Patient Rights & Notices

COVID-19 & CANCELLATIONS DUE TO ILLNESS

If you have been traveling or if you believe you are sick, we would rather you be safe and stay home. You may request a Telehealth (video) session in place of an in-person session. We encourage that you contact our office to verify that all the proper documentation has been signed for a Telehealth session prior to your appointment.

A 24-hour notice is required for all cancellations or rescheduling, otherwise a $50 fee will be charged.

Office Phone Number: 940-387-3450 Email: heathyrb@terrellcounseling.com

STANDARD NOTICE
Right to Receive a Good Faith Estimate of Expected Charges”
Under the No
Surprises Act

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

  • Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your health care provider, and any other provider you choose for a Good Faith Estimate before you schedule an item or service.

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

  • Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 940-387-3450

HIPAA Notice of Privacy Practices

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. This notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected health information" is information about you, including demographic information, that may identify you and that is related to your past, present, or future physical or mental health condition and related health care services. 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 as necessary, and any other use required by law. We will use and disclose your protected health information as necessary 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 home health agency that provides care to you; or your protected health information may be provided to a physician to whom you have referred to insure that the physician has the necessary information to diagnose or treat you. Your protected health information will be used, as needed, to obtain payment for your health care services. Your relevant protected health information may be disclosed to the health plan to obtain approval for admission. We may use or disclose, as needed, your protected health information to support the business activities of your counselor's practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of counselors associated with this practice, licensing, marketing and fund-raising activities, and conducting or arranging for other business activities. We may call you by name in the waiting room when the counselor is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to reschedule an appointment. We may use or disclose your protected health information in the following situations without your authorization: communicable diseases, abuse or neglect, food and drug administration requirements, legal proceedings, law enforcement, coroners, and if you present a threat to yourself or to others. Other Permitted and Required Uses and Disclosures will be made only with your consent, authorization and 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 the counselor's practice has taken an action in reliance on the use or disclosure indicated in the authorization. I acknowledge that I have received and understood the HIPPA Notice of Privacy Practices for this office. Consent for Use and Disclosure of Health Information: I hereby permit Terrell Counseling, Inc. to release and furnish all medical and financial data related to my care that may be necessary now or in the future for purposes of treatment, payment, or healthcare operations to assist with, aid in, or facilitate the collection of data for purposes of utilization review, quality assurance, or medical outcomes evaluation purposes. Such information may be released to HMOs, PPOs, managed care organizations, or other governmental or third-party payers, or any organization contracting with any of the above entities to perform such functions. Additionally, I consent to the release of privileged information records and waive the privilege of confidentiality afforded for medical and mental health care and alcohol and drug rehabilitation.



Your Rights as a Client

You have the right to be treated as a capable person, responsible for your own life, for the choices you make, and for your behaviors. You have the right to have your counselor be honest with you regarding the progress of your treatment. In addition, you have the right to terminate counseling services at any time during the course of treatment. It is important to note that the length of therapy can be challenging to predict. Some clients may need a couple of sessions, while other clients may require months or years of therapy sessions. Importantly, you have the right to receive ethically sound and professional services from your counselor. Your counselor aims to provide services in a professional and ethical manner within accepted legal standards. If you are ever dissatisfied with your therapy, please directly discuss these concerns with your counselor. If they are not able to resolve these issues you may report complaints to the Texas Behavioral Health Executive Council at: Address: 333 Guadalupe St., Ste. 3-900 Austin, TX 78701 Phone: 1-800-821-3205 Website: https://www.bhec.texas.gov/discipline-and-complaints/index.html