* Please note copay or coinsurance estimate provided by us is not a guarantee of insurance coverage or payment.
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. If you have any questions about this Notice, please contact us at 469-340-2777 or office@allenpsychiatry.com.
Your health information is personal, and we are committed to protecting it. We will not sell or trade your personal information.
This notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health services.
Uses and Disclosures of Protected Health Information without your written consent:
Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician’s practice, and any other use required by law. Following are the types and examples of uses and disclosures of your protected health care information that Allen Psychiatry is permitted to make without your specific authorization.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. For example, your protected health information may be provided to a providers to whom you have been referred to ensure the provider has the necessary information to diagnose or treat you.
Payment: Your protected health information may be used to obtain or provide payment for your healthcare services, including disclosures to other entities. This may include certain activities that your health insurance plan may undertake before it approves or pays for the services we recommend for you, such as making a determination of eligibility or coverage for insurance benefits, prior authorization for a treatment or prescription, reviewing services provided to you, and undertaking utilization review activities. For example, we may need to give your insurance company information about therapy you received so your insurance will pay for the care.
Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of your physician’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities. For example, we may disclose your protected health information to medical students or volunteers in our office. In addition we may use paper or digital sign-in sheet at the registration desk where you will be asked to sign your name and indicate your provider. We may also call you by name when your provider is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
Business Associates: We may share your protected health information with a third party “business associates” that perform various activities (e.g., billing, transcription services, accounting services, legal services) for Allen Psychiatry. Wheatnever an arrangement between Allen Psychiatry and business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.
Communications: At Allen Psychiatry, we prioritize your privacy while ensuring effective communication. We may use or disclose your protected health information while communicating with you via the contact details you have provided — including email address, phone number, and postal address — for communication purposes. Our communications may include, but are not limited to, scheduling and reminding you of appointments, discussing prescription matter, and addressing billing inquiries. Depending on the contact information on record, we may reach out to you via email, phone calls, voice mail, text messages, or postal mail.
Other Permitted Use: We may use or disclose your protected health information in the following situations without your authorization. These situations include: as Required By Law, Public Health issues as required by law, Communicable Diseases: Health Oversight: Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation: Research: Criminal Activity: Military Activity and National Security: Worker’s Compensation: Inmates: Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the regulations of Section 164.500.
Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization: While we may use or disclose your health information without your written authorization as explained above, there are other instances where we will obtain your written authorization. Except as otherwise provided in this Notice, we will not use or disclose your protected health information without your written authorization. You may revoke an authorization at any time by contacting our office, except to the extent Allen Psychiatry has already relied on the authorization and taken actions.
You may revoke this authorization, at any time, in writing, except to the extent that your provider or the provider's practice has taken an action in reliance on the use or disclosure indicated in the authorization.
Your Rights
Following is a statement of your rights with respect to your protected health information
You have the right to issue and copy your protected health information. Under Federal law, however, you may not inspect or copy the following records; psychotherapy notes, information compiled in reasonable anticipation or, or in use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purpose of treatment, payment or healthcare operations. You may also request that any part of your protected health information not to be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply
Your healthcare provider is not required to agree to a restriction that you may request. If your healthcare provider believes that it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to use another Healthcare Professional.
You have the right to request to receive confidential communication from us by alternative mean means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively i.e. electronically, website.
You may have the right to have your healthcare provider amend your protected health information. If we deny your request for amendment, you have the right to file to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
You then have the right to withdraw as provided in this notice.
We reserve the right to make changes to the Privacy Policy as permitted or required by applicable law. Any changes will be posted on our website and will become effective immediately upon posting.
Complaints
You may complain to us or to the Secretary of Department of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying us at office@allenpsychiatry.com or 469-340-2777. We will not retaliate against you for filing a complaint
Our office is open from Monday through Friday, 7:30 AM to 5:00 PM, and we are closed on all major holidays. We do not provide emergency services, crisis services, weekend services, or after-hours coverage. In the event of a life-threatening emergency, please proceed to the nearest emergency room or call 911 immediately.
Refills and Appointments: Allen Psychiatry mandates a virtual or in-person appointment for prescription refills. Ensure you schedule follow-ups before your current prescription depletes. Refills and medication adjustments occur only during these appointments.
Appointment Compliance: Missing appointments can interrupt your treatment and increase relapse risks.
Controlled Substance Policy: For controlled substances, prescription refills may be withheld pending drug screening (UDS) results as per your provider's instructions.
Storage Responsibility: You must store your medication, particularly controlled substances, in a secure, locked location. Lost, stolen, or damaged medications, or running out of your medication early, will not result in a replacement prescription.
Schedule 2 Prescriptions: Complying with Texas regulations, all Schedule 2 prescriptions require a 24-48 hour processing period. Expedited processing is unavailable due to mandatory reviews, including chart evaluations and Texas PMP checks.
Medication Prior Authorization: We advise each patient to obtain a copy of your formulary list prior to your visit, to ensure that the medications being prescribed are covered by your insurance company, and to give you the opportunity to discuss alternatives if possible. This will help to avoid charges incurred on your pharmacy benefits/policy.
We may need to order labs in some cases. Please note the cost of labs is not included in your visit charges. It is your responsibility to ask the lab about their cost. You may choose any lab of your choice.
Consent for Communication Methods: By supplying your contact details, such as your phone number and email address, you grant Allen Psychiatry permission to use these communication methods, which include phone calls, voicemail, and SMS/text messaging, for matters pertaining to scheduling, billing, prescription refills, and other service-related communications. This consent ensures that we can keep you informed and engaged in aspects of your care and administrative necessities.
Ensuring Security: While we ensure the security of electronic communications from our end through encryption and other safeguards, it is equally important for you to secure your communication devices and services. This includes using a PIN for voicemail, employing strong passwords for email, and ensuring secure access to text messages, which may involve device lock features or secure messaging applications.
Responsibility and Comfort with Electronic Communications: It is your responsibility to ensure that your electronic communication tools are secure. If you have concerns about the privacy and security of these communications or if they are not adequately protected on your end, please reconsider using these communication methods with us. Ensuring mutual consent and understanding regarding these communication practices is crucial to maintaining your confidentiality and the effectiveness of our services.
Insurance Responsibilities: Patients are financially responsible for all medical expenses incurred. We verify insurance benefits as a courtesy; however, this verification is not a guarantee of coverage or payment. It is the patient's responsibility to be informed about their insurance plan's specifications and to cover any charges not paid by insurance.
Credit Card Authorization: Patients authorize Allen Psychiatry to maintain a credit card on file. This card may be charged for services not covered by insurance, including fees for missed appointments, late cancellations, and any requested paperwork.
Missed Appointments and Cancellations: We require timely notice to avoid fees for missed appointments or late cancellations. These fees are outlined below and are the patient's responsibility, not billable to insurance. To avoid incurring these fees, please provide notice within the specified time frames prior to your appointment. Thank you for your understanding and cooperation.
For New Patients (Medication Management): $150 fee, 48 hours notice required.
For Established Patients (Medication Management): $100 fee, 24 hours notice required.
For Established Patients (TMS & IOP/PHP): $100 fee, 24 hours notice required.
For All Therapy Appointments: $150 fee, 24 hours notice required.
Fee for other Services:
A fee of $100 is charged for FMLA paperwork completion. Patients are asked to submit paperwork before their appointment.
Requests for letters or forms incur a fee starting at $50, requiring prepayment. Completion of such requests is at the provider's discretion.
A fee of $50 will be applied for any returned checks.
We do not practice Forensic or Occupational Psychiatry. We do not get involved in worker’s compensation cases, divorce/child custody cases, fit for duty, disability evaluations or forms or other legal matters including testimony or reports in civil matters.
We do not treat unstable actively psychotic patients with Schizophrenia and/or Acute Psychotic Disorders. Such patients require case managers and higher level of care. We do not provide social services and case management.
If you need a copy of your medical record, you must give this office a signed authorization from the patient and it may take up to 5 business days to release the records.
If legal actions occur in which your physician is subpoenaed to provide testimony (such as in custody cases) you will be responsible to provide the following even if the subpoena is sent from the opposing side of the case: a.) travel expenses b.) hourly or per diem fees based on our existing fees from the time the physician leaves the office until she returns. At least 50% of the anticipated cost will be expected prior to the court appearance.
Allen Psychiatry is committed to confidentiality to the fullest extent allowed by Texas law. There are several exceptions. The following are common: a.) any evidence of child abuse (past or present) must be reported. b.) If any individual intends to take harmful, dangerous, or criminal actions against another human being or against him/herself. It is our duty to report such actions or intent to the authorities. c.) Sexual improprieties by a former therapist or psychiatrist are a criminal offense and must be reported. You have certain rights in such reporting which your physician can explain to you. d.) Certain court order / action such as custody cases, malpractice actions and criminal cases. e.) Collection of fees. If you have questions about this area, please feel free to discuss with your provider.
In the event that your provider, in her clinical judgment believes you to be dangerous to yourself or to someone else, by signing this consent you authorize her to contact either the person listed as your emergency contact or someone else to provide assistance through a crisis situation.
Both the patient and the provider have the right to terminate the treatment relationship at any time. Should the provider decide to discontinue treatment, the patient will be promptly informed. In such instances, the provider may provide referrals for continued care. Furthermore, if deemed clinically appropriate and safe, the provider may prescribe a limited quantity of emergency medications. However, this may not include Schedule II controlled substances. The provision of any emergency medications is subject to the provider's professional judgment and adherence to relevant regulations.
