SAGE Counseling Omaha, LLC HIPAA Notice of Privacy Practices
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.
Effective Date 09-01-2019
SAGE Counseling Omaha, LLC has been and always will be committed to maintaining our clients’ confidentiality. We will only release your healthcare information in accordance with federal and state laws and the code of ethics for the counseling profession. This notice describes our policies related to the use and disclosure of your healthcare information. Uses and disclosures of your health information for the purposes of: Providing treatment services, collecting payment and conducting health care operations. These are necessary activities for providing our client’s quality care. State and federal laws allow us to use and disclose your health information for these purposes.
TREATMENT: We may need to use or disclose health information about you to provide, manage or coordinate your care or related services. This may include consultants and potential referral sources.
PAYMENT: Information needed to verify insurance coverage and/or benefits with your insurance carrier, to process your claims, as well as information needed for billing and collection purposes. We may also bill the person in your family who is identified as the primary insurance holder or responsible party.
HEALTHCARE OPERATIONS: We may need to use information about you to review our treatment procedures and business activity. Information may be used for certification, compliance and licensing activities.
Other uses or disclosures of your information, which does not require your consent: There are some instances where we may be required to use and disclose information without your consent. For example, but not limited to: Information you and/or your child or children report about physical or sexual abuse. In this circumstance, in accordance with Nebraska State Law, we are obligated to report this to Child Protective Services, if you provide information that informs us that you are in danger of harming yourself or others. Information shared with law enforcement if a crime is committed on our premises or against one of our staff. Any other instances as required by law such as a subpoena or court order. Information to remind you of /or to reschedule appointments or other treatment alternatives. Clinical records, psychotherapy notes, and other disclosures require a separate signed release of information. You have a right to or will receive notification of a breach of any unsecured personal health information. You have a right to restrict any disclosure of personal health information where you have paid for services out-of-pocket and in full.
Right to request how we contact you. It is our normal practice to communicate with you at your home address and via the daytime phone number you provided us when you scheduled your appointment, about health matters, billing information, and appointment reminders (if requested). If permitted by you, we may sometimes leave messages on your voicemail. You also reserve the right to request that our office communicate with you in a different way.
Right to release your medical records. You may consent in writing to release your records to others that you identify. You have the right to revoke this authorization, in writing, at any time. However, please note that a revocation is not valid to the extent that we acted in reliance on such authorization.
Right to inspect and copy your medical and billing records. You have the right to inspect and obtain a copy of your information contained in our medical records. To request access to your billing or health information, please contact the office manager. Under limited circumstance, we may deny your request to inspect and copy. If you ask for a copy of any information, we may charge a reasonable fee for the costs of copying, mailing and supplies.
Right to add information or amend your medical records. If you feel that information contained in your medical record is incorrect or incomplete, you may ask us to add information to amend the record. We will make a decision on your request within 60 days, or in some cases within 90 days. Under certain circumstances, we may deny your request to add or amend information. If we deny your request, you have a right to file a statement that you disagree. Your statement and our response will be added to your record. To request an amendment, you must contact the office manager. We will require you to submit your request in writing and to provide an explanation concerning the reason for your request.
Right to an accounting of disclosures. You may request an accounting of any disclosures, if any, we have made related to your medical information, except for information we used for treatment, payment, healthcare operational purposes, information that was shared with you or your family, or information that you gave us specific consent to release. This also excludes information we were required to release. To receive information regarding disclosure made for a specific time period no longer than seven years, please submit your request in writing to SAGE Counseling Omaha, LLC. We will notify you of the cost involved in preparing this list.
Right to request restrictions on uses and disclosures of your health information. You have the right to ask for restrictions on certain uses and disclosures of your health information. This request must be in writing and submitted to our office manager. However, please note that we are not required to agree to such a request.
Right to complain. If you believe your privacy rights have been violated, please contact us personally, and discuss your concerns. If you are not satisfied with the outcome, you may file a written complaint with the U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, DC 20201.
An individual will not be retaliated against for filing such a complaint.
Right to receive changes in policy. You have the right to receive any future policy changes secondary to changes in state and federal laws.
Effective Date 09-01-2019