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) remains confidential and will not be shared without your written consent. However, there are circumstances in which mental health professionals are required by law to disclose PHI. In such situations, your clinician is not required to inform you of their actions. Please note the following which includes 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 relationship.

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

Insurance companies and managed care companies require the following PHI before reimbursement is considered: diagnosis, symptoms, treatment goals, prognosis, and evaluation of progress. Such companies 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 your family and/or 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 of the circumstances listed above where confidentiality does not apply.

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

Uses and disclosures requiring your authorization.

All uses and disclosures other than those listed above will only be made with your written authorization. You may revoke your authorization by submitting a written notice to your Privacy Officer at the address listed 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;
• 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 account of disclosures 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.

Phone Calls

The office phone number is 401-227-0372. Please use this number for all routine matters including appointment changes, scheduling, and requests for letters/paperwork. Your call may be directed to voicemail, in which case every effort will be made to return your call in a timely manner (within 1-2 business days). For urgent issues that require immediate attention including, concerns for safety, please call 911 and proceed directly to the nearest emergency room. Examples of a clinical emergency include the onset of new or acute suicidal thoughts, high-risk behaviors, or life-threatening medication reactions.

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 to intake or the clinician, calling 402-227-0372, or waiting until your already scheduled appointment time.

Electronic communications will be checked during business hours only. If you have an urgent matter, please call or go to the nearest hospital.

Social Media

“Friending” a clinician on social media may expose your professional relationship and undermine your privacy. This social network policy serves as your notification that being linked as friends or contacts on these sites can compromise your confidentiality and your respective privacy. As in any other public context, you have control over your own description of the nature of your relationship with your clinician, if you choose to disclose the professional relationship. For example, if your clinician saw you at church or school and you ignored them, your clinician would follow your lead and do the same. If you introduce your clinician to your friends your clinician would agree with your description of how you know them. Your clinician will not confirm nor deny any professional relationship between themselves and clients on any social network sites. Your clinician reserves the right to discontinue any social network connection without prior notification, and East Coast Mental Wellness encourages you to do the same. East Coast Mental Wellness discourages the use of social network sites for any communication about our therapeutic relationship, including scheduling issues, due to the lack of privacy protections. In addition, viewing your online activities without your consent and without our explicit arrangement towards a specific purpose could potentially have a negative influence on your working relationship with your clinician. If there are things from your online life that you wish to share with your clinician, please bring them into our sessions where you can view and explore them together, during the therapy hour.

Fanning/Liking East Coast Mental Wellness Page may imply endorsement

East Coast Mental Wellness has a Facebook Page that allows people to share blog posts and practice updates with other Facebook users. All information shared on this page is available on the website. You are welcome to view the Facebook Page, read and/or share articles posted there, and comment on them. However, referrals from other clients are one of our best sources of business. The website, Yelp page, and Facebook Fan page are intended to let others know who we are and to make it easy to refer those you feel would benefit from our services. East Coast Mental Wellness will not confirm nor deny any professional relationship between clients on any social network site. This social media policy was constructed to inform you of the risks involved with associating on a social network.

Requesting Records

With your written consent, a summary letter will be provided from your clinician about the progress of sessions to individuals requesting to access medical records. However, copies of your medical records will not be distributed to other parties to keep client information confidential. If you wish to see your record, your therapist will review the record with you in person. If you believe there are inaccuracies in your medical record, you may request to have your record amended by writing a letter requesting specific inaccuracies be amended. If your therapist believes the record is accurate, your medical record will not be amended, but a notation will be added with your concern.

Letters/Forms

Clients frequently request forms and letters for school, work, insurance, disability, and/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 (if 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
• Family Session: 90847
• 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 includes 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 Cancelation Policy for explanations of fees

No Show/Late Cancel Appointment Policy

East Coast Mental Wellness is committed to providing proper 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-cancelled or any no-show appointments will be assessed the 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 o 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 or no-show appointments in a six-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.

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.