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No Surprises Act:

  • As of January 1, 2022 you have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. The “Good Faith Estimate” explains how much your medical and mental health care will cost. 

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

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. Your medical and behavioral health treatment information and records are personal and private, including the provision of services to you or the payment for such care. The Albani Group and its clinicians, personnel and authorized representatives (“Company” or “We”, “us”, “our”) are committed to protecting your health information. The medical and behavioral health information we create and maintain for you is known as Protected Health Information, or PHI. We are required by Federal and State laws to protect the privacy of your medical and behavioral health information. We are required by law to provide you with this notice of our legal duties and privacy practices with respect to your medical and behavioral health information.  If you are a parent or legal guardian receiving this notice, please understand when we say “you” or “your” in this notice, we are referring to your or your child’s PHI.

    HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION

    The following categories describe different ways that we use your PHI and disclose PHI to persons and entities outside of the Company. We have not listed every use or disclosure within the categories below, but all permitted uses and disclosures will fall within one of the following categories.

    Disclosure at Your Request. We may disclose your medical information when requested by you. This disclosure at your request may require a written authorization by you. “Disclosure” applies to activities outside of our practice group such as releasing, transferring or providing access to information about you to other parties. “Authorization” means written permission for specific uses or disclosures.

    For Treatment. We may use and disclose PHI to provide, coordinate or manage your treatment and related services. “Use” applies only to activities within our practice group such as sharing, employing, applying, utilizing, examining and analyzing information that identifies you. “Treatment is when we or another provider diagnoses or treats you. An example of treatment would be consulting with another provider such as another psychologist or family physician regarding your treatment.

    For Payment. We may use and disclose PHI so treatment and services received at or from our organization may be billed and payment collected. “Payment” is when we obtain payment or reimbursement for your healthcare. Examples of payment by others are when we disclose your PHI to your insurer, if applicable, to obtain reimbursement for your health care or to determine eligibility or coverage.

    Among Participants. We may share information within the Company, as necessary to carry out treatment, payment or operations.

    For Appointment Reminders. We may use and disclose PHI to contact you with a reminder about an appointment for treatment. You will inform us if you would prefer Company does not send appointment reminders.

    Individuals Involved in Care or Payment for Care. Unless you specifically tell us in advance not to do so, we may disclose PHI to a friend or family member who is involved in your care or who helps pay for your care. For example, if you bring a friend or family member to your appointment and have that person in the room while talking with a clinician, your clinician may respond with information about your private health information. You will inform us in writing if you object to disclosures to your family and friends in such circumstances.

    As Required by Law. We will disclose PHI about you when required by federal, state or local laws.

    Military Personnel. If you are a member of the United States or foreign armed forces, we may release PHI about you as required by military command or government authorities.

    Workers’ Compensation. We may release PHI for worker’s compensation or similar programs if you have a work related injury.

    To Avert Serious Threat to Health and Safety. We may use and disclose PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would be to someone able to prevent harm to the health or safety of you, another person or the public.

    Health Oversight Activities. We may disclose PHI to a health oversight agency for activities authorized or required by law. For example, these activities may include audits, investigations, inspections and licensure. These activities are necessary for the government to monitor compliance with laws. If a complaint is filed against Company with the California Board of Psychology or the California Board of Behavioral Science, those organizations and any other applicable organization may have the authority to subpoena confidential mental health information from Company relevant to that complaint.

    Lawsuits and Disputes. If you are involved in a lawsuit or a legal dispute, we may disclose PHI in response to a court or administrative order. We may disclose such information in response to a subpoena, discovery request or other lawful process by someone involved in the legal dispute. We would only disclose this information if efforts have been made to tell you about the request so you may obtain an order protecting the information requested.

    Judicial or Administrative Proceedings: Company may use and disclose your PHI when required by Federal, State, or local law. Company will make efforts to inform you in advance if this is the case. Patient privilege may not apply when you are being evaluated for a third party or where the evaluation is court ordered.

    Law Enforcement. We may disclose PHI if asked to do so by law enforcement officials.

    Uses and Disclosures Requiring Authorization:

    “Psychotherapy notes” are notes Company has made about your conversations during a private, group, joint or family therapy sessions. Company will obtain your authorization before releasing the applicable psychotherapy notes. You may revoke or modify all such authorizations at any time; however, the revocation or modification is not effective until we receive it in writing.

    Other uses and disclosures of your PHI not disclosed in this NPP may only be disclosed or used with your written authorization. If you provide us with authorization to use or disclose such information, you may revoke that permission, in writing at any time. If you revoke your authorization, this will stop any further use or disclosure of your PHI for purposes covered by your written authorization, except if we have already acted in reliance on your authorization. We are unable to take back any disclosures we have already made with your permission.

    Electronic Health Records. Company may use an electronic health record to store and retrieve your health information. All electronic health record systems used by Company meet HIPAA compliant standards. When Company enters your information into the electronic health record, we may share that information with other providers who have access to Company’s electronic health record system by using shared clinical databases or health information exchanges.

    Business Associates. Some of our functions are accomplished by individuals or companies with whom we contract, called “business associates”, to perform specialized work for Company. Examples of business associates include, accreditation agencies, management consultants, collection services, and electronic information providers. We may disclose PHI to our business associates so they can perform the tasks we have asked them to do.

    YOU / YOUR CHILD’S RIGHTS

    1.     You have the right to request restrictions on certain uses and disclosures of protected health information about you. Such restrictions must be made in writing. Please note that Company is not required to agree to a restriction you request.

    2.     You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may request your bills be sent to another address and via postal services rather than electronic communications.)

    3.     You have the right to inspect and/or obtain a copy of PHI for as long as the PHI is maintained in the record. We may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. If requested, we will discuss with you the detail of the request and denial process.

    4.     You have the right to request an addendum or amendment to attach to your PHI for as long as the PHI is maintained in the record. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We may deny this request if you ask us to amend information that is accurate and complete; or is not part of the information which you would be permitted to inspect and copy; or is not part of the medical information we keep. If we deny this request for an amendment, you have the right to submit a written addendum with respect to any item or statement in your PHI you believe is incomplete or incorrect. Please indicate in writing that you want the addendum to be made part of your medical record.

    5.     You have the right to request a paper copy of this notice, even if you have agreed to receive the notice electronically.

    6.     You have the right to obtain an accounting of disclosures of your medical information. You have the right to request a list of the disclosures we made of PHI about you other than for treatment, payment or operations.

    CHANGES TO THIS NOTICE

    We reserve the right to change the provisions of this Notice and make it effective for all PHI we maintain. A copy of the current NPP is posted in our facilities and on our web site at www.albani.group. Unless Company notifies you of such changes, however, Company is required to abide by the terms currently in effect.

    QUESTIONS AND COMPLAINTS

    If you have any questions about this notice or any complaints regarding a decision Company makes about access to your records or if you have other concerns about your privacy rights, you may contact The Albani Group, ATTN: Sasha Albani 131 Camino Alto E-3, CA 94941, email: sasha@albani.group. You have specific rights under the Privacy Rule. Company will not retaliate against you for exercising your right to file a complaint.  If you believe that your privacy rights have been violated and wish to file a complaint with the office, you may send your written complaint to:

    The Albani Group

    131 Camino Alto E-3

    Mill Valley, CA 94941

    Information on how to file a complaint to the Secretary of the U.S. Department of Health and Human Services may be found at https://www.hhs.gov/hipaa/filing-a-complaint/what-to-expect/index.html.