Privacy Policy

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 carefully. The Health Insurance Portability and Accountability Act (HIPAA) is a federal program that requires all medical records and other individually identifiable health information used and disclosed by us in any form, whether electronically, on paper, or orally, be kept confidential.  

 By clicking 'Submit', you agree to Healthcare 4 Us, LLC’s Terms of Use and Privacy Policy. You consent to receive phone calls and SMS messages from Healthcare 4 Us, LLC to provide updates and information regarding your business with Healthcare 4 Us, LLC. Message frequency may vary. Message & data rates may apply. Reply STOP to opt-out of further messaging. Reply HELP for more information.  
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1. Your medical records are used to provide treatment, bill, and receive payments, and conduct healthcare operations. Examples of these activities include but not limited to review of treatment records to ensure appropriate care, electronic or mail delivery of billing for  

treatment to you or other authorized payers, appointment reminder telephone calls, and records review to ensure completeness and quality of care. Use and disclosure of medical records is limited to internal use except required by law or authorized by the patient or legal. 

2. Federal and State laws require abuse, neglect, domestic violence, and threats to be reported to social services or other protective agencies. If such reports are made, they will be disclosed to you or your legal representative, unless disclosure increases the risk of further disclosed information, then it will be limited to the minimum necessary. You may request an account for any uses or disclosures other than those described in described in Sections 1 and Sections 2. You, or your legal representative, may request your records to be disclosed to yourself or any other entity. Your request must be made in writing, clearly identify the person authorized to request the release, specify the information you want disclosed, the name and address of the entity you want the information released to, purpose and the expiration date of the authorization. Any authorization provided may be revoked in writing at any time. We may use and disclose your medical records only for each of the following purposes: treatment, payment, and health care operations. 

TREATMENT means providing, coordinating, or managing health care and related services by one or more health care providers. For example, information obtained by a health care provider, nurse, or other person providing health services to you will have access to information regarding your care. 

PAYMENT means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review. 

HEALTH CARE OPERATIONS includes the business of running this practice such as conducting quality assessment and improvement activities, cost management analysis and customer service. Insurance Providers (when applicable) -Insurance companies and other third-party payers are given information that they request regarding services to clients.  

information that may be requested includes, but is not limited to: types of service, dates/times of service, diagnosis, treatment plan, and description of impairment, progress of therapy, case notes, and summaries. This practice may use and disclose information about you as required by law.  We have the right and obligation to report when we believe that you or individuals in your care are at risk for harm to self or others. This agreement may be modified or amended as required by law or during health care operations.  

DO NOT SHARE 

We do not share any client data with third parties. No information will be shared nor sold with third parties/affiliates for marketing/promotional purposes. Your personal information is kept confidential and is not disclosed to any outside organizations except as required by law or with your explicit consent. Healthcare 4 Us, LLc values your privacy and respects your personal information. We have established the following policy for the use of our SMS services. Please read it carefully to understand how we collect, use, and manage your phone numbers. 

We collect your phone numbers only when you voluntarily provide them to us, during calls, or inquiries on our website or social media. You opt in to receive these SMS messages verbally or our website contact us page and providing us your phone numbers.

Your phone number is used to provide you with business services, updates and communication. These text messages will always relate to business we are doing with you. Standard SMS/Data charges may be applied by your carrier.

OPTING OUT

If at any time you wish to stop receiving marketing SMS from us, you can opt out by texting STOP to opt out.

PRIVACY OF PHONE NUMBERS

Mobile information will not be shared, sold, or conveyed to third parties for marketing/promotional purposes. 

CHANGES TO THIS POLICY

 We may periodically update this policy. We thank you for your understanding and cooperation. If you have any questions or concerns about this policy, please feel free to contact us at (225)-307-0326.

LIMITS OF CONFIDENTIALITY: 

Contents of all sessions are confidential. Both verbal information and written records about a client cannot be shared with another party without the written consent of the client or the client's legal guardian. Noted exceptions are as follows:  

Minors/Guardianship -Parents or legal guardians of non-emancipated minor clients have the right to access the clients' records.  

Duty to Warn and Protect - When a client discloses intentions or a plan to harm another person, the mental health professional is required to warn the intended victim and report this information to legal authorities. In cases in which the client discloses or implies a  

plan for suicide, the health care professional is required to notify legal authorities and make reasonable attempts to notify the family of the client.  

Abuse of Children and Vulnerable Adults -If a client states or suggests that he or she is abusing a child (or vulnerable adult) or has recently abused a child (or vulnerable adult), or a child (or vulnerable adult) is in danger of abuse, the mental health professional is required to report this information to the appropriate social service and/or legal authorities.  

Prenatal Exposure to Controlled Substances - Mental Health care professionals are required to report admitted prenatal exposure to controlled substances that are potentially harmful. 

Authorization, Consent for Treatment, No Show, Late Cancellation and Co-Payment Policy 

1. I give Healthcare 4 Us, LLC permission to provide me with a range of mental health services which may include psychiatric evaluation, medication management, therapy, coaching, counseling, psychotherapy, and other therapeutic modalities. 

2. I understand I will keep my appointments as scheduled and notify Healthcare 4 Us, LLC at least 24 hours in advance if I need to reschedule. 

3. I understand that I can always reschedule or cancel 24 hours or more to my exact appointment time at no charge. However, 23 hours or less - for Rescheduling, I will incur a $20 charge. 

4. I understand Healthcare 4 Us, LLC Add on Services, Self-Pay Services, and Insured (all services) are non-refundable but I can always reschedule those services 24 hours or more prior to appointment time at no cost. 

 5. I understand that it is important to keep appointments as scheduled and I agree to give Healthcare 4 Us, LLC at least 24 hours or more notice if I need to reschedule.

 6. I acknowledge that if I fail to show up for my New Patient Initial Evaluation Appointment, I will be charged a $60 fee. Additionally, if I do not show up when scheduled for Other Special Add-On Services or Follow-Ups, I will be charged $60 of the fee for each program cost type. 

7. I understand that the No Show Fees for all Clients (self-pay or insured) begins 15 minutes after of the appointment time. 

8. I am aware that if I cancel or reschedule my appointment without providing at least 24 hours' notice, I will be charged a $25 late rescheduling fee. 

9. At Healthcare 4 Us, LLC, we firmly believe that a good provider/client relationship is based upon understanding and good communication. We understand that special unavoidable circumstances may cause you to cancel within 24 hours and we are empathetic towards such events. Fees in these extenuating instances can be adjusted on a case-by-case basis for the client only 1 (one) time. 

10. I understand that if I have three no-shows within 12 months, I may be dismissed/discharged from the practice. 

AUTHORIZATION TO BILL SELF PAY OR INSURANCE (AS APPLICABLE) 

I, the undersigned, hereby certify and attest that I have sought evaluation, treatment, or medical advice from the staff at the clinic named above. I therefore authorize the medical staff and personnel to release my or my minor child's medical information to the insurance company listed above for the purpose of determining and receiving benefits for medical bills. I understand and acknowledge that the medical staff will submit my claim to the insurance company on my behalf. I further understand that I will be held responsible for any amount of my medical bills not covered by my insurance policy or claims, and that I will be responsible for paying all deductibles, all fees, co-payments, and co-insurance payments required. I understand that any portion of my medical bills not covered by insurance will be billed to me at the address I have provided above. Non-compliance or defaulting on payments may result in denial of service and/or a legal claim against me for non-payment.

ASSIGNMENT OF BENEFITS / FINANCIAL RESPONSIBILITY / TELEHEALTH CONSENT 

I acknowledge the payment and insurance information set forth below and agree to pay for services rendered to me and/or facilitate the payment for services rendered to me by the providers affiliated with any You Bridge Health (Practice). 

1. Payment of Fees: I agree to pay for charges for services as described in this agreement. I understand that: 

Payment for sessions with providers affiliated with Practice is payable online through debit or credit card or ACH transfer, unless otherwise established 

o Payment for sessions is due after each session unless otherwise agreed upon and Practice will charge my card or bank account for my responsibility. Receipts may be provided at the time of the charge or monthly.

 o I will be charged for sessions that I do not keep, unless I provide enough notice to the provider affiliated with the Practice (your treating provider will tell you how much notice is required to avoid being charged for sessions you do not keep) 

o I understand that I cannot submit bills for cancellations to my insurance company or managed care plan 

2. Insurance and Managed Care Plans: Practice participates in several insurance and managed care plans. If Practice participates in my plan, I agree to pay all applicable deductibles, co-payments, co-insurances, and any other form of cost-sharing. If my insurance benefits run out,  

Practice will inform me of the ending date, and I will then be responsible for all charges dating from the end of insurance coverage. If my insurance plan denies the visit despite Practice following necessary procedures, I understand I may be responsible to pay in full for the service. 

3. Assignment of Insurance Fees; Release of confidentiality for authorization of benefits and for clinical care: I agree to allow my insurance plan or managed care plan to pay Practice directly, instead of paying me. If my plan pays me directly, I will promptly turn the payment over to Practice unless I have already paid the charges myself. I authorize Practice to provide my insurance plan or managed care plan with any information reasonably required to obtain insurance benefits and authorization for services. I authorize Practice to obtain at any time during my treatment here any and all relevant clinical information from clinicians and facilities that have treated me and to furnish relevant clinical information to providers who will continue to treat me. I will indicate in writing any exceptions to this. 

4. Consent to Treatment Via Telehealth: I consent to participate in tele mental health services. I understand that I have the right to refuse tele mental health services and be informed of alternative services that may be available to me. If I request alternative services, I understand that Practice may not be able to provide those services, and that I may experience delays in service, the need to travel, or any other risks associated with not having services provided via tele mental health, as well as risks associated with receiving tele mental health services in an off-site location. I understand that telehealth may result in certain risks that are less likely to occur with in-person services, such as technology failure, need for specialized electronic security systems, and less visibility of non-verbal cues. Telehealth can also provide benefits do not present with in-person services, such as creating greater flexibility for when and where services may be provided. 

EMAIL AND TEXT MESSAGES 

 Scheduling appointments. We may email or call you to schedule or remind you of appointments. Some of our patients prefer to communicate with their provider via email or text message. Email and text messages have inherent privacy and security risks, and you should be aware of those before using emails and text messages. Errors in transmission or interception of messages can occur. Your email or text message is not a secure communication between you and your treating provider. At your health care provider’s discretion, your email or text message any and all responses may become part of your medical record. Additionally, for urgent or an emergency situation, you should not rely on email communication with providers affiliated with the Practice. In those situations, you should call 911.  

 I agree to payment or co-payment charges may be processed right away, 24 hours prior, or after my visit. 

I am responsible for all out-of-pocket expenses and fees, and I understand that insurance will not cover these charges. 

I certify that all credit/debit/health account card information provided to Healthcare 4 Us, LLC is accurate & I am aware that I will be responsible for the entire amount owed if my payment is declined or found to be fraudulent. 

I authorize Healthcare 4 Us, LLC to charge my credit/debit/health account card for my scheduled appointments and all fees incurred. 

I agree with the limits of confidentiality and understand their meanings and ramifications. 

I have read and understood this privacy notice and my rights concerning use and disclosure of protected health care information. 

I agree to all policies & statements above and consent for treatment and all services Healthcare 4 Us, LLC.