Practice Policies

APPOINTMENTS

The initial meeting will typically last for 1 hour. In this meeting, we work to listen to your concerns, obtain relevant information and begin to identify some ways to assist you in addressing the problems effecting you. In this session we begin formulating “treatment goals” for therapy. Your clinician will take time to answer any questions you may have and to review our intake forms.

Subsequent meetings are typically 45 to 60 minutes.

PAYMENT FOR SERVICES

We offer three options for payment of service: In-Network Insurance, Out-of-Network Insurance benefits, or Self-Pay.

IN-NETWORK INSURANCE INFORMATION

LICSW level clinicians are in-network with Blue Cross Blue Shield and Massachusetts Behavioral Health Plan (MBHP). LCSW level clinicians can work with BCBS members as a non-credentialed provider under the supervision of Bailey or Christina. Our LCSW level clinicians will be in-network with MBHP in the near future.

It is your responsibility to confirm insurance benefits and eligibility including telehealth coverage before your first meeting. If you have BCBS and you choose to working with a LCSW level clinician you would be advised to confirm that you have "Incident To Billing" covered under your plan.

With an in-network insurance or managed care provider, we will submit the insurance claims directly and accept assignments of benefits. You are responsible for the co-payment, co-insurance or deductible payment at the time of the meeting.

Your insurance company will make the final decision as to whether meetings will be covered or are medically necessary. In all cases, regardless of insurance coverage, you are responsible for payment if your insurance fails to make a payment. Your attendance at a meeting implies your agreement to pay for services. Insurance does not cover cancellation or no-show fees.

Please inform us of any changes in insurance as soon as possible. We do not back-bill for services provided before we were informed of the change in insurance.

By choosing to use your insurance benefits, you are authorizing Mountain View Therapy to use and to disclose member records for purposes of payment and health care operations

OUT-OF-NETWORK INSURANCE INFORMATION

If you have an insurance plan that we are out-of-network for and you wish to use your Out-of-Network benefits, you will be responsible for payment of the full fee at the time of the appointment. Mountain View Therapy will provide you with a superbill to submit to your insurance for reimbursement. It is your responsibility to confirm insurance benefits and eligibility including telehealth coverage before your first meeting.

Please note we do not work with or provide superbills for UnitedHealthCare/United Behavioral Health/Harvard Pilgrim.

For LICSW level providers- Self-pay fees for professional services are $235 for the initial 1-hour meeting and subsequent 1 hour meetings, and $200 for subsequent 45 minute meetings. LCSW level providers are unable to accept Out-of-Network benefits.

If you choose to use your insurance benefits, you are authorizing Mountain View Therapy to use and to disclose member records for purposes of payment and health care operations.

SELF-PAY AND SLIDING SCALE POLICIES

If you wish to opt out of insurance and self-pay for any reason, you may do so and will need to sign an Insurance-Opt-Out form and a Fee Agreement form. You are responsible for the fee at the time of the meeting. However, if you are using a credit card, the card may not be charged until the next business day.

For LICSW level providers- Self-pay fees for professional services are $235 for the initial 1-hour meetings and subsequent 1 hour meetings, and $200 for subsequent 45 minute meetings.

For LCSW level providers- Self-pay fees for professional services are $135 for the initial 1-hour meeting and any subsequent 1-hour meetings, and $100 dollars for subsequent 45-minute meetings.

If the fee for service would generate a financial burden, please inquire about a sliding scale fee so we may explore the possibility of an agreed upon lower fee.

Self-pay fees are subject to change. You can expect a small increase each year to account for inflation and increased overhead costs, and to better reflect market rates for our clinicians' credentials, specialty and experience level. We will provide you with notice at least 30 days in advance.

CANCELLATIONS

We have a 48 hour cancellation fee. Please remember to cancel or reschedule 48 hours in advance. You will be responsible for the $85 dollar late cancellation/no-show fee if cancellation is less than 48 hours. When you schedule an appointment, time is reserved for you. A timely cancellation allows your clinician to schedule other clients who may be waiting to meet. I appreciate your understanding and consideration.

--> Please note that cancellation fees cannot be billed to your insurance.

--> If you are late for a session, you may lose some of that session time. If you are more than 15 minutes late it may be treated as a no-show and you may reschedule your appointment.

--> The only exceptions to the cancellation/no-show fee are severe medical emergencies.

--> After 3 late cancellations or missed appointments, we will discuss decreasing the frequency of meetings or discontinuing therapy.

This late cancellation/no-show fee does not apply to clients using Masshealth (MBHP) plans for insurance. Masshealth prohibits charging of cancellation fees, but after 3 late cancellations or missed appointments, we will discuss decreasing the frequency or discontinuing therapy.

ADDITIONAL FEES

If additional reports or meetings not covered by the insurance company are needed, you are responsible for paying Mountain View Therapy for the time it takes to write these reports and/or attend these meetings. Reports that would incur a fee would be for, but not limited to: a disability claim and worker’s compensation. Meetings that would incur a fee are, but not limited to: attending an IEP meeting, speaking with an attorney and testifying at court. If a clinician is needed for court, fees may include time lost for cancelled sessions, time for preparation, travel, or waiting, even if the need for testimony is cancelled.

Telephone conversations, preparation of reports and required discussion with third parties are charged at the relevant hourly rate. If a clinician is needed to testify in court you will be charged $300/hour plus travel time and expenses due to the amount of time this takes from the clinic, other clients, and for preparation.

TELEPHONE/TEXT/EMAIL COMMUNICATION

If you need to contact your clinician urgently you can leave them a voice mail and they will try to return your call between meetings. Our practice at Mountain View Therapy is to make every attempt to return phone calls within 24 hours. We do not provide crisis intervention; If a true emergency situation arises, please call 988 for mental health crises, or call 911, or go to your local emergency room.

Confidentiality of communication cannot through phone, email or text message. Mountain View Therapy practice is to use these forms of communication to communicate logistical or scheduling concerns. We do not use these methods of communication to discuss therapeutic content or request assistance for emergencies. If you choose to communicate protected health information via phone call, email or text, it will indicate that you accept the possible risks associated with such communication.

If you contact your clinician in any manner with a message that indicates a possible emergency or life-threatening situation, you and/or your guardian reserve them the right to make a professional judgment to reach out to the appropriate emergency services or your emergency contact person. We will not be held liable when sharing the information to emergency services or your emergency contact person.

SOCIAL MEDIA

Due to the importance of your confidentiality and the importance of minimizing dual relationships, is Mountain View Therapy's practice that clinicians do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). Adding clients as friends or contacts on these sites creates potential to compromise your confidentiality and your clinicians respective privacy.

COMMUNICATION OUTSIDE OF THERAPY

If your clinician sees you accidentally outside of therapy, they will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to us, and we do not wish to jeopardize your privacy. However, if you acknowledge your clinician first, they will speak briefly with you. Lengthy discussions in public or outside of therapy creates potential to compromise your confidentiality and your clinicians respective privacy.

COUPLES/PARTNERS NO SECRETS POLICY

At Mountain View Therapy we do not keep “secrets” between couples/partners participating in therapy. Your clinician may choose to see one of you for an individual meeting but those meeting should bee seen as part of the work being done with the couple/partners. You clinician may need to share information from the individual meeting with the other partner(s). They will use their best judgment when making decisions as to whether, when, and to what extent such a disclosure would be made. When possible they will give the individual the opportunity to make the disclosure. If you would like to discuss matters that you do not want to be shared with your partner(s) we can set you up with an individual therapist.

MINORS

If you are a minor, your parents/guardian may be legally entitled to some information about your therapy. It is our practice at Mountain View Therapy to negotiate with parent and child what information is appropriate for the parent to receive and which issues are more appropriately kept confidential.

TELEHEALTH

Mountain View Therapy is a virtual practice and we use the HIPAA compliant telehealth platform Simple Practice. There will be no recording of meetings by either party unless consented to. Meetings cannot be conducted if you are driving, intoxicated or inappropriately dressed.

Potential risks include but are not limited to disruption of transmission by technology failures, interruption and/or breaches of confidentiality by unauthorized persons, and limited ability to respond to emergencies. If you get disconnected please exit and enter the virtual meeting again. If there continues to be a problem, clinician will call/text you to determine next steps.

State law requires that you be physically located in a state where your provider is licensed during a meeting. You must provide your exact address (in Massachusetts, or for Bailey’s clients- Massachusetts or Florida) at the beginning of each meeting for me to document. You must also have an emergency contact person on file for me to contact on behalf of a life-threatening emergency.

If you are experiencing suicidal or homicidal thoughts, actively experiencing psychotic symptoms or experiencing a mental health crisis that cannot be resolved remotely, it may be determined that telehealth is not an appropriate medium and a higher level of care may be required.

RECORDS

Standards of profession require that Mountain View Therapy maintain appropriate records of the work you do with your clinician, and these records will be maintained indefinitely. You have the right to these records at your request.


PRIVACY PRACTICES AND PATIENT'S RIGHTS

Your health record contains personal information about you and your health. This information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law, including the Health Insurance Portability and Accountability Act (“HIPAA”), regulations promulgated under HIPAA including the HIPAA Privacy and Security Rules, the NASW Code of Ethics and Massachusetts statutes and regulations. It also describes your rights regarding how you may gain access to and control your PHI.

We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will provide you with a copy of the revised Notice of Privacy Practices by email, sending a copy to you in the mail upon request or providing one to you at your next appointment.

The rules of confidentiality are complicated and governed by numerous statutes and regulations. If you have any questions, it is your right and obligation to ask for further clarification before you sign this document. If you have any additional concerns regarding your rights, it is best to seek legal counsel from an attorney in advance of undertaking the therapeutic process.

I. USES AND DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS, REQUIRING CONSENT

We may use or disclose your PHI for treatment, payment and health care operations purposes with your consent as discussed below:

For Treatment. Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with clinical supervisors or other treatment team members. An example of treatment would be when we consult with another health care provider, such as a family physician or another social worker for peer consultation when necessary and appropriate. We will attempt to protect your identifying information to preserve confidentiality, but we will seek consultation under our discretion without obtaining informed consent. We may disclose PHI to any other consultant only with your authorization.

For Payment. We may use and disclose PHI so that we can receive payment for the treatment services provided to you. This will only be done with your consent. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purposes of collection.

For Health Care Operations. We may use or disclose, as needed, your PHI in order to support our business activities including, but not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities. For example, we may share your PHI with third parties that perform various business activities (e.g., billing or typing services) provided we have a written contract with the business that requires it to safeguard the privacy of your PHI.

II. USES AND DISCLOSURES REQUIRING AUTHORIZATION

Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked at any time, except to the extent that we have already made a use or disclosure based upon your authorization. The following uses and disclosures will be made only with your written authorization:

  • to speak with outside providers, people in your care team

  • most uses and disclosures of PHI for marketing purposes

  • disclosures that constitute a sale of PHI

  • For training or teaching purposes

  • For disclosure or psychotherapy notes which are different from your progress notes and separate from your health record

  • other uses and disclosures not described in this Notice of Privacy Practices.

III. USES AND DISCLOSURES WITH NEITHER CONSENT NOR AUTHORIZATION

We may use or disclose PHI without your consent or authorization in the following circumstances:

Serious Threat to Your own Health or Safety: If you present a clear and present danger to yourself and refuse to accept further appropriate treatment, and I have a reasonable basis to believe that you can be committed to a hospital, I must seek said commitment and may contact members of your family, a crisis intervention team or other individuals if it would assist in protecting you.

Serious Threat to others (Duty to Warn): If you communicate to me an explicit threat to kill or inflict serious bodily injury upon an identified person and you have the apparent intent and ability to carry out the threat, I must take reasonable precautions. Reasonable precautions may include warning the potential victim, notifying law enforcement, or arranging for your hospitalization. I must also do so if I know you have a history of physical violence and I believe there is a clear and present danger that you will attempt to kill or inflict bodily injury upon an identified person.

Child Abuse: If we, in our professional capacity, have reasonable cause to believe that a minor child is suffering physical or emotional injury resulting from abuse inflicted upon him or her which causes harm or substantial risk of harm to the child's health or welfare (including sexual abuse), or from neglect, including malnutrition, we must immediately report such condition to the Massachusetts Department of Children and Families.

Elder Abuse: If we have reasonable cause to believe that an elderly person (age 60 or older) is suffering from or has died as a result of abuse, we must immediately make a report to the Massachusetts Department of Elder Affairs.

Abuse of a Disabled Person: If we have reasonable cause to suspect abuse of an adult (ages 18-59) with mental or physical disabilities, we must immediately make a report to the Massachusetts Disabled Persons Protection Commission.

Health Oversight: The Board of Registration of Social Workers has the power, when necessary, to subpoena relevant records should we be the focus of an inquiry.

Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment and the records thereof, such information is privileged under state law and we will not release information without written authorization from you or your legally-appointed representative, or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court-ordered. You will be informed in advance if this is the case. I can also disclose PHI in the event that I need to defend myself in legal proceedings if you call action against me in a lawsuit.

Worker’s Compensation: If you file a workers’ compensation claim, your records relevant to that claim will not be confidential to entities such as your employer, the insurer and the Division of Worker’s Compensation.

Specialized Government Functions: We may review requests from U.S. military command authorities if you have served as a member of the armed forces, authorized officials for national security and intelligence reasons and to the Department of State for medical suitability determinations, and disclose your PHI based on your written consent, mandatory disclosure laws and the need to prevent serious harm.

Public Health: If required, we may use or disclose your PHI for mandatory public health activities to a public health authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, or if directed by a public health authority, to a government agency that is collaborating with that public health authority.

Medical Referrals

Coroners, medical examiners or funeral directors

IV. YOUR RIGHTS AND OUR OBLIGATIONS

Patient’s Rights:

You have the following rights regarding PHI we maintain about you:

  • Right of Access to Inspect and Copy. You have the right to inspect or obtain a copy (or both) of PHI and progress notes in our mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. Your access may be denied in certain circumstances, but in some cases, you may be able to have this decision reviewed. On your request, we will discuss with you the details of the request and denial process. We may charge a reasonable, cost-based fee for copies. If your records are maintained electronically, you may also request an electronic copy of your PHI. You may also request that a copy of your PHI be provided to another person.

  • Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information although we are not required to agree to the amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy. On your request, we will provide you with details of the amendment process.

  • Right to an Accounting of Disclosures. You have the right to request an accounting of PHI for which you have neither provided authorization nor consent. On request, we will discuss with you the details of the accounting process. We may charge you a reasonable fee if you request more than one accounting in any 12-month period.

  • Right to Request Restrictions. You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. We are not required to agree to your request unless the request is to restrict disclosure of PHI to a health plan for purposes of carrying out payment or health care operations, and the PHI pertains to a health care item or service that you paid for out of pocket. In that case, we are required to honor your request for a restriction.

  • Right to not disclose PHI to a health plan if you pay out of pocket.

  • Right to Receive Confidential Communications by Alternative Means and at Alternative Locations. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. We will accommodate reasonable requests. (For instance, you may not want a family member to know you are seeing us. Upon your request, we will send your bills to another address.) We may require information regarding how payment will be handled or specification of an alternative address or other method of contact as a condition for accommodating your request. We will not ask you for an explanation of why you are making the request.

  • Breach Notification. If there is a breach of unsecured PHI concerning you, we may be required to notify you of this breach, including what happened and what you can do to protect yourself.

  • Right to a Paper Copy of this Notice. You have the right to a paper copy of this notice upon request, even if you have agreed to receive the notice electronically.

Our Obligations:

  • We are required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI.

  • We reserve the right to change the privacy practices described in this Notice. Unless we notify you of such changes, however, we are required to comply with the terms currently in effect.

  • If we revise our privacy practices, we will provide you with a revised notice by email.

V. COMPLAINTS

If you believe we have violated your privacy rights or you disagree with a decision we made about access to your records, you may contact our HIPAA Compliance Officer, Christina Peterson, LICSW at 518-435-5116 or christina@mountainviewtherapyma.com. You may also send a written complaint to the Secretary of Health and Human Services at 200 Independence Avenue, S.W. Washington, D.C. 20201 or by calling (202) 619-0257. We will not retaliate against you for filing a complaint.

This policy went into effect on March 10, 2021