Insurance
What should I know about mental health insurance?
Insurance companies require using a mental disorder diagnosis to justify reimbursement. Many relationship/parenting problems don’t fall into mental disorder categories and would not be covered. Your insurance company may not pay for anything outside of these categories and you would be expected to pay for professional counseling services.
Some problems do fit into a mental disorder diagnosis, such as depression or anxiety, and are covered by insurance plans. Use of insurance for counseling means a record of treatment for a mental disorder on your files at the insurance company and/or your place of employment. You must decide if this is a concern or not.
In order to continue reimbursements, some insurance companies require evidence of your continued mental disorder that must be provided by the therapist on a regular basis to warrant further treatment. At the same time, evidence of progress must be provided. This evidence may be considered personal and private information by you. Some insurance companies evaluate the evidence and make the decision whether you are to continue counseling or not. Again, you must decide if this is a process you are comfortable with.
Some of my clients prefer to pay privately without using their insurance due to privacy concerns. On the other hand, other clients are comfortable using their insurance coverage as a resource they have already paid into, making counseling more affordable. I am currently on the Provider list for Premera/Blue Cross Insurance, LifeWise Assurance, Regence Blue Shield Insurance, First Choice Health, Kaiser, and ValueOptions. If you would like to discuss your options about working with me with or without using insurance, please call me at (206) 393-8478 or e-mail me at elsa@drelsahwee.com.
Privacy and HIPAA
How your privacy is protected
Elsa Hwee, Psy. D. / Licensed Psychologist
Disclosure Statement for Psychological Services
And
HIPAA Notice of Privacy Practices
This document contains important information about my professional services and business policies and how it applies to your personal mental health care. It also contains information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protection and patient rights regarding the use and disclosure of and access to your Protected Health Information (PHI) used for treatment, payment, and health care operations. Your signature acknowledges that I have provided you with this information and that you understand and agree. Although this document is long and complex, it is very important that your read it carefully. Please ask me to explain anything you do not understand. When you sign this, it will represent an agreement between us. You may revoke this agreement in writing at any time.
Parties to the Professional Relationship: The professionals in this suite share only the physical facilities. Each of our practices is separate and independent of the other. My professional records are separately maintained and no other professionals have access to them without your specific, written permission. I alone am fully responsible for services provided to you. Therefore, this agreement is entirely between you and me, Elsa Hwee, Psy. D., a licensed psychologist practicing independently.
Therapeutic Orientation and Course of Treatment: Treatment is specifically designed and adapted to the needs of each client and the typical duration of treatment is highly variable. I believe problems can be identified and solutions defined in a straightforward and understandable manner. Please feel free to ask about the strategies I am using or the expected goals or outcomes of your therapy or for that of your child.
Psychotherapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, psychotherapy has also been shown to have many benefits. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. But there are no guarantees of what you will experience.
During our first few sessions, your needs will be evaluated and we can both decide if I am the best person to provide the services you need in order to meet your treatment goals. I will be able to offer you some first impressions of what our work will include and a treatment plan to follow, if you decide to continue with therapy. You should evaluate this information along with your own opinions of whether you feel comfortable working with me. Therapy involves a large commitment of time, money, and energy, so you should be very careful about the therapist you select. If you have questions about my procedures, we should discuss them whenever they arise. If your doubts persist, I will be happy to help you set up a meeting with another mental health professional for a second opinion or make a referral.
Psychotherapy with children and adults can take three to six sessions to identify the major areas of therapeutic focus, followed by treatment sessions. For adult and adolescent issues, a cognitive-behavioral theoretical approach is used to help individuals identify, evaluate, and change thoughts, assumptions, beliefs, and expectations which influence feelings and behavior. With teens, I may act as a facilitator between parents and teen to enhance communication and foster understanding. For young children, therapy can take the form of games, stories, play, and art as a child expresses thoughts and feelings. Parents may be given parenting support and suggestions on how to support their child. I also provide regular updates to parents of young children.
Screening for for Attention Deficit Disorder includes gathering information from a number of sources, including parents, teachers, and my own observations. As needed, I may conduct initial screening and then refer you to another professional to conduct formal evaluation. I am available to help coordinate therapy goals and treatment once the evaluation is completed.
Once psychotherapy is begun, your specific needs and goals and the treatment plan I recommend will be coordinated to determine how often we should meet together. We will also establish points at which to evaluate your satisfaction and progress. In the latter stages, we will also discuss how many more sessions would be recommended before terminating therapy. Typically, the therapeutic relationship ends as your goals are attained and we wind down slowly. For children this process ends when the reasons for their coming are stabilized, the symptoms are within acceptable limits, and the child is functioning satisfactorily at home and in school. Even after we have ended, “check-in” or “booster” sessions are available to focus on old concerns or new ones, should they arise. I am available as an ongoing resource for you to use as is needed.
Although you may terminate your therapy whenever you wish, it is most helpful to have at least one session together to summarize your progress, define the work that remains, and to say good-bye. You may at any time request a change in treatment or a referral to another provider.
Reports: Written reports or extended letters to other mental health, medical, legal or educational agencies are an additional expense to the actual assessment and treatment sessions. These reports are charged according to the time taken to prepare them. This usually means one and a half to three hours.
Clients have a responsibility to be informed consumers. As such, you are responsible for choosing the provider and treatment modality which best suits your needs. You may, at any time, refuse or request a change in treatment or a referral to another therapist. You are expected to actively participate in your therapy. Keeping your appointments and completing various homework assignments will be an important part of the process to help facilitate your progress.
My personal Christian beliefs and values influence my perspective. At the same time, the beliefs and values of my clients are treated with respect. The therapeutic process should be characterized by openness and a collaborative attitude on both of our parts. Please feel free to share any concerns and ask questions about any aspect of the counseling process. This may include the treatment approach used, your treatment goals and progress toward those goals, and the termination process.
Ethics and Standards: I follow the code of ethics of the American Psychological Association, (available in the office for your review) as well as the ethical and professional standards of the Washington State Psychology Licensing Law (RCW 18.83, 18.130, WAC 246-924) which are available on-line at www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/Psychologist/Laws. If you have questions or concerns about the treatment you receive in this office please feel free to discuss them with me. In addition, or instead, you may contact the Examining Board of Psychology in Olympia, Washington at (206) 753-2147 and/or the Washington State Psychological Association’s Professional Ethics and Standards Review Committee in Seattle, at (206) 363-9772.
Education and Training: I have a B.S. in Psychology, University of Calgary; M.A. and Psy. D. in Clinical Psychology, Western Baptist Seminary, Portland, OR. My clinical experience has been in a university counseling center, community mental health clinics, residential treatment centers, and in private practice. I received post graduate supervision for licensure as Psychologist, State of Washington, #2005.
Fees: The standard fees are $125.00 per 45 minutes, $160.00 per 55-60 minutes, $175 per evaluation session. Payment is requested at the start of each contact unless other arrangements are made in advance. There will be a $25.00 charge for all returned checks. Also, charges may be made for procedures test supplies, questionnaires, inventories, test scoring and interpretation, report preparation, extended phone calls, sessions where the identified client is not present, and missed appointments.
If you become involved in a litigation that requires my participation, you will be expected to pay for the professional time required including preparation, time reserved for testimony and travel time with a retainer required in advanced. Because of the complexity and difficulty of legal involvement, these fees are one and a half times the standard fee.
If my attendance is required at meetings or conferences held at locations other than my office, charges will be made for travel time as well as the time spent in conference.
Charges may be incurred for requests for client records. This will include the time for searching, duplicating, summarizing, or preparing written descriptions of the record. I may ask for this fee to be paid prior to release of the material. The standard fee for this service is $175.0.
Cancellations and Missed Appointments: There is no charge for appointments that are canceled more than 24 hours in advance of the scheduled appointment time. Except in the case of an emergency or other unavoidable circumstance, a charge will be made for missed appointments. Missed appointments will be charged at the regular rate, charged to the client, not insurance.
Unpaid Bills: Accounts not paid according to the guidelines above are both a business and a therapy concern. If payment is not made as agreed to, there may be some anxiety or discomfort that can decrease the effectiveness of treatment. If your account is overdue, I will discuss this with you, and every effort will be made to arrive at a mutually agreeable plan for bringing the account current. In general, I will limit a client’s debt to the cost of two unpaid sessions. No further appointments will be set until the account has been paid in full. If the costs are related to problems with insurance reimbursement, I will discuss this with you and work to find a solution.
HIPAA Notice of Privacy Practice
It is my legal duty to safeguard your Protected Health Information (PHI). By law I am required to insure that your PHI is kept private. The PHI constitutes information created or noted by me that can be used to identify you. It contains data about your past, present, or future health or condition, the provision of health care services to you, or the payment for such health care. I am required to provide you with this Notice about my privacy procedures. This Notice must explain when, why, and how I would use and/or disclose your PHI. Use of PHI means when I share, apply, utilize, examine, or analyze information within my practice; PHI is disclosed when I release, transfer, give, or otherwise reveal it to a third party outside my practice. With some exceptions, I may not use or disclose more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is made; however, I am always legally required to follow the privacy practices described in this Notice.
Please note that I reserve the right to change the terms of this Notice and my privacy policies at any time as permitted by law. Any changes will apply to PHI already on file with me. Before I make any important changes to my policies, I will immediately change this Notice and post a new copy of it in my office and on my website (if applicable). You may also request a copy of this Notice from me, or you can view a copy of it in my office or on my website, which is located at (insert website address, if applicable).
How I will use and disclose your PHI. I will use and disclose your PHI for many different reasons. Some of the uses or disclosures will require your prior written authorization; others, however, will not. Below you will find the different categories of my uses and disclosures, with some examples.
A. Uses and Disclosures Related to Treatment, Payment, or Health Care Operations Do Not Require Your Prior Written Consent. I may use and disclose your PHI without your consent for the following reasons:
1. For treatment. I can use your PHI within my practice to provide you with mental health treatment, including disclosing your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are otherwise involved in your care. Example: If a psychiatrist is treating you, I may disclose your PHI to her/him in order to coordinate your care.
2. For health care operations. I may disclose your PHI to facilitate the efficient and correct operation of my practice. Examples: Quality control - I might use your PHI in the evaluation of the quality of health care services that you have received or to evaluate the performance of the health care professionals who provided you with these services. I may also provide your PHI to my attorneys, accountants, consultants, and others to make sure that I am in compliance with applicable laws.
3. To obtain payment for treatment. I may use and disclose your PHI to bill and collect payment for the treatment and services I provided you. Example: I might send your PHI to your insurance company or health plan in order to get payment for the health care services that I have provided to you. I could also provide your PHI to business associates, such as billing companies, claims processing companies, and others that process health care claims for my office.
4. Other disclosures. Examples: Your consent isn't required if you need emergency treatment provided that I attempt to get your consent after treatment is rendered. In the event that I try to get your consent but you are unable to communicate with me (for example, if you are unconscious or in severe pain) but I think that you would consent to such treatment if you could, I may disclose your PHI.
B. Certain Other Uses and Disclosures Do Not Require Your Consent. I may use and/or disclose your PHI without your consent or authorization for the following reasons:
1. When disclosure is required by federal, state, or local law; judicial, board, or administrative proceedings; or, law enforcement. Example: I may make a disclosure to the appropriate officials when a law requires me to report information to government agencies, law enforcement personnel and/or in an administrative proceeding.
2. If disclosure is compelled by a party to a proceeding before a court of an administrative agency pursuant to its lawful authority.
3. If disclosure is required by a search warrant lawfully issued to a governmental law enforcement agency.
4. If disclosure is compelled by the patient or the patient's representative pursuant to WA Health and Safety
Codes or to corresponding federal statutes of regulations, such as the Privacy Rule that requires this Notice.
5. to avoid harm. I may provide PHI to law enforcement personnel or persons able to prevent or mitigate a serious threat to the health or safety of a person or the public (i.e., adverse reaction to meds).
6. If disclosure is compelled or permitted by the fact that you are in such mental or emotional condition as to be dangerous to yourself or the person or property of others, and if I determine that disclosure is necessary to prevent the threatened danger.
7. If disclosure is mandated by the WA Child Abuse and Neglect Reporting law. For example, if I have a reasonable suspicion of child abuse or neglect.
8. If disclosure is mandated by the WA Elder/Dependent Adult Abuse Reporting law. For example, if I have a reasonable suspicion of elder abuse or dependent adult abuse.
9. If disclosure is compelled or permitted by the fact that you tell me of a serious/imminent threat of physical violence by you against a reasonably identifiable victim or victims.
10. For public health activities. Example: In the event of your death, if a disclosure is permitted or compelled, I may need to give the county coroner information about you.
11. For health oversight activities. Example: I may be required to provide information to assist the government in the course of an investigation or inspection of a health care organization or provider.
12. For specific government functions. Examples: I may disclose PHI of military personnel and veterans under certain circumstances. Also, I may disclose PHI in the interests of national security, such as protecting the President of the United States or assisting with intelligence operations.
13. For research purposes. In certain circumstances, I may provide PHI in order to conduct medical research.
14. For Workers' Compensation purposes. I may provide PHI in order to comply with Workers' Compensation laws.
15. Appointment reminders and health related benefits or services. Examples: I may use PHI to provide appointment reminders. I may use PHI to give you information about alternative treatment options, or other health care services or benefits I offer.
16. If an arbitrator or arbitration panel compels disclosure, when arbitration is lawfully requested by either party, pursuant to subpoena duces tectum (e.g., a subpoena for mental health records) or any other provision authorizing disclosure in a proceeding before an arbitrator or arbitration panel.
17. If disclosure is required or permitted to a health oversight agency for oversight activities authorized by law. Example: When compelled by U.S. Secretary of Health and Human Services to investigate or assess my compliance with HIPAA regulations.
18. If disclosure is otherwise specifically required by law.
C. Certain Uses and Disclosures Require You to Have the Opportunity to Object. Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other individual who you indicate is involved in your care or responsible for the payment for your health care, unless you object in whole or in part. Retroactive consent may be obtained in emergency situations.
Other Uses and Disclosures Require Your Prior Written Authorization. In any other situation not described in Sections A, B, and C above, I will request your written authorization before using or disclosing any of your PHI. Even if you have signed an authorization to disclose your PHI, you may later revoke that authorization, in writing, to stop any future uses and disclosures (assuming that I haven't taken any action subsequent to the original authorization) of your PHI by me.
Your Rights Regarding Your PHI
These are your rights with respect to your PHI:
The Right to See and Get Copies of Your PHI. In general, you have the right to see your PHI that is in my possession, or to get copies of it; however, you must request it in writing. If I do not have your PHI, but I know who does, I will advise you how you can get it. You will receive a response from me within 15 working days of my receiving your written request. Under certain circumstances, I may feel I must deny your request, but if I do, I will give you, in writing, the reasons for the denial. I will also explain your right to have my denial reviewed. If you ask for copies of your PHI, I will charge you $1.12 page for the first 30 pages, $.84 per page after that, plus $25 handling charge, payment due in advance. I may see fit to provide you with a summary or explanation of the PHI, but only if you agree to it, as well as to the cost, in advance.
The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask that I limit how I use and disclose your PHI. While I will consider your request, I am not legally bound to agree. If I do agree to your request, I will put those limits in writing and abide by them except in emergency situations. You do not have the right to limit the uses and disclosures that I am legally required or permitted to make.
The Right to Choose How I Send Your PHI to You. It is your right to ask that your PHI be sent to you at an alternate address (for example, sending information to your work address rather than your home address) or by an alternate method (for example, via email instead of by regular mail). I am obliged to agree to your request providing that I can give you the PHI, in the format you requested, without undue inconvenience. I may not require an explanation from you as to the basis of your request as a condition of providing communications on a confidential basis.
The Right to Get a List of the Disclosures I Have Made. You are entitled to a list of disclosures of your PHI that I have made. The list will not include uses or disclosures to which you have already consented, i.e., those for treatment, payment, or health care operations, sent directly to you, or to your family; neither will the list include disclosures made for national security purposes, to corrections or law enforcement personnel. Disclosure records will be held for six years.
I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I give you will include disclosures made in the previous six years unless you indicate a shorter period. The list will include the date of the disclosure, to whom PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. I will provide the list to you at no cost, unless you make more than one request in the same year, in which case I will charge you a reasonable sum based on a set fee for each additional request.
The Right to Amend Your PHI. If you believe that there is some error in your PHI or that important information has been omitted, it is your right to request that I correct the existing information or add the missing information. Your request and the reason for the request must be made in writing. You will receive a response within 60 days of my receipt of your request. I may deny your request, in writing, if I find that: the PHI is (a) correct and complete, (b) forbidden to be disclosed, (c) not part of my records, or (d) written by someone other than me. My denial must be in writing and must state the reasons for the denial. It must also explain your right to file a written statement objecting to the denial. If you do not file a written objection, you still have the right to ask that your request and my denial be attached to any future disclosures of your PHI. If I approve your request, I will make the change(s) to your PHI. Additionally, I will tell you that the changes have been made, and I will advise all others who need to know about the change(s) to your PHI.
The Right to Get This Notice by Email. You have the right to get this notice by email. You have the right to request a paper copy of it, as well.
How to complain about my Privacy Practices If, in your opinion, I may have violated your privacy rights, or if you object to a decision I made about access to your PHI, you are entitled to file a complaint with me. You may also send a written complaint to the Secretary of the Department of Health and Human Services at 200 Independence Avenue S.W. Washington, D.C. 20201. If you file a complaint about my privacy practices, I will take no retaliatory action against you.
Notification of Breaches: In the case of a breach, [Insert therapist's name] requires to notify each affected individual whose unsecured PHI has been compromised. Even if such a breach was caused by a business associate, [Insert therapist's name] is ultimately responsible for providing the notification directly or via the business associate. If the breach involves more than 500 persons, OCR must be notified in accordance with instructions posted on its website. [Insert therapist's name] bears the ultimate burden of proof to demonstrate that all notifications were given or that the impermissible use or disclosure of PHI did not constitute a breach and must maintain supporting documentation, including documentation pertaining to the risk assessment.
PHI After Death: Generally, PHI excludes any health information of a person who has been deceased for more than 50 years after the date of death. [Insert therapist's name] may disclose deceased individuals' PHI to non-family members, as well as family members, who were involved in the care or payment for healthcare of the decedent prior to death; however, the disclosure must be limited to PHI relevant to such care or payment and cannot be inconsistent with any prior expressed preference of the deceased individual.
Individuals' Right to Restrict Disclosures; Right of Access: To implement the 2013 HITECH Act, Elsa Hwee, Psy. D. is required to restrict the disclosure of PHI about you, the patient, to a health plan, upon request, if the disclosure is for the purpose of carrying out payment or healthcare operations and is not otherwise required by law. The PHI must pertain solely to a healthcare item or service for which you have paid the covered entity in full. (OCR clarifies that the adopted provisions do not require that covered healthcare providers create separate medical records or otherwise segregate PHI subject to a restrict healthcare item or service; rather, providers need to employ a method to flag or note restrictions of PHI to ensure that such PHI is not inadvertently sent or made accessible to a health plan.)
The 2013 Amendments also adopt the proposal in the interim rule requiring Elsa Hwee. Psy. D., to provide you, the patient, a copy of PHI to any individual patient requesting it in electronic form. The electronic format must be provided to you if it is readily producible. OCR clarifies that [Insert therapist's name] must provide you only with an electronic copy of their PHI, not direct access to their electronic health record systems. The 2013 Amendments also give you the right to direct Elsa Hwee, Psy. D. to transmit an electronic copy of PHI to an entity or person designated by the you. Furthermore, the amendments restrict the fees that Elsa Hwee, Psy. D. may charge you for handling and reproduction of PHI, which must be reasonable, cost-based and identify separately the labor for copying PHI (if any). Finally, the 2013 Amendments modify the timeliness requirement for right of access, from up to 90 days currently permitted to 30 days, with a one-time extension of 30 additional days.
NPP (Notice of Privacy Practices) Most uses and disclosures of psychotherapy notes, marketing disclosures and sale of PHI do require prior authorization by you, and you have the right to be notified in case of a breach of unsecured PHI.
Consent to Treatment: Your signature below indicates that you have read and received copies of Therapist Disclosure Statement and HIPAA Notice of Privacy Practices (this form) and the Considering Seeking Help From a Psychologist? brochure, and that you understand and agree to all the provisions contained in these materials. A photocopy of this form and signature shall be considered as valid as the original.
Persons 13 years and older must also sign this consent. If you are a minor authorizing services, a parent or guardian must also sign this agreement if they are responsible for payment. If your parent or guardian is not responsible for payment, some other formal arrangement for payment must accompany this document.
Client Signature _______________________________________________________
Date _________________________
(if minor: birth date)_______________________________________
Parent/Guardian Signature ______________________________________________
Date _________________________
Parent/Guardian Signature ______________________________________________
Date _________________________
Elsa Hwee, Psy. D. _____________________________________________________
Date _________________________
