Privacy Policy

NOTICE OF PRIVACY PRACTICES 

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. 

 I. MY PLEDGE REGARDING HEALTH INFORMATION: I understand that health information about you and your health care is personal. I am committed to protecting your health information. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with specific legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice explains how I may use and disclose your health information. I also describe your rights to the health information I keep about you and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to: 

• Ensure that protected health information (“PHI”) that identifies you is kept confidential. 
• Provide you with this notice of my legal duties and privacy practices regarding health information. 
• Follow the terms of the notice that is currently in effect. 
• I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request from my office and on my website.  

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures, I will explain what I mean and provide examples. Not every use or disclosure in a category will be listed. However, all permitted uses and disclosures of information fall within one of the categories.  For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have a direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment, or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician consulted with another licensed health care provider regarding your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, to assist the clinician in diagnosing and treating your mental health condition.  Disclosures for treatment purposes are not limited to the minimum necessary standard. Therapists and other health care providers need access to the whole record and/or complete information to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers, and referrals of a patient for health care from one health care provider to another.  Lawsuits and Disputes: If you are involved in a lawsuit or dispute, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process served on someone else involved in the dispute, but only if efforts have been made to notify you of the request or to obtain an order protecting the information requested.  

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

     1. Psychotherapy Notes. I do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is: 

• For my use in treating you. 
• For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy. 
• For my use in defending myself in legal proceedings instituted by you. 
• For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA. 
• Required by law, and the use or disclosure is limited to the requirements of such law. 
• Required by law for certain health oversight activities regarding the originator of the psychotherapy notes. 
• Required by a coroner who is performing duties authorized by law. 
• Required to help avert a serious threat to the health and safety of others.

     2. Marketing Purposes. As a psychotherapist, I will not use or disclose your PHI for marketing purposes.

     3. Sale of PHI. As a psychotherapist, I will not sell your PHI in the regular course of my business. 

 IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:  

1. When disclosure is required by state or federal law, the use or disclosure complies with, and is limited to, the requirements of that law.   
2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.  
3. For health oversight activities, including audits and investigations. 
4. For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain Authorization from you before doing so.  
5. For law enforcement purposes, including reporting crimes occurring on my premises.  
6. To coroners or medical examiners, when such individuals are performing duties authorized by law.  
7. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of treatment for the same condition.  
8. Specialized government functions, including ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or helping to ensure the safety of those working within or housed in correctional institutions.  
9. For workers' compensation purposes. Although my preference is to obtain your Authorization, I may disclose your PHI to comply with workers' compensation laws.
10.  Appointment reminders and health-related benefits or services. I may use and disclose your PHI to contact you to remind you of your appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.

 V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT

1. Disclosures to family, friends, or others. I may disclose your PHI to a family member, friend, or other person you indicate is involved in your care or the payment for your health care, unless you object, in whole or in part. Consent may be obtained retroactively in emergencies. 

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:  

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to request that I not use or disclose certain PHI for treatment, payment, or health care operations. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.  
3. The Right to Choose How I Send PHI to You. You have the right to request that I contact you at a specific number (e.g., home or office) or to send mail to a different address, and I will comply with all reasonable requests.  
4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary thereof, within 30 days of receiving your written request, and I may charge a reasonable, cost-based fee for doing so. 
5. The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will provide will include disclosures made in the last six years unless you request a shorter period. I will provide the list at no charge, but if you make more than one request in the same year, I will charge a reasonable, cost-based fee for each additional request.  
6. The Right to Correct or Update Your PHI. If you believe there is a mistake in your PHI, or that critical information is missing from it, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request. 
7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.  

EFFECTIVE DATE OF THIS NOTICE This notice went into effect on September 20, 2013

 APPOINTMENTS AND CANCELLATIONS: Please remember to cancel or reschedule 48 hours in advance. If you cancel with less than 48 hours' notice, you will be responsible for the no-show or late-cancellation fee. You may be discharged from services after three or more late cancellations and no-shows.

The standard duration of psychotherapy is 50 to 60 minutes. However, you are responsible for determining the length of your sessions. Requests to change the 50-minute session must be discussed with the therapist at the scheduled time. A 25.00 service charge may be assessed for each 15-minute increment exceeding an hour. This service charge is not payable by insurance.

Office Wait Times: All scheduled appointments will occur no later than 60 minutes after the scheduled appointment time. Walk-ins during business hours will be seen within two hours of their arrival. If not possible, the appointments will be scheduled for the next business day.

A $30.00 service charge will be assessed for any checks returned for special handling.

Cancellations and rescheduled sessions will be subject to a $75.00 charge if NOT RECEIVED AT LEAST 48 HOURS IN ADVANCE. This is necessary because a time commitment is made to you and is held exclusively for you. You may lose some of that time if you are late for a session.

CREDIT CARD AUTHORIZATION If you are using your insurance, the cost of services is confirmed once the insurance provider processes your claims. SHINE Counseling, PLLC will contact the insurance provider to project out-of-pocket costs. However, note that the final cost determination is confirmed only after SHINE Counseling, PLLC submits claims for each session, and the insurance provider processes them. If you are self-pay, the cost per session may be provided to you before the appointment, and is due on or before the appointment.

SHINE Counseling, PLLC requires that the patient portion of the session be paid by credit/debit card (Visa or Mastercard). This is due to the high incidence of unreported deductibles and the fact that not all health plans have to cover counseling or therapy. By paying by credit/debit card, you acknowledge that your card information will be stored on file in PCI-compliant, encrypted form with the following credit card processor: STRIPE. You further agree and understand that if insurance does not pay the contracted rate for services, any remaining balance due that is the legal patient's responsibility will be charged to this credit/debit card. This amount typically includes copayments, coinsurance, and deductibles that have not yet been met or were misquoted by the insurer.

TELEPHONE ACCESSIBILITY If you need to contact me between sessions, please leave a message on my voicemail. I am often not immediately available; however, I will attempt to return your call within 24 hours. Please note that Face-to-face sessions are highly preferable to virtual sessions. However, if you are out of town, ill, or need additional support, phone sessions are available. If an actual emergency arises, please call 911 or any local emergency room.

CRISIS RESPONSE SERVICES SHINE Counseling, PLLC (SHINE) shall be available to meet the acute needs of a client during periods when they are not physically present in the program. Access to crisis intervention services is provided by qualified staff via a twenty-four-hour-a-day, seven-day-a-week crisis hotline, answered by SHINE staff in Charlotte, North Carolina, at 704-734-9480. Crisis intervention includes face-to-face intervention when clinically indicated. QMHP and/or mental health therapist is available 24 hours a day to take crisis calls. If either is unavailable, a voicemail will provide the caller with regular business hours and after-hours assistance, and/or direct them to contact their appointed therapist. The voice message will also direct the caller to dial 911 if the emergency is immediate and cannot be addressed through the client’s person-centered crisis plan. A SHINE staff member (QMHP or mental health therapist) will lead a review/debriefing following a crisis episode or request for the urgent need of services within 24-48 hours via telephone call or a scheduled face-to-face visit. Staff will provide the usual documentation of the call and, if appropriate, submit it to the relevant managing care organization, incident response improvement system, or other appropriate reporting entity.

SOCIAL MEDIA AND TELECOMMUNICATION Due to the importance of your confidentiality and the importance of minimizing dual relationships, I do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please raise them when we meet, and we can discuss them further.

ELECTRONIC COMMUNICATION I cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, I will do so. While I may try to respond promptly, I cannot guarantee an immediate response, and I request that you do not use these methods to discuss therapeutic content or to request assistance in emergencies.

Services provided electronically, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail, are considered telemedicine under the State of North Carolina. Under the North Carolina Telemedicine Act of 1996, telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another. Suppose you and your therapist choose to use information technology for some or all of your treatment. In that case, you need to understand that: (1) You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled. (2) All existing confidentiality protections are equally applicable. (3) Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee. (4) Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent. (5) There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to, improved communication capabilities; convenient access to up-to-date information, consultations, and support; reduced costs; improved quality; changes in the conditions of practice; improved access to therapy; better continuity of care; and reduced lost work time and travel costs. Effective treatment is often facilitated when the therapist gathers, within a session or a series of sessions, a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, diagnoses, and interventions based not only on direct verbal or auditory communications, written reports, and third-person consultations but also on direct visual and olfactory observations, information, and experiences. When using information technology in therapy services, potential risks include, but are not limited to, the therapist's inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as your physical condition, including deformities, apparent height, and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, essential grooming, and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression. Potential consequences include the therapist's unawareness of what they consider essential information, which you may not recognize as significant to present to them.

MINORS
If you are a minor, your parents may be legally entitled to some information about your therapy. I will discuss with you and your parents which information is appropriate for them to receive, and which issues are best kept confidential.

TERMINATION Ending relationships can be difficult. Therefore, it is vital to have a termination process to achieve closure. The appropriate duration of the termination depends on the treatment duration and intensity. I may terminate treatment after proper discussion with you and a termination process if I determine that the psychotherapy is not being used effectively or if you are in default on payment. I will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, I will provide you with a list of qualified psychotherapists to treat you. You may also choose someone yourself or through another referral source. You are subject to termination if you have three or more late cancellations and or no-shows. Should you fail to schedule an appointment for four consecutive weeks, unless other arrangements have been made in advance, I must, for legal and ethical reasons, consider the professional relationship to be discontinued.

If you are using your insurance benefits, the cost of services is confirmed once your insurer processes your claim. SHINE Counseling, PLLC will contact the insurance provider to estimate out-of-pocket expenses, but the final cost determination is confirmed only after claims for each session are submitted by SHINE Counseling, PLLC and processed by the insurance provider.

SHINE Counseling, PLLC, requires that the patient portion of the session be paid by credit/debit card (Visa or Mastercard). This is due to the high incidence of unreported deductibles and the fact that not all health plans have to cover counseling or therapy. 

By paying via credit/debit card, you acknowledge that this credit/debit card information will be automatically kept on file via PCI-compliant encrypted code with the following credit card processor: STRIPE You further agree and understand that if insurance does not pay the contracted rate for services, any remaining balance due that is the legal patient responsibility will be charged to this credit/debit card. This amount typically includes co-pays, co-insurance, and deductibles that have not yet been met or were misquoted by the insurance provider. 

You can view your account online via the client portal. 

In addition, you authorize SHINE Counseling, PLLC to keep your credit/debit card on file and to charge your credit/debit card accordingly.

 SHINE Counseling, PLLC has a no-refund policy and requires at least 48 hours' notice for cancellations. If cancellation is less than 48 hours, you will be responsible for a cancellation fee of $75.00, regardless of client status as a private pay or insured pay. 

Please remember to cancel or reschedule 48 hours in advance. The standard meeting time for individual, family & couples therapy is 50 minutes. A scheduled appointment is a time commitment made to you and is held exclusively for you.  Therefore, cancellations and rescheduled sessions will be subject to the cancellation fee if NOT RECEIVED AT LEAST 48 HOURS IN ADVANCE. You are responsible for payment before your next scheduled appointment. 

Please note that if you are late for a session, you may lose some of that session time. In addition, frequent cancellations or missed appointments will necessitate a prompt reevaluation of your need for services. This evaluation may result in the termination of services or a referral.

SHINE Counseling, PLLC, will charge the card on file within 24 hours of the appointment. If unable, the appointment may be canceled. However, the client will be notified before its cancellation.

EAP - If you are an EAP client and do not give a 48-hour notice of cancellation, your appointment will be counted as one of your allowed visits. If your EAP doesn’t cover the missed session, then you are responsible for the $75.00 cancellation fee.

Missed Appointments: Missed appointments will be documented in your record. If you miss more than four scheduled appointments, you may be informed that SHINE Counseling, PLLC will be unable to provide additional services, and you will be discharged from the practice.

Late Arrivals: If you arrive more than 10 minutes late to your scheduled appointment, you will be given the option to reschedule. Late Arrivals are considered a no-show.

Appointment Reminders:  Please note that appointment reminders are provided as a courtesy of SHINE Counseling, PLLC.  If you do not receive a reminder, you are responsible for keeping your scheduled appointments.  We encourage you not to rely on reminders as your only means of remembering your appointments.