HIPAA Notice of Privacy Practices
Effective Date: December 2022
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.
Mindful Gateway Therapy, operated by Sandy Karina Weeks, LPCC, is committed to protecting your privacy and the confidentiality of your Protected Health Information (PHI). We comply with all applicable state and federal privacy laws, including the California State Law regarding treatment records and confidentiality, the Health Insurance Portability and Accountability Act (HIPAA), United States Federal Law, and the ethical codes of the American Counseling Association (ACA), National Association of Social Workers (NASW), and American Association of Marriage and Family Therapy (AAMFT).
Our Responsibilities
We are required by law to maintain the privacy and security of your PHI. If a breach occurs that may compromise your information, we will notify you promptly. We must follow the duties and privacy practices described in this notice and provide you with a copy. We will not share your information other than as described here unless you give us written permission, which you may revoke at any time. We are required to abide by the terms of this notice until a new notice is adopted.
Your Rights as a Client
As a client, you have the right to obtain a copy of your health and claims records, for which a reasonable fee may apply. You may request corrections to your health and claims records if they are incorrect or incomplete; we will respond to your request within sixty days and may decline the request if necessary. You may request confidential communications, such as asking us to contact you at a specific address or phone number. You may also request restrictions on what we use or share for treatment, payment, or operations, though we may decline if it would negatively affect your care. You have the right to receive an accounting of disclosures of your information for up to six years prior to your request, excluding disclosures for treatment, payment, or healthcare operations. If you pay for services out of pocket in full, you may request that we not share information with your insurer. You may obtain a paper copy of this notice at any time. If you have given someone medical power of attorney or if someone is your legal guardian, you may choose someone to act for you, and we will confirm their authority before taking any action. You may opt out of marketing or fundraising communications.
If you believe your privacy rights have been violated, you may file a complaint with our practice by contacting Sandy Karina Weeks at Contact Us. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by sending a letter to 200 Independence Ave, SW, Washington DC 20201, calling 1-877-696-6775, or visiting HIPPA Website. All complaints must be in writing. There will be no retaliation for filing a complaint.
How We Use and Disclose Your Protected Health Information
The most common ways we use or share your health information are to treat you, to operate our practice, and to bill for our services. For example, we may share information with other healthcare providers involved in your care, use your information to contact you or schedule appointments, and use your information to process payments. Less common uses and disclosures include situations where we are required to report suspected abuse, neglect, or domestic violence; report adverse medication reactions; assist with public health and safety issues; prevent or reduce a serious threat to anyone’s health or safety; prevent disease; conduct research; support government functions; contribute to the public good; respond to workers’ compensation claims; support health oversight agencies’ activities as authorized by law; comply with state or federal laws; respond to law enforcement requests; assist with product recalls; and respond to lawsuits or legal actions.
How We Will Not Use Your Protected Health Information
We will not use your PHI for marketing purposes without your written permission. We will not share psychotherapy notes without your express written authorization, except as permitted by law. We will not sell your health information.
Financial Policies
All payment is due in full at the time of service. Session fees are automatically charged to your payment method on file after each session. If your payment method fails, you must provide an alternate payment before your next session. Clients are not allowed to carry balances, and having an unpaid balance may affect your ability to schedule future appointments. If you are the parent or guardian of a minor receiving counseling, you are responsible for all associated fees.
If you need to cancel or reschedule your appointment, you must do so at least 24 hours in advance. If you miss your appointment or request to cancel or reschedule within 24 hours, you will be charged the full cost of the session ($160), not just your copay or coinsurance. If you contact your therapist outside business hours, your request will still be received as long as you provide 24 hours notice.
If you are using insurance, you are responsible for knowing your coverage and for paying any fees not covered by insurance. Mindful Gateway Therapy will obtain an estimated verification of benefits for you as a courtesy prior to your appointment and will file claims to your insurance company. It may take a few weeks for claims to process, and sometimes coverage may differ from the initial estimate. Once your claims are processed, our billing department will notify you of any unexpected costs. If your insurance company is out of network, it is your responsibility to request a receipt of services from your therapist or our billing department for reimbursement.
If you have any questions about these policies, please contact us through our Contact Portal.