Good Faith Estimate
NOTICE TO PATIENTS AND PROSPECTIVE PATIENTS:
Under the law, health care providers are required to give clients who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
You can ask any health care provider you choose for a Good Faith Estimate before you schedule a service, or at any time during treatment.
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 more information about a Good Faith Estimate, you can visit https://www.cms.gov/nosurprises.
NOTICE OF PRIVACY PRACTICES
HIPAA NOTICE OF PRIVACY PRACTICES
I. 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.
II. IT IS the LEGAL DUTY of Bateman Psychology, Inc. TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI).
By law, BATEMAN PSYCHOLOGY, INC. (herein referred to as “The Practice”) is required to ensure 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. The Practice is required to provide you with this Notice about its privacy procedures. This Notice must explain when, why, and how The Practice would use and/or disclose your PHI. Use of PHI means when The Practice shares, applies, utilizes, examines, or analyzes information within the practice; PHI is disclosed when The Practice releases, transfers, gives, or otherwise reveals it to a third party outside The Practice. With some exceptions, The Practice 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, The Practice is always legally required to follow the privacy practices described in this Notice.
Please note that The Practice reserves the right to change the terms of this Notice and its privacy policies at any time as permitted by law. Any changes will apply to PHI already on file with The Practice. Before The Practice makes any important changes to its policies, The Practice will immediately change this Notice and post a new copy of it in the office and on the website (https://www.batemanpsycholoy.com). You may also request a copy of this Notice from the CEO of The Practice (Dr. Alison Bateman: drbateman@batemanpsychology.com).
III. HOW bateman psychology, inc. WILL USE AND DISCLOSE YOUR PHI.
BATEMAN PSYCHOLOGY, INC. 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 The Practice’s 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. The Practice may use and disclose your PHI without your consent for the following reasons:
1. For treatment. The Practice can use your PHI to provide you with mental health treatment, including discussing or sharing your PHI with trainees and interns, where relevant. The Practice may disclose 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, The Practice may disclose your PHI to that him/her/them to coordinate your care.
2. For health care operations. The Practice may disclose your PHI to facilitate the efficient and correct operation of business. Examples: Quality control— The Practice 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. The Practice may also provide your PHI to its attorneys, accountants, consultants, and others to make sure The Practice is in compliance with applicable laws.
3. To obtain payment for treatment. The Practice may use and disclose your PHI to bill and collect payment for the treatment and services The Practice provided you. Example: The Practice might send your PHI to your insurance company or health plan to obtain payment for the health care services that The Practice has provided you. The Practice could also provide your PHI to business associates, such as billing companies, claims processing companies, and business associates that process health care claims for The Practice.
4. Other disclosures. Examples: Your consent isn't required if you need emergency treatment provided The Practice attempts to get your consent after treatment is rendered. In the event that The Practice tries to get your consent but you are unable to communicate with your provider/The Practice (for example, if you are unconscious or in severe pain) but your provider/The Practice believes you would consent to such treatment if you could, The Practice may disclose your PHI.
B. Certain Other Uses and Disclosures Do Not Require Your Consent. We 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: The Practice may make a disclosure to the appropriate officials when a law requires The Practice 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 California 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 your provider/The Practice determines that disclosure is necessary to prevent the threatened danger.
7. If disclosure is mandated by the California 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 California 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 your provider 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: The Practice 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: The Practice may disclose PHI of military personnel and veterans under certain circumstances. Also, The Practice 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, The Practice may provide PHI to conduct medical research.
14. For Workers' Compensation purposes. The Practice may provide PHI to comply with Workers’ Compensation laws.
15. Appointment reminders and health related benefits or services. Examples: The Practice may use PHI to provide appointment reminders. The Practice may use PHI to give you information about alternative treatment options, or other health care services or benefits The Practice offers.
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 The Practice’s compliance with HIPAA regulations.
18. If disclosure is otherwise specifically required by law.
C. Special Protections of Confidentiality for Specific Records and Their Circumstances
1. Use and Disclosure of Substance Use Disorder Records Subject to 42 CFR Part 2.
If applicable, your substance use disorder (“SUD”) records are protected by federal law under 42 C.F.R. Part 2 (“Part 2”). The Practice is not considered a Part 2 facility, but may receive records of yours from a Part 2 provider or facility (ie, in coordinating care). This law provides extra confidentiality protections and requires a separate patient consent for the use and disclosure of SUD counseling notes. SUD treatment records received from Part 2 programs cannot be used or disclosed in civil, criminal, administrative, or legislative proceedings against the individual unless based on written consent or a court order (after notice and opportunity to be heard). But the court order must be accompanied by a subpoena or other legal requirement compelling disclosure. Each disclosure made with patient consent must include a copy of the consent or a clear explanation of the scope of the consent. It must also be accompanied by a written notice containing the language in 42 CFR Part 2.32(a). Disclosure of these records requires your explicit written consent, except in limited circumstances such as: (a) Medical Emergencies: to the extent necessary to treat you, (b) Reporting Crimes on Program Premises, (c) Child Abuse Reporting: In connection with incidents of suspected child abuse or neglect to appropriate state or local authorities, and (d) Fundraising: We will provide you with an opportunity to decline to receive any fundraising communications prior to making such communications. You may revoke this consent at any time. Information disclosed under HIPAA may be subject to redisclosure by the recipient and therefore lose its protection.
2. Prohibitions on Use and Disclosure of Part 2 Records.
SUD records received from programs subject to Part 2, or testimony relaying the content of such records, shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless based on your written consent, or a court order after notice and an opportunity to be heard is provided to you or the holder of the record, as provided in Part 2. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested SUD record is used or disclosed. If SUD records are disclosed to us or our business associates pursuant to your written consent for treatment, payment, and healthcare operations, we or our business associates may further use and disclose such health information without your written consent to the extent that the HIPAA regulations permit such uses and disclosures, consistent with the other provisions in this Notice regarding PHI. Information disclosed under HIPAA may be subject to redisclosure by the recipient and therefore lose its protection.
3. AB 82 and SB 497: Confidentiality, Record Handling, and Subpoena Response for Gender-Affirming Care. The Practice is prohibited from disclosing patient information related to legally-protected health care activity, including gender-affirming health care and gender-affirming mental health care, in response to subpoenas or requests from out-of-state entities seeking to penalize care lawful in California.
D. Certain Uses and Disclosures Require You to Have the Opportunity to Object.
Disclosures to family, friends, or others. The Practice 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.
E. Other Uses and Disclosures Require Your Prior Written Authorization. In any other situation not described in Sections IIIA, IIIB, and IIIC above, The Practice 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 The Practice hasn't taken any action subsequent to the original authorization) of your PHI by The Practice.
IV. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI
These are your rights with respect to your PHI:
A. The Right to See and Get Copies of Your PHI. In general, you have the right to see your PHI that is in possession of The Practice, or to get copies of it; however, you must request it in writing. If The Practice does not have your PHI, but The Practice knows who does, The Practice will advise you how you can get it. You will receive a response from me within 30 days of my receiving your written request.
Under certain circumstances, The Practice decide to deny your request, but if The Practice does, you will be provided, in writing, the reasons for the denial. The Practice will also explain your right to have the denial reviewed.
If you ask for copies of your PHI, The Practice will charge you not more than $.25 per page. The Practice 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.
B. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask that The Practice limit how it uses and discloses your PHI. While The Practice will consider your request, it is not legally bound to agree. If The Practice does agree to your request, The Practice 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 The Practice is legally required or permitted to make.
C. The Right to Choose How The Practice Sends 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). The Practice is obliged to agree to your request providing that The Practice can give you the PHI, in the format you requested, without undue inconvenience. The Practice may not require an explanation from you as to the basis of your request as a condition of providing communications on a confidential basis.
D. The Right to Get a List of the Disclosures The Practice Has Made. You are entitled to a list of disclosures of your PHI that The Practice has 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, or disclosures made before April 15, 2003. After April 15, 2003, disclosure records will be held for six years.
The Practice will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list The Practice 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. The Practice will provide the list to you at no cost, unless you make more than one request in the same year, in which case The Practice will charge you a reasonable sum based on a set fee for each additional request.
E. 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 The Practice 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 its receipt of your request. The Practice may deny your request, in writing, if The Practice finds that: the PHI is (a) correct and complete, (b) forbidden to be disclosed, (c) not part of the records, or (d) written by someone other than a provider at The Practice. The 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 The Practice approves your request, The Practice will make the change(s) to your PHI. Additionally, The Practice will tell you that the changes have been made, and The Practice will advise all others who need to know about the change(s) to your PHI.
F. 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.
V. HOW TO COMPLAIN ABOUT these PRIVACY PRACTICES
If, in your opinion, The Practice may have violated your privacy rights, or if you object to a decision The Practice made about access to your PHI, you are entitled to file a complaint with the person listed in Section VI below. You may also file a complaint with the Department of Health and Human Services, and instructions and options for filing a complaint can be found at https://www.hhs.gov/hipaa/filing-a-complaint/index.html. If you file a complaint about The Practice’s privacy practices, The Practice will take no retaliatory action against you.
VI. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT these PRIVACY PRACTICES
If you have any questions about this notice or any complaints about these privacy practices, please the CEO of The Practice: Alison Bateman, Ph.D.: drbateman@batemanpsychology.com; 408-477-9777.
VII. NOTIFICATIONS OF BREACHES
In the case of a breach, HIPAA requires The Practice to notify each affected individual whose unsecured PHI has been compromised. Even if such a breach was caused by a business associate, The Practice 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. The Practice 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.
VIII. 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. The Practice 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.
IX. INDIVIDUALS' RIGHT TO RESTRICT DISCLOSURES; RIGHT OF ACCESS
To implement the 2013 HITECH Act, the Privacy Rule is amended. The Practice 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 The Practice 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 The Practice 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 The Practice to transmit an electronic copy of PHI to an entity or person designated by you. Furthermore, the amendments restrict the fees that The Practice 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.
X. NPP
The Practice’s NPP must contain a statement indicating that 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.
XI. EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on January 1, 2026.