What to Expect, Billing, Insurance

Free, No-Obligation 15 Minute Phone Consultation:

Kaela offers new clients a free 15 minute consultation to meet one another, briefly discuss client concerns, and determine if Kaela is able to offer the therapy services the client requires. New clients can schedule their initial consultation by calling 614-647-HELP or emailing contact@kaelaraevance.com.

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Next Step, Initial Diagnostic Evaluation:

After the initial consultation, if Kaela and the new client determine that counseling should proceed together, Kaela will schedule a new client diagnostic evaluation, where Kaela and the client will meet at Kaela's office in Dublin to discuss the client's needs in further detail, some assessments may be performed, after which Kaela will recommend an initial treatment plan and work with the client to schedule their next therapy appointment(s). New clients will be asked to allow two hours for this initial diagnostic evaluation session. The new client diagnostic evaluation rate is $150. For additional information about Diagnostic Evaluations, please call 614-647-HELP, or send a secure, HIPAA-compliant message to Kaela through her online client portal.

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Treatment & Achieving Your Goals:

Once the evaluation and treatment plan are complete, Kaela will work with clients to schedule their follow-up therapy sessions. Kaela offers a secure, HIPAA-compliant online client portal through her website, where clients are able to review their appointments, billing, records, and exchange secure messages with Kaela. Standard 50 minute therapy sessions will be billed at $100 per session. Additional services are available and Kaela will discuss what to expect and the cost for those services as appropriate on a per client basis. For additional information about therapy, please call 614-647-HELP, or send a secure, HIPAA-compliant message to Kaela through her online client portal.

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Rescheduling & Cancelling Appointments:

Clients are responsible for cancelling or rescheduling appointments more than 24hrs in advance, otherwise clients will be automatically billed for 100% of their session rate. To reschedule or cancel an appointment, please call 614-647-HELP, or send a secure, HIPAA-compliant message to Kaela through her online client portal.

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Billing:

Clients will be expected to provide a debit or credit card through Kaela's online client portal through her website prior to the client's initial diagnostic evaluation session, and sessions will be billed to that credit/debit card automatically at each session. For additional information about client billing, please call 614-647-HELP, or send a secure, HIPAA-compliant message to Kaela through her online client portal.

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Insurance:

While Kaela does not accept health insurance at this time, if you have out of network benefits for a insurance plan, she is able to provide you a billing statement ("Super Bill") for services that you can provide to your insurance company for reimbursement. For additional information about insurance, please call 614-647-HELP, or send a secure, HIPAA-compliant message to Kaela through her online client portal.

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Records:

Clients are entitled access to their medical records. As such, a client may access the medical records that Kaela maintains by accessing the secure, HIPAA-compliant online client portal through her website, or by calling 614-647-HELP. If a client requests paper copies of their records, Kaela is permitted to charge a reasonable fee to provide printed copies.

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Privacy:

Kaela takes your privacy concerns seriously and adheres to the highest HIPAA compliance standards. Kaela secures Business Associate Agreements ("BAA") with vendors who provide services to her business (GoogleSimplePractice, etc.) and these vendors are required to honor Kaela's obligations to ensure your private health information (PHI) remains confidential. Furthermore, Kaela maintains strict security measures to ensure that her files and data are protected using methods beyond industry standard. For additional details 

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HIPAA Statement:

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

Your health record contains personal information about you and your health. This information, called Protected Health Information (“PHI”) may identify you and relates to your past, present or future physical/mental health condition(s) and related health care services. 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, HIPAA Privacy and Security Rules, and the AAMFT Code of Ethics. 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 your PHI and to provide you with notice of our legal duties and privacy practices with respect to your 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 sending a copy to you in the mail upon request or providing one to you at your next appointment.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

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. We may disclose PHI to any other consultant only with your authorization.

For Payment. We may use and disclose your PHI so that we can receive payment for the treatment services provided to you. Examples of payment-related activities are: determining eligibility or coverage of 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 your PHI necessary for purposes of collection.

For Health Care Operations. We may use or disclose, as needed, your PHI to support our business activities including, but not limited to, quality assessment 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/person that requires it to safeguard the privacy of your PHI. In house employees or independent contractors of Counseling for Hope and Healing, LLC will have access to your information for in house auditing and supervision purposes.

Required by Law. We must make disclosures to the Secretary of the Department of Health and Human for investigating or determining our compliance with the requirements of the Privacy Rule.

Without Authorization. Following is a list of the categories of uses and disclosures permitted by HIPAA without an authorization. Applicable law and ethical standards permit us to disclose information about you without your authorization only in a limited number of situations.

• Child Abuse or Neglect. We may disclose your PHI to a state or local agency that is authorized by law to receive reports of child abuse or neglect.

• Judicial and Administrative Proceedings. We may disclose your PHI if you are involved in a lawsuit or a dispute in response to a court or administrative order. This includes our own legal advisement. With properly signed authorization, we may also disclose your protected health information in response to a subpoena, disposition, discovery request, or other lawful process if such disclosure is permitted by law.

• Law Enforcement. We may disclose your PHI for certain law enforcement purposes if permitted by law. For example, to report emergencies, wounds or suspicious deaths; to comply with court order, warrant, or similar legal process; or to answer certain requests for information concerning crimes.

• Deceased Patients. We may disclose a PHI regarding deceased patients as mandated by state law, or to a family member or friend that was involved in your care or payment for care prior to death, based on your prior consent. A release of information regarding deceased patients may be limited to an executor or administrator of a deceased person’s estate or the person identified as next-of-kin. The PHI of persons that have been deceased for more than fifty (50) years is not protected under HIPAA.

• Medical Emergencies. We may use or disclose your PHI in a medical emergency to medical personnel only in order to prevent serious harm.

• Family Involvement in Care. We may disclose information to close family members or friends directly involved in your treatment based on your consent or as necessary to prevent serious harm.

• Health Oversight. If required, we may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance to the program (such as third-party payors based on your prior consent) and peer review organizations performing utilization and quality control.

• 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 to a public health authority authorized by law to collect or receive such information for 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.

• Public Safety. We may disclose your PHI if necessary, to prevent or lessen a serious an imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.

• Verbal Permission. We may also use or disclose your information to family members and/or providers that are directly involved in your treatment with your verbal permission.

With 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.

SPECIAL RULES REGARDING DISCLOSURE OF PSYCHIATRIC, SUBSTANCE ABUSE, AND HIV RELEATED INFORMATION AS WELL AS MINORS IN TREATMENT AND PSYCHOTHERAPY NOTES

• Psychiatric Information. We may be disclosed certain mental health information for treatment, payment and health care operations as permitted or required by Ohio law.

• Substance Abuse Treatment Information. If you are in treatment for substance abuse, your permission will be needed for certain disclosures. This excludes emergency situations.

• HIV Related Information. We will disclose HIV related information as permitted or required by Ohio law. Any use and disclosure for such purposes will be to someone able to reduce the outcome of exposure and limited in accordance with Ohio law. For example, your HIV related protected health information may be disclosed in the event of a significant exposure to another known person or known partner.

• Minors. We will comply with Ohio law when using or disclosing protected health information of minors.

• Psychotherapy Notes. Psychotherapy notes are separate from your PHI and can only be obtained through court order. Psychotherapy notes may be used to carry out certain treatment, payment, health care operations or for defense in a legal action.

YOUR RIGHTS REGARDING YOUR PHI

You have the following rights regarding your PHI. To exercise any of these rights, please submit your request in writing to via the below contact form.

• Right of Access to Inspect and Copy. You have the right, which may be restricted only in exceptional circumstances, to inspect and copy your PHI that is maintained in a “designated record set”. A designated record set contains mental health/medical and billing records and any other records that are used to make decisions about your care. Your right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you or to others or if the information is contained in separately maintained psychotherapy notes. We may charge a reasonable, cost-based fee for copies. You may also request that a copy of your PHI be provided to another person with written authorization.

• 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.

• Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures that we make of your PHI. We may charge you a reasonable fee if you request more than one accounting in any twelve-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 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. This does not include court subpoenaed request.

• Right to Request Confidential Communication. You have the right to request that we communicate with you about health matters in a certain way. We will accommodate reasonable requests.

• 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 Copy of this Notice. You have the right to a copy of this notice.

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Complaints:

This information is required by the State of Ohio Counselor, Social Worker & Marriage and Family Therapist Board, which regulates all licensed counselors, social workers and marriage and family therapists. If you have complaints about professional services from a counselor, social worker or marriage and family therapist, contact the: Ohio Counselor, Social Worker & Marriage and Family Therapist Board at 50 West Broad St., Suite 1075 Columbus, OH 43215, or www.cswmft.ohio.gov.

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