PRIVACY NOTICE

Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule; Effective March 01, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This notice describing legal duties and privacy practices regarding protected health information is required by law, and its details must be abided by unless revised. Any revision will be posted in the patient waiting area, and a copy will be made available by request. If revisions are made, they will apply to all protected health information maintained.

To abide by law, and in an attempt to protect patients’ health care information, Confidential Associates, LLC (CA) will use reasonable professional judgment in releasing only the minimum amount of protected health information necessary to carry out its business functions and provide services to its patients. By law, CA is permitted to release information in order to provide treatment, receive payment, and to carry out health care operations. For instance, CA may exchange names, social security numbers, dates of birth, other identifying data, and diagnoses with your insurance carrier to determine benefits or claims status. Another example might be coordinating treatment with other clinicians, social workers, guardians, and the like.

Circumstances may necessitate telephone calls or bills being initiated for setting/confirming appointments, and receiving outstanding payment. Additionally, it is necessary for accountants and clerical staff to have information similar to that given to insurance companies; however, they are not permitted to view actual psychotherapy notes. It is important for you to understand that we cannot guarantee confidentiality when you use your insurance benefits. Insurance companies do not have the same limitations on confidentiality as professional therapists. Should you pursue third party (insurance, family, agencies, etc.) payment, your therapeutic diagnoses, attendance, and treatment concerns may become unprotected and a source of unwanted disclosure, and may include disclosure to the plan’s sponsor, such as your employer.

The “minimum amount”, explained above, does not apply to compliance of HIPAA “Administrative Simplification Rules”, patient-authorized disclosures, if the patient initiates legal action against CA, Department of Health and Human Services (HHS) disclosures if they so require it under the Privacy Rule for enforcement purposes, or disclosures required by other law.

Other disclosures may be prompted by communication regarding a minor child being the victim or subject of a crime or at risk of victimization, or in response to a subpoena from a court, or the Department of Licensing Director. Other uses or disclosures may only be made with your written authorization. Written revocation of further authorized use and disclosure may be made at any time.

You have the right to inspect, copy, obtain a paper copy, request amendments and restrictions on uses and disclosures of your protected health information, receive an accounting of disclosures, and to receive confidential communications of that information. Although CA generally wants to cooperate with patients, CA is not obligated to agree to requested restrictions. CA accommodates reasonable requests to make communications confidential, such as calling or writing alternative locations.

If you believe your privacy rights have been violated, you may file a complaint with the United States Department of Health and Human Services Secretary or with CA by writing an explanation of what information was wrongly disclosed to whom, and requesting that the information be delivered to the CA Privacy & Security Officer. There will be no retribution for filing privacy complaints. For further information, you may contact the CA Privacy & Security Officer at the CA telephone number at the top of this notice.