95 Springbrook Ave #101, Clayton, NC
Phone (919) 553-6224 Fax (919) 553-7805
HIPPA Notice of Privacy PracticesThis Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations (TPO), and for other purposes that are permitted or required by law.
Protected health information (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
Uses and Disclosure of Protected Health Information: Your protected health information may be used and disclosed by your counselor, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the counselor’s practice, and any other use required by law.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination of management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a managed care company that provides insurance coverage for your treatment here. Your protected health information may also be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to properly diagnose or treat you.
Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for continued treatment or a hospital stay might require that your relevant protected health information be disclosed to the health plan to obtain approval for more sessions or hospital admission.
Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of this practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of mental health professionals, licensing, marketing and fund raising activities, and conducting or arranging for other business activities. For example, we may disclose your protective health information to interns or students that see patients in our office. In addition, we may call you by name in the waiting room when your counselor is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.We may use or disclose your protected health information in the following situation without your authorization. These situations include, as required by law: public health issues as required by law, communicable diseases, health oversight, abuse or neglect, food and drug administration requirements, legal proceedings, research, criminal activity, military activity, national security, workers’ compensation, inmates, required use and disclosures under the law. We must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of section 164.500.
Other permitted and required uses and disclosures will be made only with your consent, authorization or opportunity to object unless required by law.You may revoke this authorization at any time, in writing, except to the extent that your counselor or this counseling practice has taken an action in reliance on the use or disclosure indicated in the authorization.
Your Rights: Following is a statement of your rights with respect to your protected health information.
You have the right to inspect and copy your protected health information: Under Federal law, however, you may not inspector copy the following records: counseling notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.
You have the right to request a restriction of your protected health information: This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment, or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in the Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restrictions to apply. We again request you provide this in writing.Your mental health professional is NOT required to agree to a restriction that you may request. If a mental health professional believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You always have the right to use another healthcare professional.You have the right to receive confidential communications from us by alternative means or at an alternative location. You even have the right to obtain a paper copy of this notice from us.
You MAY have the right to have your mental health professional amend your protected health information. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of such rebuttal.You have the right to receive an accounting of certain disclosures we have made, if any, or your protected health information.We reserve the right to change the terms of this notice and will inform you by mail of any changes. You then have the right to object or withdraw as provided in this notice.
Complaints: You may complain to the Secretary of Health and Human Services or us if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint.
This notice was published and went into effect on 4/14/2003.
Medicare Prescription Drug Coverage and Your Rights
Your Medicare rights
You have the right to request a coverage determination from your Medicare drug plan if you disagree with information provided by the pharmacy. You also have the right to request a special type of coverage determination called an “exception” if you believe:
· you need a drug that is not on your drug plan’s list of covered drugs. The list of covered drugs is called a “formulary;”
· a coverage rule (such as prior authorization or a quantity limit) should not apply to you for medical reasons; or
· you need to take a non-preferred drug and you want the plan to cover the drug at the preferred drug price.
What you need to do
You or your prescriber can contact your Medicare drug plan to ask for a coverage determination by calling the plan’s toll-free phone number on the back of your plan membership card, or by going to your plan’s website. You or your prescriber can request an expedited (24 hour) decision if your health could be seriously harmed by waiting up to 72 hours for a decision. Be ready to tell your Medicare drug plan:
1. The name of the prescription drug that was not filled. Include the dose and strength, if known.
2. The name of the pharmacy that attempted to fill your prescription.
3. The date you attempted to fill your prescription.
4. If you ask for an exception, your prescriber will need to provide your drug plan with a statement explaining why you need the off-formulary or non-preferred drug or why a coverage rule should not apply to you.
Your Medicare drug plan will provide you with a written decision. If coverage is not approved, the plan’s notice will explain why coverage was denied and how to request an appeal if you disagree with the plan’s decision.
Refer to your plan materials or call 1-800-Medicare for more information.