Health Insurance and Confidentiality of Records Sample Clauses

Health Insurance and Confidentiality of Records. Your health insurance carrier may require disclosure of confidential information in order to process claims. Only the minimum necessary information will be communicated to your insurance carrier, including diagnosis, the date and length of our appointments, and what services were provided. Often the billing statement and your company's claim form are sufficient. Sometimes treatment summaries or progress toward goals are also required. Unless explicitly authorized by you, Psychotherapy Notes will not be disclosed to your insurance carrier. While insurance companies claim to keep this information confidential, I have no control over the information once it leaves my office. Please be aware that submitting a mental health invoice for reimbursement carries some risk to confidentiality, privacy, or future eligibility to obtain health or life insurance. Client Agreement and Therapeutic Policies XX XXXXXXX X HANZY, LMFT Owner MYFAITH COMMUNITY & COUNSELING SERVICES 0000 Xxxxxx Xx Xxx 000-209 Antioch, Ca 94509 P: 000-000-0000 E: drhanzy@ xxxxxxxx.xxx Contra Costa Mental Health Access Line 0-000-000-0000 24-Hour Crisis Lines 800-273-TALK drhanzy@myfaithcs .org xxx.xxxxxxxxx.xxx
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Health Insurance and Confidentiality of Records. Xx. Xxxx Xxxxxx does not accept insurance. If you would like to be reimbursed by your insurance provider for visits with her, you will have to submit the required forms but Xx. Xxxxxx will provide you with a superbill upon request. You must be aware that disclosure of a mental health diagnosis is required on the superbill for insurance companies to reimburse you and that diagnosis goes into your permanent medical record. Initial Confidentiality of E-mail and Cell Phone Communication: It is important to be aware that e-mail and cell phone communication can be accessed by unauthorized people and hence, the privacy and confidentiality of such communications can be compromised. Litigation Limitation: Due to the nature of the therapeutic process and the fact that it often involves making a full disclosure with regard to many matters which may be of a confidential nature, it is agreed that should there be legal proceedings (such as, but not limited to divorce and custody disputes, injuries, lawsuits, workers comp claims, etc), neither you (patient) nor your attorney, not anyone else acting on your behalf will call on Xx. Xxxx Xxxxxx to testify in court or at any other proceedings, nor will a disclosure of the psychotherapy records be requested. Initial
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Health Insurance and Confidentiality of Records. Disclosure of confidential information may be required by Clients' health insurance carrier or managed care organization in order to process the claims. If Clients so instructs Therapist, only the minimum necessary information will be communicated. Clients must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk to confidentiality, privacy, or to future eligibility to obtain health or life insurance.
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Health Insurance and Confidentiality of Records. Disclosure of confidential information may be required by your health insurance carrier HMO/PPO/ MCO/EAP in order to process claims. If you instruct your therapist, only he minimum necessary information will be communicated to the carrier. You must be aware that submitting a mental health invoice for reimbursement carries a certain amount if risk of confidentiality, privacy or to the future capacity to obtain health or life insurance or even a job. The risk stems from the fact that mental health information is likely to be entered into the National Medical Data Bank. Accessibility to companies' computers or to the National Medical Data Bank database is always in question as computers are inherently vulnerable to break ins and unauthorized access. Medical data has been reported to be legally accessed by enforcement and other agencies, which also puts you in a vulnerable position. Fee and Fee Arrangements The fee for service is $165.00 per 50 minute individual therapy session. The fee for service is $165.00 per 50 minute conjoint (marital /family) therapy session. Fees are payable at the beginning of the session on the day services are rendered. The usual and customary fee for service is $165.00 per 50-minute session. Sessions longer than 50- minutes are charged for the additional time pro rata. Therapist reserves the right to periodically adjust this fee. Parent/Caregiver will be notified of any fee adjustment in advance. In addition, this fee may be adjusted by contract with insurance companies, HMOs, managed care organizations, or other third-party payor, or by agreement with Therapist. From time-to-time, Therapist may engage in telephone contact with Patient or Parent/Caregiver for purposes other than scheduling sessions. Parent/Caregiver is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. In addition, from time-to-time, Therapist may engage in telephone contact with third parties at the request of Patient or Parent/Caregiver and with the advance written authorization of Patient or Parent/Caregiver. Parent/Caregiver is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. Parent/Caregiver is expected to pay for services at the time services are rendered. Therapist accepts cash and checks.
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Health Insurance and Confidentiality of Records. Disclosure of confidential information may be required by your health insurance carrier or HMO/PPO/MCO/EAP in order to process the claims. If you so instruct Ravenhill Psychological Services only the minimum necessary information will be communicated to the carrier. Unless authorized by you explicitly, the psychotherapy notes will not be disclosed to your insurance carrier. Ravenhill Psychological Services has no control or knowledge over what insurance companies do with the information s/he submits or who has access to this information. You must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk to confidentiality, privacy, or to future eligibility to obtain health or life insurance. The risk stems from the fact that mental health information is entered into insurance companies’ computers and soon will also be reported to the Congress-approved National Medical Data Bank. Accessibility to companies’ computers or to the National Medical Data Bank database is always in question, as computers are inherently vulnerable to break-ins and unauthorized access. Medical data have been reported to have been sold, stolen, or accessed by enforcement agencies; therefore, you are in a vulnerable position. Confidentiality of e-mail, cell phone, and fax communication It is very important to be aware that e-mail and cell phone (also cordless phones) communication can be relatively easily accessed by unauthorized people and, hence, the privacy and confidentiality of such communication can be easily compromised. E-mails, in particular, are vulnerable to such unauthorized access due to the fact that servers have unlimited and direct access to all e-mails that go through them. Faxes can be sent erroneously to the wrong address. Please notify Ravenhill Psychological Services at the beginning of treatment if you decide to avoid or limit in any way the use of any or all of the above-mentioned communication devices. Please do not use e-mail or faxes in emergency situations.
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Health Insurance and Confidentiality of Records. Disclosure of confidential information may be required by your health insurance carrier HMO/PPO/MCO/EAP in order to process claims. If you instruct your therapist, only he minimum necessary information will be communicated to the carrier. You must be aware that submitting a mental health invoice for reimbursement carries a certain amount if risk of confidentiality, privacy or to the future capacity to obtain health or life insurance or even a job. The risk stems from the fact that mental health information is likely to be entered into the National Medical Data Bank. Accessibility to companies' computers or to the National Medical Data Bank database is always in question as computers are inherently vulnerable to break ins and unauthorized access. Medical data has been reported to be legally accessed by enforcement and other agencies, which also puts you in a vulnerable position.
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Health Insurance and Confidentiality of Records. Disclosure of confidential information may be required by Client’s health insurance carrier or HMO/PPO/MCO/EAP in order to process the claims. If Client instructs Therapist through a written authorization, only the minimum necessary information will be communicated to the carrier. Therapist has no control or knowledge over what insurance companies do with the information submitted or who has access to this information. Client must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk to confidentiality, privacy or future capacity to obtain health or life insurance. The risk stems from the fact that accessibility to companies’ computers is inherently vulnerable to unauthorized access. Medical data has been reported to be sold, stolen, or accessed by enforcement agencies, which put Client in a vulnerable position. Initial Sliding Scale Therapist has very limited openings for clients seeking sliding fee accommodations. A sliding scale is offered based on income and will be renegotiated as Client’s income changes. Should Client(s) need such accommodations, he/she should discuss the issue with Therapist. Initial
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Health Insurance and Confidentiality of Records. The health Insurance and Portability and accountability Act of 1996 (HIPAA) is a federal law that is designed to protect the privacy of patient information, provide the electronic and physical security of health and patient information, and simplifying billing and other electronic transactions by standardizing codes and procedures. A piece of law recently took effect and is known as the HIPAA Privacy Rule. The HIPAA Privacy Rule crates minimum federal standard for the use and disclosure of Protected Health Information (PHI) by health organizations. One of the requirements of the Privacy Rule is that we give to you a Notice of Privacy Practices (NPP) that describes your rights and protections regarding your health care records (PHI) ~ I have reviewed and understand Live Happy Counseling’s HIPAA Policies and Notice of Privacy Practice. ~ I have read and above agreement and office policies and general information carefully. I understand and agree to comply with them. I am consenting to move forward with therapeutic treatment with Live Happy Counseling. Client name Date Client signature/ Legal Guardian signature Date Legal Guardian name/ Relationship to client Date Guardian Name: Phone Number: Address: Caregiver Name: Phone Number: Address:
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Health Insurance and Confidentiality of Records. Your health insurance carrier may require disclosure of confidential information in order to process claims. Only the minimum necessary information will be communicated to your insurance carrier, including diagnosis, the date and length of our appointments, and what services were provided. Often the billing statement and your company's claim form are sufficient. Sometimes treatment summaries or progress toward goals are also required. Unless explicitly authorized by you, Psychotherapy Notes will not be disclosed to your insurance carrier. While insurance companies claim to keep this information confidential, I have no control over the information once it leaves my office. Please be aware that submitting a mental health invoice for reimbursement carries some risk to confidentiality, privacy, or future eligibility to obtain health or life insurance. Client Agreement and Therapeutic Policies XXXXXXX X XXXXX, PHD, LMFT Owner MYFAITH COMMUNITY & INFORMATION ABOUT THIS PRACTICE The name of this practice is: MyFaith Community & Counseling Services The individual therapist(s) who operate this practice is/are: COUNSELING Xxxxxxx X Xxxxx LMFT 85938 SERVICES 0000 Xxxx Xxxx Xxx Xxx X Xxxxxxx, Xx 00000 P: 000-000-0000 E: drhanzy@ xxxxxxxx.xxx Contra Costa Mental Health Access Line 0-000-000-0000 24-Hour Crisis Lines 800-273-TALK drhanzy@myfaithcs .org xxx.xxxxxxxxx.xxx NAME OF THERAPIST LICENSE TYPE LICENSE NUMBER MINORS AND CONFIDENTIALITY Communications between therapists and patients who are minors (under the age of 18) are confidential. However, parents and other guardians who provide authorization for their child’s treatment are often involved in their treatment. Consequently, your therapist, in the exercise of his or her professional judgment, may discuss the treatment progress of a minor patient with the parent or caretaker. Patients who are minors and their parents are urged to discuss any questions or concerns that they have on this topic with their therapist. Complaints: If you have a concern or complaint about your treatment, please talk with me about it. I will take your criticism seriously and respond with care and respect. If you believe that I’ve been unwilling to listen and respond, or that I have behaved unethically, you can contact the Board of Behavioral Science Examiners which oversees licensing, and they will review the services I have provided. Board of Behavioral Sciences 0000 Xxxxx Xxxxxx Xxxx., Xxxxx X000, Xxxxxxxxxx, XX 00000 Telephone: (000) ...
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Related to Health Insurance and Confidentiality of Records

  • Data Protection and Confidentiality 3.1. We obtain, use, process and disclose personal data about you and data subjects (as defined in the DPA) in order that we may provide the Services and for other related purposes including updating and enhancing client records, analysis for management purposes and statutory returns, crime prevention and legal and regulatory compliance.

  • Confidentiality of Contractor Information The Contractor acknowledges and agrees that this Contract and any and all Contractor information obtained by the State in connection with this Contract are subject to the State of Vermont Access to Public Records Act, 1 V.S.A. § 315 et seq. The State will not disclose information for which a reasonable claim of exemption can be made pursuant to 1 V.S.A. § 317(c), including, but not limited to, trade secrets, proprietary information or financial information, including any formulae, plan, pattern, process, tool, mechanism, compound, procedure, production data, or compilation of information which is not patented, which is known only to the Contractor, and which gives the Contractor an opportunity to obtain business advantage over competitors who do not know it or use it. The State shall immediately notify Contractor of any request made under the Access to Public Records Act, or any request or demand by any court, governmental agency or other person asserting a demand or request for Contractor information. Contractor may, in its discretion, seek an appropriate protective order, or otherwise defend any right it may have to maintain the confidentiality of such information under applicable State law within three business days of the State’s receipt of any such request. Contractor agrees that it will not make any claim against the State if the State makes available to the public any information in accordance with the Access to Public Records Act or in response to a binding order from a court or governmental body or agency compelling its production. Contractor shall indemnify the State for any costs or expenses incurred by the State, including, but not limited to, attorneys’ fees awarded in accordance with 1 V.S.A. § 320, in connection with any action brought in connection with Contractor’s attempts to prevent or unreasonably delay public disclosure of Contractor’s information if a final decision of a court of competent jurisdiction determines that the State improperly withheld such information and that the improper withholding was based on Contractor’s attempts to prevent public disclosure of Contractor’s information. The State agrees that (a) it will use the Contractor information only as may be necessary in the course of performing duties, receiving services or exercising rights under this Contract; (b) it will provide at a minimum the same care to avoid disclosure or unauthorized use of Contractor information as it provides to protect its own similar confidential and proprietary information; (c) except as required by the Access to Records Act, it will not disclose such information orally or in writing to any third party unless that third party is subject to a written confidentiality agreement that contains restrictions and safeguards at least as restrictive as those contained in this Contract; (d) it will take all reasonable precautions to protect the Contractor’s information; and (e) it will not otherwise appropriate such information to its own use or to the use of any other person or entity. Contractor may affix an appropriate legend to Contractor information that is provided under this Contract to reflect the Contractor’s determination that any such information is a trade secret, proprietary information or financial information at time of delivery or disclosure.

  • Confidentiality of Health Information (a) A Nurse shall not be required to provide her or his manager/supervisor specific information regarding the nature of her or his illness or injury during a period of absence. However, the Employer may require the Nurse to provide such information to persons responsible for occupational health.

  • Confidentiality of Records Each Investor agrees to use, and to use its best efforts to insure that its authorized representatives use, the same degree of care as such Investor uses to protect its own confidential information to keep confidential any information furnished to it which the Company identifies as being confidential or proprietary (so long as such information is not in the public domain), except that such Investor may disclose such proprietary or confidential information to any partner, subsidiary or parent of such Investor for the purpose of evaluating its investment in the Company as long as such partner, subsidiary or parent is advised of the confidentiality provisions of this Section 3.3.

  • Confidentiality of Client Information ENP providers shall ensure that information about, or obtained from a participant’s records, shall be maintained in a confidential manner.

  • Privacy and Confidentiality A. Contractors may use or disclose Medi-Cal PII only to perform functions, activities or services directly related to the administration of the Medi-Cal program in accordance with Welfare and Institutions Code section 14100.2 and 42 Code of Federal Regulations section 431.300 et.seq, or as required by law. Disclosures which are required by law, such as a court order, or which are made with the explicit written authorization of the Medi-Cal client, are allowable. Any other use or disclosure of Medi-Cal PII requires the express approval in writing of DHCS. Contractor shall not duplicate, disseminate or disclose Medi-Cal PII except as allowed in the Agreement.

  • Confidentiality of Student Records 1. Student educational records created as a result of this Agreement shall be retained and disseminated in accordance with Family Educational Rights and Privacy Act (FERPA) requirements.

  • Confidentiality Data Protection The terms and conditions of this Agreement are confidential and may not be disclosed to or discussed with anyone except as permitted. Confidential information may include: any trade/business secret, technical knowledge or know-how, financial information, plans, customer/client lists, your customer information or data, your customers’ accounting or financial information, your customers’ tax information, your customers’ miscellaneous information, supplier information, pricing policies, fee structure, standard operating procedures, protocols, marketing data and/or promotional techniques, product data, purchase information, sales policies, employee lists, policies, computer records, computer access codes, plans and programs, any formula pattern or compilation of information, used during this Agreement, or any of its/ their clients. Confidentiality will exist regardless of whether such information is received by you under a validly executed confidentiality Agreement or not, or which is disclosed (whether in writing, delivery of items/ reports, manuals, verbally, visual representation, inspection of tangible objects, on office or site visits, or by any other means and whether directly or indirectly) whether before or after the date of this Agreement. Confidential Information may include “Proprietary information” as defined from now on. Each party shall honor the confidentiality and data protection of the other party’s “Confidential Information” and shall not disclose such information to any third party without the prior written consent of the confiding party. Neither party shall disclose any of the terms of this Agreement to assigned remote staff or any of other employees or affiliates, except the appointed Account Manager and person signing this Agreement on our behalf. To protect the Confidential Information, both the parties now agree and undertake to keep secret and treat as confidential all Confidential Information described above. Neither party shall use any Confidential Information at any time, either during this Agreement or after the termination of the Agreement, for any purpose other than in the ordinary course of business and furtherance of the confiding party’s interest. We may not be permitted to use your name as our client in any marketing literature, brochures, or for any private reference unless you permit it.

  • Confidentiality and Safeguarding of University Records; Press Releases; Public Information Under this Agreement, Contractor may (1) create, (2) receive from or on behalf of University, or (3) have access to, records or record systems (collectively, University Records). Among other things, University Records may contain social security numbers, credit card numbers, or data protected or made confidential or sensitive by Applicable Laws. [Option (Include if University Records are subject to FERPA.): Additional mandatory confidentiality and security compliance requirements with respect to University Records subject to the Family Educational Rights and Privacy Act, 20 United States Code (USC) §1232g (FERPA) are addressed in Section 12.41.] [Option (Include if University is a HIPAA Covered Entity and University Records are subject to HIPAA.): Additional mandatory confidentiality and security compliance requirements with respect to University Records subject to the Health Insurance Portability and Accountability Act and 45 Code of Federal Regulations (CFR) Part 160 and subparts A and E of Part 164 (collectively, HIPAA) are addressed in Section 12.26.] Contractor represents, warrants, and agrees that it will: (1) hold University Records in strict confidence and will not use or disclose University Records except as (a) permitted or required by this Agreement, (b) required by Applicable Laws, or (c) otherwise authorized by University in writing; (2) safeguard University Records according to reasonable administrative, physical and technical standards (such as standards established by the National Institute of Standards and Technology and the Center for Internet Security [Option (Include if Section 12.39 related to Payment Card Industry Data Security Standards is not include in this Agreement.):, as well as the Payment Card Industry Data Security Standards]) that are no less rigorous than the standards by which Contractor protects its own confidential information; (3) continually monitor its operations and take any action necessary to assure that University Records are safeguarded and the confidentiality of University Records is maintained in accordance with all Applicable Laws and the terms of this Agreement; and (4) comply with University Rules regarding access to and use of University’s computer systems, including UTS165 at xxxx://xxx.xxxxxxxx.xxx/board-of-regents/policy-library/policies/uts165-information-resources-use-and-security-policy. At the request of University, Contractor agrees to provide University with a written summary of the procedures Contractor uses to safeguard and maintain the confidentiality of University Records.

  • Records and Confidentiality All records pertaining to the operation and administration of the Trust and the Fund (whether prepared by the Adviser or supplied to the Adviser by the Trust or the Fund) are the property and subject to the control of the Trust. In the event of the termination of this agreement, all such records in the possession of the Adviser shall be promptly turned over to the Trust free from any claim or retention of rights. All such records shall be deemed to be confidential in nature and the Adviser shall not disclose or use any records or information obtained pursuant to this Agreement in any manner whatsoever except as expressly authorized by the Trust or as required by federal or state regulatory authorities. The Adviser shall submit to all regulatory and administrative bodies having jurisdiction over the operations of the Adviser or the Trust, present or future, any information, reports or other material obtained pursuant to this Agreement which any such body may request or require pursuant to applicable laws or regulations.

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