Policies

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health 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 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 your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a 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.

HIPAA Notice of Rights and Privacy Practices

NOTICE:

We keep a record of the health care services we provide you.  You may ask us to see and copy that record.  You may also ask us to correct that record.  We will not disclose your record to others unless you direct us to do so or unless the law authorizes or compels us to do so.  You may see your record or get more information about it at 2627 Eastlake Ave E, Seattle, WA 98102.

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 health record contains personal information about you and your health.  State and Federal law protects the confidentiality of this information.  Protected Health Information (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical and mental health, or condition, and related health care services.  If you suspect a violation of these legal protections, you may file a report to the appropriate authorities in accordance with Federal and State regulations.

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.  This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with all applicable law.  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 PHI and to provide you with notice of our legal duties and privacy practices with respect to 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 make available a revised Notice of Privacy Practices by sending you an electronic copy, sending a copy to you in the mail upon your request, or providing one to you in person.

How we are permitted to use and disclose your PHI

• For Treatment.  We may use medical and clinical information about you to provide you with treatment services.

• For Payment.  We may use and disclose medical information about you so that we can receive payment for the treatment services provided to you.

• For Healthcare Operations.  We may use and disclose your protected PHI for certain purposes in connection with the operation of my professional practice, including supervision and consultation.

• Without Your Authorization. State and Federal law also permits us to disclose information about you without your authorization in a limited number of situations, such as with a court order.

• With Authorization. We must obtain written authorization from you for other uses and disclosures of your PHI.  You may revoke such authorizations in writing in accordance with 45 CFR. 164.508(b)(5).

• Incidental Use and Disclosure.  We are not required to eliminate every risk of an incidental use or disclosure of your PHI.  Specifically, a use or disclosure of your PHI that occurs as a result of, or incident to an otherwise permitted use or disclosure is permitted as long as we have adopted reasonable safeguards to protect your PHI, and the information being shared was limited to the minimum necessary.

Examples of How We May Use and Disclose Your PHI

Listed below are examples of the uses and disclosures that we may make of your PHI.  These examples are not meant to be a complete list of all possible disclosures, rather, they are illustrative of the types of uses and disclosures that may be made.

• Treatment. Your PHI may be used and disclosed by us for the purpose of providing, coordinating, or managing your health care treatment and any related services. This may include coordination or management of your health care with a third party, consultation or supervision activities with other health care providers, or referral to another provider for health care services.

• Payment. We may use your PHI to obtain payment for your health care services.  This may include providing information to a third party payor, or, in the case of unpaid fees, submitting your name and amount owed to a collection agency.

• Healthcare Operations. We may use or disclose your PHI in order to support the business activities of our professional practice including; disclosures to others for health care education, or to provide planning, quality assurance, peer review, or administrative, legal, financial, or actuarial services to assist in the delivery of health care, provided we have a written contract with the business that prohibits it from re-disclosing your PHI and requires it to safeguard the privacy of your PHI. We may also contact you to remind you of your appointments.

Other Uses and Disclosures That Do Not Require Your Authorization

• Required by Law. We may use or disclose your PHI to the extent that the use or disclosure is required by law, made in compliance with the law, and limited to the relevant requirements of the law. Examples of this type of disclosure include healthcare licensure related reports, public health reports, and law enforcement reports.  Under the law, we must make certain disclosures of your PHI to you upon your request.  In addition, we must make disclosures to the US Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of privacy rules.

• Health Oversight. We may disclose 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) and peer review organizations performing utilization and quality control.  If we disclose PHI to a health oversight agency, we will have an agreement in place that requires the agency to safeguard the privacy of your information.

• Abuse or Neglect. We may disclose your PHI to a state or local agency that is authorized by law to receive reports of abuse or neglect.  However, the information we disclose is limited to only that information which is necessary to make the required mandated report.

• Deceased Clients. We may disclose PHI regarding deceased clients for the purpose of determining the cause of death, in connection with laws requiring the collection of death or other vital statistics, or permitting inquiry into the cause of death.

• Research. We may disclose PHI to researchers if (a) an Institutional Review Board reviews and approves the research and a waiver to the authorization requirement; (b) the researchers establish protocols to ensure the privacy of your PHI; and (c) the researchers agree to maintain the security of your PHI in accordance with applicable laws and regulations.

• Criminal Activity or Threats to Personal Safety. We may disclose your PHI to law enforcement officials if we reasonably believe that the disclosure will avoid or minimize an imminent threat to the health or safety of yourself or any third party.

• Compulsory Process. We may be required to disclose your PHI if a court of competent jurisdiction issues an appropriate order, and if the rule of privilege has been determined not to apply.  We may be required to disclose your PHI if we have been notified in writing at least fourteen days in advance of a subpoena or other legal demand, no protective order has been obtained, and a competent judicial officer has determined that the rule of privilege does not apply.

• Essential Government Functions. We may be required to disclose your PHI for certain essential government functions.  Such functions include: assuring proper execution of a military mission, conducting intelligence and national security activities that are authorized by law, providing protective services to the President, making medical suitability determinations for U.S. State Department employees, protecting the health and safety of inmates or employees in a correctional institution, and determining eligibility for or conducting enrollment in certain government benefit programs.

• Law Enforcement Purposes. We may be authorized to disclose your PHI to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) in response to a law enforcement official’s request for information about a victim or suspected victim of a crime; (4) to alert law enforcement of a person’s death, if we suspect that criminal activity caused the death; (5) when we believe that protected health information is evidence of a crime that occurred on our premises; and (6) in a medical emergency not occurring on our premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.

• Psychotherapy Notes. If kept as separate records, we must obtain your authorization to use or disclose psychotherapy notes with the following exceptions.  We may use the notes for your treatment.  We may also use or disclose, without your authorization, the psychotherapy notes for our own training, to defend ourself in legal or administrative proceedings initiated by you, as required by the Washington Department of Health or the US Department of Health and Human Services to investigate or determine our my compliance with applicable regulations, to avoid or minimize an imminent threat to anyone’s health or safety, to a health oversight agency for lawful oversight, for the lawful activities of a coroner or medical examiner or as otherwise required by law.

Uses and Disclosures of PHI With Your Written Authorization

Other uses and disclosures of your PHI will be made only with your written authorization.  We will not make any other uses or disclosures of your psychotherapy notes, We will not use or disclosure your PHI for marketing proposes, and We will not sell your PHI without your authorization.  You may revoke your authorization in writing at any time.  Such revocation of authorization will not be effective for actions we may have taken in reliance on your authorization of the use or disclosure.

Your Rights Regarding Your PHI

You have the following rights regarding PHI that we maintain about you.  Any requests with respect to these rights must be in writing.  A brief description of how you may exercise these rights is included.

• Right of Access to Inspect and Copy.  You may inspect and obtain a copy of your PHI that is contained in a designated record set for as long as we maintain the record.  A "designated record set" contains medical and billing records and any other records that we use for making decisions about you.  Your request must be in writing.  We may charge you a reasonable cost-based fee for the copying and transmitting of your PHI.  We can deny you access to your PHI in certain circumstances.  In some of those cases, you will have a right of recourse to the denial of access.  Please contact me if you have questions about access to your medical record.

• Right to Amend. You may request, in writing, that we amend your PHI that has been included in a designated record set.  In certain cases, we may deny your request for an 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 of any such rebuttal.

• Right to an Accounting of Disclosures. You may request an accounting of disclosures made for treatment purposes or made as a result of your authorization, for a period of up to six years, excluding disclosures made to you.  We may charge you a reasonable fee if you request more than one accounting in any 12-month period.  Please contact us if you have questions about accounting of disclosures.

• Right to Request Restrictions. You have the right to ask us not to use or disclose any part of your PHI for treatment, payment or health care operations or to family members involved in your care.  Your request for restrictions must be in writing and we are not required to agree to such restrictions.  Please contact us if you would like to request restrictions on the disclosure of your PHI.  You also have the right to restrict certain disclosures of your PHI to your health plan if you pay out of pocket in full for the health care we provide to you.

• Right to Request Confidential Communication.  You have the right to request to receive confidential communications from us by alternative means or at an alternative location.  We will accommodate reasonable written requests.  We may also condition this accommodation by asking you for information regarding how payment will be handled or specification of an alternative address or other method of contact.  Please contact us if you would like to make this request.

• Right to a Copy of this Notice.  You have the right to obtain a copy of this notice from us.  Any questions you have about the contents of this document should be directed to us.

• Right to Opt Out.  You have the right to choose not to receive fundraising communications.  However, we will not contact you for fundraising purposes.

• Right to Notice of Breach.  You have the right to be notified of any breach of your unsecured PHI.

Contact Information

Our Privacy and Security Officer is designated below.  If you have any questions about this Notice of Privacy Practices, please contact that person.  The contact information is:

Alaina Boyle
511 28th Ave E
Seattle, WA 98112
(206) 581-1087

Complaints

If you believe we have violated your privacy rights, you may file a complaint in writing with our Privacy Officer, as specified above.  You also have the right to file a complaint in writing to the Washington Department of Health or to the US Secretary of Health and Human Services.  We will not retaliate against you in any way for filing a complaint.

Effective Date

The effective date of this notice: November 1, 2022

Our in-person protocols.

In accordance with the latest King County Department of Health requirements for health care providers, masks are currently optional at Sequoia Teen Counseling Center.

We recognize that for some individuals, including those at higher risk of serious illness or living with those at higher risk, masks continue to be an important safety measure. We will continue to have masks available at our offices and we encourage you to talk with your clinician directly if you would like them to continue to wear a mask in your sessions together.

In order to continue to protect the health and safety of our staff and clients, we ask that you wear a mask if you feel at all sick, are coughing or sneezing for any reason, or have had a close exposure to someone who tested positive for COVID. We also ask that you adhere to the latest isolation/quarantine guidance from the CDC regarding any positive COVID tests, symptoms, or exposure. If you have COVID-19 or have had a fever in the past 24 hours please contact your clinician to cancel your appointment or switch to telehealth.

We appreciate your understanding as we navigate this challenging, ever-changing situation! Please don't hesitate to reach out with any questions or concerns.

In addition, our in-person protocols are as follows:

• All Sequoia Teen Counseling Center clinicians have been fully vaccinated.

• Clinicians will regularly disinfect all shared surfaces

• Hand sanitizer and extra masks will be provided for clinician and client use if desired.

• Both clinicians and clients will be asked to follow the latest King County Department of Health isolation and quarantine guidance if exposed to COVID-19 or testing positive for COVID-19. When isolating or quarantining, sessions can be held online instead of in person.

We are offering in-person sessions for clients who are interested and feel safe doing so; no one will be required to return to in-person counseling sessions should they prefer virtual sessions.  We will continue offering virtual sessions indefinitely.

For more information, please see the State of Washington Coronavirus response page.

We require 24 hours advance notice of cancellation for a session. Failure to cancel before that period will lead to your appointment being charged at the full rate.

Sequoia Teen Counseling Center LLC is considered an out-of-network provider by all insurance companies, including Medicaid and Apple Health. All payment for services is made directly by clients to Sequoia TCC at the time of the appointment. It is the responsibility of the client to undertake any communication with their insurance provider.

Sequoia TCC does not contract with any insurance provider, nor do we communicate with insurance providers on your behalf.

We recommend contacting your insurance provider before scheduling with Sequoia TCC in order to obtain accurate coverage details and reimbursement information. Sequoia TCC cannot guarantee any coverage options.

Sequoia TCC is able to provide you with a superbill through our platform, Simple Practice which contains all of the information you need to request reimbursement from your insurance provider. You will automatically receive a superbill via Simple Practice each month. If you need any corrections made to your superbill, please contact hello@sequoiateencounseling.com.

Sequoia Teen Counseling Center LLC does not accept payment via check.

All client payments must be made via credit card and are billed at the time of service.

If you require help with making a payment, please contact hello@sequoiateencounseling.com

Overview

In the state of Washington, minors may receive outpatient mental health treatment if they are 13 years of age or older without the consent of a parent or guardian, and a client release of information (ROI) is required to notify a parent/guardian of services, or to share any protected health information with parents/guardians (RCW 71.34.530).

Clinical research shows that, in many cases, parent/guardian involvement in their adolescent’s treatment improves outcomes. At Sequoia, we love family involvement in therapy! At the same time, we are careful to adhere to legal confidentiality requirements and put teens at the center of decision-making regarding their own treatment in order to build and maintain the trust that is the cornerstone of a successful therapeutic relationship.

When beginning services with Sequoia Teen Counseling Center, all clients between the ages of 13 to 18 are asked to sign an ROI to parent/guardian, and select what information they permit to be shared. To have a parent/guardian pay for services, the client will need to permit disclosure of billing and scheduling information. This will include superbills, which contain the client’s primary diagnosis. Clients may also choose to share treatment summaries with parents/guardians if they would like to give their clinician the option to provide any clinical information to parents/guardians. Even if a client has agreed to share treatment summaries with a parent/guardian, clinicians will check with clients before disclosing specific information discussed in therapy sessions in order to maintain trust and transparency. In the event of any safety concerns, clinicians will use their clinical judgment regarding the need to break confidentiality in order to protect client safety.

Phone and Email Communication

Parents/guardians are permitted to contact their child’s clinician via phone or email regardless of the status of their child’s ROI. If choosing to communicate electronically, individuals are consenting to the confidentiality risks inherent in electronic communication. Parents/guardians are encouraged to ask for resources or general recommendations, and clinicians can respond broadly, without sharing specific information about a client. In the case of parents/guardians asking specific questions about their child, clinicians may be limited in their ability to respond depending on what information the client has agreed to share with parents/guardians. Additionally, any emails containing clinically relevant information may be entered into the client’s file, which can be requested by the client at any time. Clinicians may also inform clients that they have received a message from their parent/guardian. Therefore, in most circumstances, it is recommended that parents inform their child when they are reaching out to the child’s clinician, in order to model open communication and transparency and allow the clinician to directly address any content with the client.

Clinicians are often in back-to-back client sessions for several hours of the day, and may not be immediately available to respond to messages. If there is a crisis situation, please reach out to the crisis line at 9-8-8 for immediate assistance. Clinicians will do their best to respond to all messages within 1-2 working days. Please note that Sequoia clinicians’ working schedules vary, with some clinicians working part-time. If you have questions about your clinician’s schedule and response time, please ask them directly. Additionally, if an email will take greater than 10 minutes to read and respond to, clinicians may ask to schedule a meeting or phone call instead in order to ensure that they are appropriately compensated for their time and allow for more thorough communication.

Session Participation

Depending on the individual client, their age, therapy goals, and preferences, there can be a wide range of how involved parents are in sessions. Regardless, any parent/guardian participation in a client’s session (whether it is in-person or virtual) should be pre-arranged with the client and clinician. This allows clinicians to appropriately prepare for family sessions, and promotes a client’s feeling of autonomy, safety, and predictability in the therapeutic environment.

Additional Support Options

If a parent/guardian would like to be more involved in supporting their child’s mental health and therapy process, we recommend parent/guardian coaching. Sequoia now offers Caregiver Coaching, where parents/guardians work with a counselor specializing in parenting techniques and relationship-building. This service builds wrap-around support to best navigate a teen’s mental health challenges, while still maintaining the confidentiality and autonomy that many teens seek in the therapy process. If you are interested in learning more, visit our website or reach out to us at hello@sequoiateencounseling.com.