAA regulations. A copy of the HIPAA regulations and privacy policy will be provided to you upon request.

Insurance and Good Faith Estimate

Insurance Reimbursements & Super Bills

We can provide you with an invoice including billing codes that you may choose to submit to your insurance company if they offer reimbursement for out-of-network providers. If you plan to seek reimbursement from your insurance company, we recommend checking reimbursement rates, deductibles, and other policies prior to starting treatment.

No Surprises Act and Good Faith Estimate

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

Under the law, healthcare providers need to give patients 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.
Make sure your healthcare provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or 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 questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call (800) 368-1019

Self-Harm

Threats, plans or attempts to harm or kill oneself. Therapist is permitted to take steps toprotect the client’s safety, which may include disclosure of confidential information.

Harm to Others

Threats regarding harm to another person. If you threaten bodily harm ordeath to another person, the therapist is required by law to report this to the appropriate authority.

Court Order & Legal Subpoenas

If the therapist receives a subpoena for your records, they will contact you so you may take whatever steps you deem necessary to prevent the release of your confidential information. Therapist will contact you twice by phone. If the therapist cannot get in touch with you by phone, they will send you written correspondence. If a court of law issues a legitimate court order, the therapist is required by law to provide the information specifically described in the order.

Despite any attempts to contact you and keep your records confidential, the therapist is required to comply with a court order.

Law Enforcement

A public health authority that is authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability; to a health oversight agency for oversight activities authorized by law, including audits; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or action; limited information (such as name, address, DOB, dates of treatment, etc.) to a law enforcement official for the purpose of identifying or locating a suspect, fugitive, material witness, or missing person; and information that your clinician believes in good faith establishes that a crime has been committed on the premises.

Government Oversight

receipt of health care, claim for public benefits related to mental health, or qualification for, or receipt of, public benefits or services when your mental health is integral to the claim for benefits or services, or for specialized government functions such as fitness for military duties, eligibility for VA benefits, and national security and intelligence.

Despite any attempts to contact you and keep your records confidential, the therapist is required to comply with a court order.

Upon Your Death

To a law enforcement official for the purpose of alerting of your death if there is a suspicion that such death may have resulted from criminal conduct, to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other duties as authorized by law.

Victim of a Crime

Limited information, in response to a law enforcement officials request for information about you if you are suspected to be a victim of a crime; however, except in limited circumstances, we will attempt to get your permission to release information first.

Court Ordered Therapy

At this time, the therapist will not see any clients who are court ordered for therapy. As mentioned above, rarely, but on occasion, a court will order a therapist to testify, be deposed, or appear in court for a matter relating to your treatment or case. To protect your confidentiality, the therapist strongly suggests not being involved in the court. If the therapist gets called into court by you or your attorney, you will be charged a fee of $500 per hour to include travel time, court time, preparing documents, etc.

Written Request

Clients must sign a release of information form before any information may be sent to a third party. A summary of visits may be given in lieu of actual “psychotherapy/progress notes”, except if the third party is part of the medical team. If therapy sessions involve more than one person, each person over the age of 18 MUST sign the release of information before information is released.

Fee Dispute

In the case of a credit card dispute, the therapist reserves the right to provide the necessary documentation (i.e. your signature on the “Therapy Consent and Agreement”) that covers the cancellation policy to your bank or credit card company should a dispute of a charge occur. If there is a financial balance on account, a bill will be sent to the home address on the intake form unless otherwise noted.