HIPAA NOTICE OF PRIVACY PRACTICES

NOTICE OF HIPAA PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, HOW YOU CAN GET ACCESS TO THIS INFORMATION, YOUR RIGHTS CONCERNING YOUR HEALTH INFORMATION AND OUR RESPONSIBILITIES TO PROTECT YOUR HEALTH INFORMATION. PLEASE REVIEW IT CAREFULLY.

Mending Hearts LLC (the “Practice”) is committed to protecting your privacy. The Practice is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. The Practice is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains the Practice's legal duties and privacy practices and your rights regarding PHI that we collect and maintain.


YOUR RIGHTS

Your rights regarding PHI are explained below. To exercise these rights, please submit a written request to the Practice at the address noted below.


To inspect and copy PHI.

You can ask for an electronic or paper copy of PHI. The Practice may charge you a reasonable fee. The Practice may deny your request if it believes the disclosure will endanger your life or another person's life. You may have a right to have this decision reviewed.


To amend PHI.

You can ask to correct PHI you believe is incorrect or incomplete. The Practice may require you to make your request in writing and provide a reason for the request. The Practice may deny your request. The Practice will send a written explanation for the denial and allow you to submit a written statement of disagreement.


To request confidential communications.

You can ask the Practice to contact you in a specific way. The Practice will say “yes” to all reasonable requests.

To limit what is used or shared. You can ask the Practice not to use or share PHI for treatment, payment, or business operations.


The Practice is not required to agree if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask the Practice not to share PHI with your health insurer. You can ask for the Practice not to share your PHI with family members or friends by stating the specific restriction requested and to whom you want the restriction to apply.


To obtain a list of those with whom your PHI has been shared. You can ask for a list, called an accounting, of the times your health information has been shared. You can receive one accounting every 12 months at no charge, but you may be charged a reasonable fee if you ask for one more frequently.


To receive a copy of this Notice.

You can ask for a paper copy of this Notice, even if you agreed to receive the Notice electronically.

To choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights.


To file a complaint if you feel your rights are violated.

You can file a complaint by contacting the Practice using the following information:

email: jennifer@mending-hearts.com or by mail at:


Mending Hearts LLC

8620 North New Braunfels Ave. Suite # 538

San Antonio, Texas 78217


You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.


The Practice will not retaliate against you for filing a complaint. To opt out of receiving fundraising communications. The Practice may contact you for fundraising efforts, but you can ask not to be contacted again.


OUR USES AND DISCLOSURES


1. Routine Uses and Disclosures of PHI

The Practice is permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The Practice typically uses or shares your health information in the following ways:


To treat you.

The Practice can use and share PHI with other professionals who are treating you.

Example: Your primary care doctor asks about your mental health treatment.


To run the health care operations.

The Practice can use and share PHI to run the business, improve your care, and contact you.

Example: The Practice uses PHI to send you appointment reminders if you choose.


To bill for your services.

The Practice can use and share PHI to bill and get payment from health plans or other entities.

Example: The Practice gives PHI to your health insurance plan so it will pay for your services.


2. Uses and Disclosures of PHI

That May Be Made Without Your Authorization or Opportunity to Object

The Practice may use or disclose PHI without your authorization or an opportunity for you to object, including:


To help with public health and safety issues

Public health: To prevent the spread of disease, assist in product recalls, and report adverse reactions to medication.

Required by the Secretary of Health and Human Services: We may be required to disclose your PHI to the Secretary of Health and Human Services to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.


Health oversight: For audits, investigations, and inspections by government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.


Serious threat to health or safety:

To prevent a serious and imminent threat.


Abuse or Neglect:

To report abuse, neglect, or domestic violence.


To comply with law, law enforcement, or other government requests

Required by law: If required by federal, state or local law.


Judicial and administrative proceedings:

To respond to a court order, subpoena, or discovery request.


Law enforcement:

For law locate and identify you or disclose information about a victim of a crime.


Specialized Government Functions:

For military or national security concerns, including intelligence, protective services for heads of state, or your security clearance.


National security and intelligence activities:

For intelligence, counterintelligence, protection of the President, other authorized persons or foreign heads of state, for purpose of determining your own security clearance and other national security activities authorized by law.


Workers' Compensation:

To comply with workers' compensation laws or support claims.


To comply with other requests

• Coroners and Funeral Directors: To perform their legally authorized duties.

• Organ Donation: For organ donation or transplantation.

• Research: For research that has been approved by an institutional review board.

• Inmates: The Practice created or received your PHI in the course of providing care.

• Business Associates: To organizations that perform functions, activities or services on our behalf.


3. Uses and Disclosures of PHI

That May Be Made With Your Authorization or Opportunity to Object

Unless you object, the Practice may disclose PHI:

To your family, friends, or others if PHI directly relates to that person's involvement in your care.

If it is in your best interest because you are unable to state your preference.


4. Uses and Disclosures of PHI Based Upon Your Written Authorization

The Practice must obtain your written authorization to use and/or disclose PHI for the following purposes:

Marketing, sale of PHI, and psychotherapy notes. You may revoke your authorization, at any time, by contacting the Practice in writing, using the information above. The Practice will not use or share PHI other than as described in Notice unless you give your permission in writing.

Payment: We may use and disclose your health information to seek payment for services we provide to you. This disclosure involves our business office staff and may include insurance organizations, collections or other third parties that may be responsible for such costs, such as family members.

Disclosure: We may disclose and/or share protected health information (PHI) including electronic disclosure with other health care professionals who provide treatment and/or service to you. These professionals will have a privacy and confidentiality policy like this one. Health information about you may also be disclosed to your family, friends and/or other persons you choose to involve in your care, only if you agree that we may do so.

As of March 26, 2013 immunization records for students may be released without an authorization (as long as the PHI disclosed is limited to proof of immunization). If an individual is deceased you may disclose PHI to a family member or individual involved in care or payment prior to death. Psychotherapy notes will not be used or disclosed without your written authorization. Genetic Information Nondiscrimination Act (GINA) prohibits health plans from using or disclosing genetic information for underwriting purposes. Uses and disclosures not described in this notice will be made only with your signed authorization.

Accounting of Disclosures: You have the right to request an “accounting of disclosures” of your protected information if the disclosure was made for purposes other than providing services, payment, and or business operations. In light of the increasing use of Electronic Medical Record technology (EMR), the HITECH Act allows you the right to request a copy of your health information in electronic form if we store your information electronically.

Disclosures can be made available for a period of 6 years prior to your request and for electronic health information 3 years prior to the date on which the accounting is requested. If for some reason we aren’t capable of an electronic format, a readable hardcopy will be provided. To request this list or accounting of disclosures, you must submit your request in writing to our Privacy Officer. Lists, if requested, will be $0.25 for each page and the staff time charged will be $35.00 per hour including the time required to locate and copy your health information.

Please contact our Privacy Officer for an explanation of our fee structure. May 23, 2016 OCR clarified a flat fee for electronic copies may not exceed $6.50 (including labor for copies, supplies and postage); this does not mean that the ceiling for all requests for access is $6.50. Right to Request Restriction of PHI: If you pay in full out of pocket for your treatment, you can instruct us not to share information about your treatment with your health plan; if the request is not required by law. Effective March 26, 2013, The Omnibus Rule restricts provider’s refusal of an individual’s request not to disclose PHI.

Non-routine Disclosures: You have the right to receive a list of non-routine disclosures we have made of your health care information. You can request non-routine disclosures going back 6 years starting on April 14, 2003. Emergencies: We may use or disclose your health information to notify, or assist in the notification of a family member or anyone responsible for your care, in case of any emergency involving your care, your location, your general condition or death.

If at all possible we will provide you with an opportunity to object to this use or disclosure. Under emergency conditions or if you are incapacitated we will use our professional judgment to disclose only that information directly relevant to your care. We will also use our professional judgment to make reasonable inferences of your best interest by allowing someone to pick up filled prescriptions, x-rays or other similar forms of health information and/or supplies unless you have advised us otherwise.

Healthcare Operations: We will use and disclose your health information to keep our practice operable. Examples of personnel who may have access to this information include, but are not limited to, our medical records staff, insurance operations, health care clearinghouses and individuals performing similar activities. Including the disclosure of your PHI in the event of transfer, merger, or sale of the existing practice to a new provider.

Required by Law: We may use or disclose your health information when we are required to do so by law. (Court or administrative orders, subpoena, discovery request or other lawful process.) We will use and disclose your information when requested by national security, intelligence and other State and Federal officials and/or if you are an inmate or otherwise under the custody of law enforcement. National Security: The health information of Armed Forces personnel may be disclosed to military authorities under certain circumstances. If the information is required for lawful intelligence, counterintelligence or other national security activities, we may disclose it to authorized federal officials.

Access: Upon written request, you have the right to inspect and get copies of your health information (and that of an individual for whom you are a legal guardian.) We will provide access to health information in a form format requested by you. There will be some limited exceptions. If you wish to examine your health information, you will need to complete and submit an appropriate request form. Contact our Privacy Officer for a copy of the request form. You may also request access by sending us a letter to the address at the end of this Notice. Once approved, an appointment can be made to review your records. Copies, if requested, will be $0.25 for each page and the staff time charged will be $35.00 per hour including the time required to copy your health information. If you want the copies mailed to you, postage will also be charged. Access to your health information in electronic form if (readily producible) may be obtained with your request. If for some reason we aren’t capable of an electronic format, a readable hard-copies will be provided. If you prefer a summary or an explanation of your health information, we will provide it for a fee. Please contact our Privacy Officer for an explanation of our fee structure. May 23, 2016 OCR clarified a flat fee for electronic copies may not exceed $6.50 (including labor for copies, supplies and postage); this does not mean that the ceiling for all requests for access is $6.50.

Amendment: You have the right to amend your healthcare information, if you feel it is inaccurate or incomplete. Your request must be in writing and must include an explanation of why the information should be amended. Under certain circumstances, your request may be denied. Breach Notification Requirements: It is presumed that any acquisition, access, use or disclosure of PHI not permitted under HIPAA regulations is a breach. We are required to complete a risk assessment, and if necessary, inform HHS and take any other steps required by law. You will be notified of the situation and any steps you should take to protect yourself against harm due to the breach.


Appointment Reminders: We may use your health records to remind you of recommended services, treatment or scheduled appointments.


Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. This information will be disclosed only to the extent necessary to prevent a serious threat to your health or safety or that of others.


Public Health Responsibilities:

We will disclose your health care information to report problems with products, reactions to medications, product recalls, disease/infection exposure and to prevent and control disease, injury and/or disability. Marketing Health-Related Services: We will not use your health information for marketing purposes.

OUR RESPONSIBILITIES

  1. The Practice is required by law to maintain the privacy and security of PHI.

  2. The Practice is required to abide by the terms of this Notice currently in effect. Where more stringent state or federal law governs PHI, the Practice will abide by the more stringent law.

  3. The Practice reserves the right to amend Notice. All changes are applicable to PHI collected and maintained by the Practice. Should the Practice make changes, you may obtain a revised Notice by requesting a copy from the Practice, using the information above, or by viewing a copy on the website www.jenniferlhillier.com/HIPAA.

  4. The Practice will inform you if PHI is compromised in a breach.

QUESTIONS AND COMPLAINTS

You have the right to file a complaint with us if you feel we have not complied with our Privacy Policies. Your complaint should be directed to our Privacy Officer Jennifer L. Hillier CEO of Mending Hearts LLC by phone at (210) 895-4315. If you feel we may have violated your privacy rights, or if you disagree with a decision we made regarding your access to your health information, you can complain to us in writing. Request a Complaint Form from our Privacy Officer. We support your right to the privacy of your information and will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

This Notice is effective on 1/1/2022.

Contacting Jennifer L. Hillier

Counselor: Jennifer L. Hillier M.A. LPC & CCTP1

Practice Location: North New Braunfels Ave. Suite 538,

San Antonio, Texas 78217

Phone: 210-895-4315 Fax: 210-899-1415

Hours of operations are Monday through Friday from 8:00 AM–5:00 PM. Our voices mails are not monitored. If you are experiencing a crisis, please call 911. Counselor Jennifer L. Hillier does not provide medical emergencies. Your call is very important. If you are unable to reach me by phone please leave me an email or text message with the following information: Your first and last name. Contact Information, Email address, and Reason for calling

Health Insurance & Medicaid Benefits Accepted

In Network Health Insurance Provider Accepted: Ambetter, Ameri-group, BCBS, Beacon, Health Smart, Humana Military, OPTUM Health, Molina, Multi-plan, Superior Health Plan, Texas Medicaid, United Health Care.

EAP: BHS Accepted

PLEASE CONTACT US TO ENSURE WE ACCEPT YOUR INSURNACE BENEFITS; AS THIS IS SUBJECT TO CHANGE WITHOUT NOTICE!

How to Utilize Your Out of Network Benefits

Guide to Understanding Your Out of Network Health Insurance Benefits

ONN “out-of-network benefits” or coverage means that if you want to see a provider that is not in your insurance company’s network, your insurance may provide partial or total coverage. Each health insurance plan is different, the best way to determine if you have out-of-network benefits is to call and speak with a benefits representative at your insurance company directly. The representative you speak with should be able to explain the details of your plan, as well as provide you with necessary instructions to use your benefits. I encourage you to have something to write with to document the date, representative’s name with ID number, and call confirmation number. This will also be helpful in case we need to appeal or challenge a claim. Sometimes there are different providers for behavioral health and medical care existing under one insurance plan who may oversee your mental health benefits. Please keep in mind that you may have to call to confirm the which provider manage your behavioral health benefits if your insurance card does not show it. You will find contact information needed on the back of your insurance card.

REQUESTING INFORMATION ABOUT YOUR COVERAGE.

Ask the benefit’s representative to explain what your out-of-network benefits are. Is there a deductible, or is there an annual visit maximum amount? Ask the representative to confirm the requirements to use out-of-network benefits. For example, they may insist you pay the full fee out-of-pocket, and then submit a completed Health Insurance Claim Form (Superbill). In this case, you would receive the reimbursement check directly. It is also important to confirm the processing time once a claim form or invoice is submitted, so you can plan accordingly. If your plan is a HMO (Health Maintenance Organization) they may have more in-depth requirements to go outside of the network, and want to pay me directly. Again, each plan is different. Take detailed notes, do not hesitate to ask clarifying questions, and feel free to contact me for any help along the way. Once you understand your benefit options and how to use them, please email me all the requirements at jennifer@mending-hearts.com.

Private Pay

Thinking of starting counseling but in need to of complete anonymity due to your identity or professionalism?

Online counseling can provide the privacy and confidentiality you are looking for. For some individual, their social status in the family, community, and career may requires anonymity to maintain the status quo, avoid stigmatization, personal reasons, preserve reputations, and/or for clearance qualifications needed to maintain employment.

The Benefits of Utilizing Private Pay for Counseling:

Provides the highest standard of privacy and confidentiality for individual needing anonymity. Ability to select the professional who is best suited for you and your family needs. Eliminates requirements to share your personal health information with a third party. There are no set limitations on the number of visits you can schedule with your counselor. Choose the focus, length, and frequency of therapy. Most importantly, there is no mandatory requirement for mental health diagnosis. While insurance can be an affordable option, high deductible can make it unaffordable. Private pay may be more cost effective.

Counseling Session Rate:

Individual Intake Assessment (50 minutes) $180.00

Individual Counseling Session (50 minutes) $150.00

Couple Intake Assessment (50 minutes) $230 .00

Couple Counseling Session (50 minutes) $200.00

Cancellation and Refunds

APPOINTMENT CANCELLATION POLICY:

A minimum 48 hour notice for cancellation is required. Mending-hearts reserve the right to charge you the full session rate if you have given us less than 48 hours notice. I understand that sometimes cancelling a session is unavoidable. Please contact us to explain the situation. Mending-hearts is not inclined to charge you for missing a session, as long as, you have tried to contact us, as soon as possible. I ask you to give us as much notice as possible in order for us to allocate the session to someone else. If I am unable to allocate the session, you will be charged the full session rate.

REFUND POLICY:

All appointment cancelled 48 hours before appointment will be fully refunded. Please allow 7 business days to process your request. There are circumstances in which it is not possible to give a 48 hour notice. In certain events. We have the options at our discretion to reschedule your appointment at a later time if you were not able to cancel your appointment within the 48 hour window. This option is typically for emergency only with verified documentation.

Appointment Availability

Counseling and Therapy Services provides online counseling and therapy services for all residents in Texas. Appointment are available Monday - Friday from 8:00 am to 4:00 pm. Limited evenings appointments are available from 5:00 to 7:00 pm. Weekend Saturday and Sunday appointment are available.


Accepting New Clients: Yes, we are currently accepting new client ages 12 years old and up.

Online Counseling (Telehealth): Currently only seeing client online for counseling services.

Face to Face: Currently at this time we are not seeing clients face to face

In-home Counseling: Currently at this time we are not seeing client in their home.