Office Policies and Procedures

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.

East Coast Mental Wellness is committed to client confidentiality. Personal Health Information(PHI) is kept confidential and not shared without your written consent. However, there are circumstances when mental health professionals are required by law to disclose PHI without your consent. In such situations, your clinician is not required to inform you of their actions. Please note the following include some but not all, exceptions to confidentiality.

 

• Confidentiality does not apply when there is knowledge of potential harm to oneself or others. Your clinician may need to contact a family member, emergency rescue or law enforcement to ensure your safety and/ or the safety of others.
• Confidentiality does not apply when there is knowledge of suspected abuse/neglect of children or the elderly.
• Confidentiality does not apply to cases involving criminal proceedings, except communications by a person voluntarily involved in a substance abuse program.
• A mental health professional may disclose confidential information in proceedings brought about by a client against said professional
• Confidentiality may not apply in cases involving legal proceedings involving the parent-child relations- hip.
  

East Coast Mental Wellness will make every effort to keep your PHI as private as possible and only disclose what is necessary for the above situations.

Insurance and managed care companies require PHI including diagnosis, symptoms, treatment goals, prognosis, evaluation of progress, and other information before reimbursement is considered. Such companies may also maintain the right to have a copy of your records. Your written authorization will be obtained at the onset of treatment.

In order to provide outstanding care, it is often necessary to communicate with your other providers who can help complete your medical history. Gathering information from selected sources including family, significant other may provide the most accurate assessment of your current needs. East Coast Mental Wellness will obtain your permission before contacting anyone outside the office, with exceptions to the circumstances listed above when confidentiality does not apply.

 

The office staff at East Coast Mental Wellness may also have access to your PHI for the purposes of scheduling, mai- ntaining medical records, taking messages, and when communicating with insurance companies for prior authorization and claims reimbursement. All staff is required to sign a nondisclosure agreement and training prior to working with PHI to ensure that your information is handled appropriately and is kept confidential.

 

Breach Notification:

East Coast Mental Wellness is required by law to notify you if a breach occurs that may have compromised the privacy or security of your protected health information.

 

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Right to Restrict Disclosure to Insurance (Self-Pay Services):

If you pay in full for a service out-of-pocket, you have the right to request that information related to that service not be disclosed to your health plan. East Coast Mental Wellness is required to honor this request unless disclosure is otherwise required by law.

 

You have the right to file a complaint if you believe your privacy rights have been violated. Complaints may be filed with the U.S. Department of Health & Human Services, Office for Civil Rights. Filing a complaint will not affect your care.

Website: www.hhs.gov/ocr/privacy/hipaa/complaints/

 

Uses and disclosures requiring your authorization.

Generally, all uses and disclosures other than those listed above will be made only with your written authorization. You may revoke your authorization by submitting a written notice to our intake department at intake@eastcoastmentalwellness.com or via mail to the address below. Your revocation will be effective as of the date of receipt of our written notice.

 

Your health information rights.

You have the right to:

• Request a restriction of certain uses and disclosures of your information. Please specify the restriction requested and to whom you want the restriction to apply. East Coast Mental Wellness is not required to agree to the requested restriction;
• Obtain a paper copy of this Notice of Privacy Practices upon request;
• Inspect and obtain a copy of your health record as long as we maintain it;
• Amend your health record, depending upon the circumstances (see: Requesting medical records)
• Request communications of your PHI by alternative means or at alternative locations;
• Revoke your authorization to use or disclose PHI except to the extent that action has already been taken;
• Receive an accounting of disclosures made of your PHI not related to payment, treatment or operations.

Obligations of East Coast Mental Wellness.

• East Coast Mental Wellness is required to:
• Maintain the privacy of your PHI;
• Provide you with this notice and its legal duties and privacy practices with respect to your PHI;
• Abide by the terms of this notice;
• Notify you if we are unable to agree to a requested restriction on how your information is used or disclosed;
• Accommodate reasonable requests to communicate PHI by alternative means or to alternative locations;
• Obtain your written authorization to use or disclose your PHI for reasons other than those listed above and permitted under law.

East Coast Mental Wellness reserves the right to change its information practices and to make the new provisions effective for all protected PHI it maintains. Revised notices will be made available to individuals covered by East Coast Mental Wellness within 60 days of a material revision.

 

Termination of Services

East Coast Mental Wellness has the right to terminate services if the clinician feels like their treatment modality is not therapeutically appropriate or if the clinicians feels like the client is in need of a higher level of care. Treatment may also be canceled if there is more than three no-shows, late cancelations (less than 24 notice), or late arrive to session (more than 15 minutes) within a three month period.  The clinician will make an attempt to make a referral for a more appropriate provider. Please note, this does not guarantee that the referred providers can take on a new client.

 

Paperwork Completion Fee:

Requests for completion of external forms, letters, or other documentation by your therapist or clinician that require 5 minutes or more will be subject to a $50 fee. This fee covers the time required for professional review and documentation.

 

Electronic Communication/ Patient Portal

You will be invited to utilize the patient portal to sign documents and pay your bill.You will also have the ability to email your clinician on a secure web-based interface that is encrypted, HIPAA compliant and automatically a part of your medical record.

 

Please be aware that communication with your clinician via personal email and text message is not secure and puts your privacy at risk. Communications via email and text message are not encrypted but still become part of your medical record. Any text or email initiated by yourself is implicit consent to receive communication by our office within the same medium.

**PLEASE DO NOT contact the clinician via SMS (text) if therapeutic intervention is needed, please request a sooner appointment time by sending an email, calling 402-227-0372, or wait until your already scheduled appointment time. For emergencies, contact 911.

 

Social Media, Online Interaction, and Public Review Policy

To protect your privacy and maintain clear professional boundaries, East Coast Mental Wellness clinicians do not accept friend requests, follow clients, or engage in personal interactions on social media. Being connected online or interacting publicly with your clinician can reveal your professional relationship and compromise your confidentiality. Your clinician will not confirm or deny any therapeutic relationship on social media or any public platform and may remove online connections without notice to protect your privacy.

East Coast Mental Wellness maintains public social media accounts to share information, resources, and practice updates. You are welcome to view, like, and share content from these pages. However, we do not use social media for therapy communication or scheduling due to limited privacy protections.

Clients may choose to leave public reviews on platforms such as Google, Facebook, or Yelp. Please understand that doing so may publicly identify you as a therapy client and may reveal health information that cannot be withdrawn once posted. We cannot respond to reviews in a way that confirms or discusses your care due to confidentiality laws.

If you have concerns or negative feedback, we encourage you to speak with us directly so that we can address your experience privately, respectfully, and appropriately.

This policy is intended to protect your privacy and support a safe, ethical therapeutic relationship.

 

Requesting Medical Records

Under the Health Insurance Portability and Accountability Act (HIPAA), you have the right to access and obtain a copy of your medical records. To request your records, you must complete and sign a Release of Information (ROI) form. Once the request is received, we will process it within 30 days, as required by law. In certain cases, we may extend this timeframe by an additional 30 days, and you will be notified in writing if an extension is necessary.

 

If you believe there is an error in your medical record, you have the right to submit a written request for an amendment. If your clinician determines that the record is accurate, no changes will be made; however, a statement of your concerns will be added to your file.

 

To ensure the security of your protected health information (PHI), records can be provided via secure electronic transmission, printed copies, or mailed to a designated address, based on your preference. Fees may apply for copying and mailing services in accordance with HIPAA guidelines.

 

Additional Protections for Substance Use/Dependency (SUD) Treatment Records:
Records of SUD diagnosis or treatment are protected by federal law (42 C.F.R. Part 2). These records cannot be used in legal proceedings or disclosed without your written consent or a court order, even if they are included in your general medical record. Consent for disclosure cannot be combined with general consents for treatment or payment, and SUD counseling notes require a separate authorization similar to psychotherapy notes. 

 

Record Retention

East Coast Mental Wellness maintains patient records for at least seven (7) years after the most recent patient encounter, as required by the Rhode Island Department. Records may be retained longer in accordance with federal or insurance requirements.

 

Letters/Forms

Clients frequently request forms and letters for school, work, insurance, disability, or medical treatment. If time permits, brief forms will be completed during your allotted appointment time. Simple forms or letters requiring 5 minutes or less can be done outside of the appointment. Longer forms or letters may require an additional appointment or an extra fee (self-pay).

 

Health Insurance/Fees:

At East Coast Mental Wellness, not all clinicians are paneled on every insurance. Please ask your clinician or intake department about what specific insurances your clinician takes. Since Clinicians are independent contractors of East Coast Mental Wellness, they choose their fees and rates. Some clinicians offer a sliding scale. Please speak to your clinician regarding sliding scale fees. Your clinician may be an out-of-network provider for some of the insurance companies. You can contact your insurance company to determine whether your plan includes out-of-network benefits. You will need to know if you have out-of-network benefits, the amount of deductible for your out-of-network befits that you are responsible for and the dollar reimbursement amount for the following codes.

• Initial Evaluation: 90791(Sometimes take more than 1 visit)
• Individual sessions: 90837 or 90834
• Family Session: 90847
• A session with Family member without client: 90846
• Couples Therapy: 90847
  
• Group Therapy: 90853

You will be given a receipt for the services provided to submit to your insurance company with all necessary information if you choose to pay out of pocket. Insurance that included out-of-network benefits reimburses 20-90% of fees.

 

Financial Responsibility

Payment is due at the time of service unless other financial arrangements have been made prior to treatment. Most insurance plans have an annual deductible which must be met before insurance reimbursement begins. If you have a deductible, this is your responsibility to pay in addition to all fees incurred that are not covered by your insurance. Please see No show fees and late cancellation Polity for explanations of fees

 

No Show/Late Cancel Appointment Policy

East Coast Mental Wellness is committed to providing treatment for our clients. In order to do this, consistency with care and regularly scheduled appointments are necessary. We maintain a waitlist of individuals in dire need of care. Due to these facts, the following apply:

• Any appointment NOT canceled within 24 hours will be considered a late cancellation.
• Any appointment late-canceled or no-show appointments will be assessed a missed fee of $60.00. Late fees are the responsibility of the client and are not covered by the insurance company. Any fees must be paid in full prior to your next appointment.
• Payment plans can be made for the fee. If you miss a payment, you will not be able to schedule your next appointment until arrangements are made
• 3 late-canceled, no-show appointments or late arrival (later than 15 minutes to scheduled sessions) in a 3-month period are grounds for termination from treatment.
• If your child is participating in our School-Based Program, we ask that you call the office at 401-277-0372 to inform your child’s clinician if your child will not be attending school. 3 absentees in a 2 month period are grounds for termination.

 

Card on file policy:

At East Coast Mental Wellness, we require that all clients provide a form of payment (“Card on File”) to cover any remaining balance after insurance has processed the claim for services rendered. This policy ensures smoother transactions, allowing us to efficiently manage billing and collect payments for our services in a timely manner.

 

Exceptions to the “Card on File” policy include:

• Clients covered by Medicare or Medicaid

Accepted forms of payment for the “Card on File” include:

• Health Savings Account (HSA)
• Health Reimbursement Arrangement (HRA)
• Flexible Spending Account (FSA)
• Debit Card
• Credit Card

Please note, all payment information is securely stored using encrypted and tokenized systems.

 

Good Faith Estimate Notice (for Self-Pay Clients):

Under the federal No Surprises Act you have the right to receive a Good Faith Estimate of expected charges for services if you are uninsured or choose to self  pay. Upon scheduling or at your request, we will provide a written estimate outlining the expected services, their CPT/HCPCS codes, the clinician’s fees and any other anticipated. This estimate is not a contract; actual charges may vary. You may dispute a bill if the actual charges substantially exceed the estimate.

Please ask your clinician or the billing department for more information.

 

Complaints or Questions.

If you believe your privacy rights have been violated, you may file a complaint with East Coast Mental Wellness by writing to:

East Coast Mental Wellness

1 Richmond Square Suite 350w Providence, RI 02906-4402

You also have the right to contact the Secretary of the United States Department of Health and Human Services with your complaint. You will not be retaliated against for filing a complaint.

U.S. Department of Health & Human Services Office for Civil Rights:
 Website: www.hhs.gov/ocr/privacy/hipaa/complaints/