Social Media Policy
Purpose of Social Media Policy
While complying with ethical obligations when conducting myself and my practice on the Internet, this policy is meant to outline how I engage with current or former clients on social media.
Friending and Following
I ONLY accept friend requests from current or former clients on social networking platforms related to HP Psychotherapy. This means that I will NOT accept any interactions or requests on personal/private profiles. This provides an organic avenue for trust-building and authentic learning. Note that I will not follow your account back, as I believe it could negatively impact our working relationship.
I do not respond to social networking comments nor direct messages. If you would like to contact me in between sessions, please do so via the secure portal https://hannah-paull.clientsecure.me or email me (a less secure option) at email@example.com. As a reminder, I cannot guarantee I will be checking these messages right away, so please do not use them for an emergency.
In the case of an emergency or crisis, please utilize the following resources:
Call 988 Suicide & Crisis Lifeline (provides 24/7 free and confidential support for those in an emotional distress or suicidal crisis).
For GA residents: Call 1-800-715-4225 for the Georgia Crisis & Access Line (GCAL) or check-out other available resources online at https://namiga.org/resources/crisis-info-2/
For Philadelphia residents: Call 215-685-6440 for the suicide prevention and crisis hotline or check-out other available resources online at https://namiphilly.org/crisis-info/
Note: Questions meant to inspire a healthy conversation and comments are welcome. However, discriminatory remarks (ableist, xenophobic, homophobic, etc.) will not be tolerated.
Thank you for reading my Social Media Policy. As always, if you have any questions, comments, or concerns, please let me know.
APPOINTMENTS AND CANCELLATIONS
Please remember to cancel or reschedule 24 hours in advance. You will be responsible for the entire fee if cancellation is less than 24 hours.
The standard meeting time for psychotherapy is 50 minutes. It is up to you, however, to determine the length of time of your sessions. Requests to change the 50-minute session needs to be discussed with the therapist in order for time to be scheduled in advance.
A $10.00 service charge will be charged for any checks returned for any reason for special handling.
Cancellations and re-scheduled sessions will be subject to a full charge if NOT RECEIVED AT LEAST 24 HOURS IN ADVANCE. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late for a session, you may lose some of that session time. I will wait 15 minutes into the session before assuming you are not going to show up. After 15 minutes, your session status will turn to a “no-show” and you will be charged the full session fee.
If you need to contact me between sessions, please leave a message on my voicemail. I am often not immediately available; however, I will attempt to return your call within 24 hours.
SOCIAL MEDIA AND TELECOMMUNICATION
Due to the importance of your confidentiality and the importance of minimizing dual relationships, I do not accept friend or contact requests from current or former clients on any of my personal social networking profiles (Facebook, LinkedIn, etc). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.
I cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, I will do so. While I may try to return messages in a timely manner, I cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.
Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail is considered telemedicine by the State of California. Under the California Telemedicine Act of 1996, telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another. If you and your therapist chose to use information technology for some or all of your treatment, you need to understand that:
(1) You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled.
(2) All existing confidentiality protections are equally applicable.
(3) Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee.
(4) Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent.
(5) There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel costs. Effective therapy is often facilitated when the therapist gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third person consultations, but also from direct visual and olfactory observations, information, and experiences. When using information technology in therapy services, potential risks include, but are not limited to the therapist's inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: your physical condition including deformities, apparent height and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression. Potential consequences thus include the therapist not being aware of what he or she would consider important information, that you may not recognize as significant to present verbally to the therapist.
If you are a minor, your parents may be legally entitled to some information about your therapy. I will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately kept confidential.
Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. I may terminate treatment after appropriate discussion with you and a termination process if I determine that the psychotherapy is not being effectively used or if you are in default on payment. I will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, I will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.
Should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued.
Informed Consent for Psychotherapy
The therapeutic relationship is unique in that it is a highly personal and at the same time, a contractual agreement. Given this, it is important for us to reach a clear understanding about how our relationship will work, and what each of us can expect. This consent will provide a clear framework for our work together. Feel free to discuss any of this with me.
The Therapeutic Process
You have taken a very positive step by deciding to seek therapy. The outcome of your treatment depends largely on your willingness to engage in this process, which may, at times, result in considerable discomfort. Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. There are no miracle cures. I cannot promise that your behavior or circumstance will change. I can promise to support you and do my very best to understand you and repeating patterns, as well as to help you clarify what it is that you want for yourself.
The session content and all relevant materials to the client’s treatment will be held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons. Limitations of such client held privilege of confidentiality exist and are itemized below:
If a client threatens or attempts to commit suicide or otherwise conducts him/her/them self in a manner in which there is a substantial risk of incurring serious bodily harm.
If a client threatens grave bodily harm or death to another person.
If the therapist has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.
Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.
Suspected neglect of the parties named in items #3 and # 4.
If a court of law issues a legitimate subpoena for information stated on the subpoena.
If a client is in therapy or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney.
Occasionally I may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name.
If we see each other accidentally outside of the therapy office, I will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to me, and I do not wish to jeopardize your privacy. However, if you acknowledge me first, I will be more than happy to speak briefly with you, but feel it appropriate not to engage in any lengthy discussions in public or outside of the therapy office.
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. MY PLEDGE REGARDING HEALTH INFORMATION: I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to:
Make sure that protected health information (“PHI”) that identifies you is kept private.
Give you this notice of my legal duties and privacy practices with respect to health information.
Follow the terms of the notice that is currently in effect.
I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.
II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.
For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.
Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.
Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
Psychotherapy Notes. I do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is: a. For my use in treating you. b. For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy. c. For my use in defending myself in legal proceedings instituted by you. d. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA. e. Required by law and the use or disclosure is limited to the requirements of such law. f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes. g. Required by a coroner who is performing duties authorized by law. h. Required to help avert a serious threat to the health and safety of others.
Marketing Purposes. As a psychotherapist, I will not use or disclose your PHI for marketing purposes.
Sale of PHI. As a psychotherapist, I will not sell your PHI in the regular course of my business.
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:
When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
For health oversight activities, including audits and investigations.
For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.
For law enforcement purposes, including reporting crimes occurring on my premises.
To coroners or medical examiners, when such individuals are performing duties authorized by law.
For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
For workers’ compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers’ compensation laws. 10 Appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.
Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.
The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.
The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost based fee for doing so.
The Right to Get a List of the Disclosures I Have Made.You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost based fee for each additional request.
The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.
The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.
The Right to Choose Someone to Act For You. If you have given someone medical power of attorney or if someone is your legal guardian, that person can make choices about your health information.
The Right to Revoke an Authorization.
The Right to Opt out of Communications and Fundraising from our Organization.
The Right to File a Complaint. You can file a complaint if you feel I have violated your rights by contacting me using the information on page one or by filing a complaint with the HHS Office for Civil Rights located at 200 Independence Avenue, S.W., Washington D.C. 20201, calling HHS at (877) 696-6775, or by visiting www.hhs.gov/ocr/privacy/hipaa/complaints. I will not retaliate against you for filing a complaint.
VII. CHANGES TO THIS NOTICE
I can change the terms of this Notice, and such changes will apply to all the information I have about you. The new Notice will be available upon request and on my website.
No Surprises Act & Good Faith Estimate
As required by CMS and Federal Legislation, effective January 1, 2022 (the “No Surprises Act”) the
Practice is required to provide you with a good faith estimate for services. The Practice’s office policies
outline most of the requirements of this legislation, but this separate document will include the
information in a way that complies with this legislation.
The purpose of this document is to let you know about your protection from unexpected medical bills. It
also asks whether you would like to give up those protections and pay more for out-of-pocket network
Important: You aren’t required to sign this form and shouldn’t if you didn’t have a choice of health care
providers when you received care. You can choose to get care from a provider or facility in your health
plan’s network, which may cost you less. If you’d like assistance with this document, please contact the
practice. Please retain a copy for your records.
You are getting this notice because this provider or facility isn’t in your health plan’s network. This
means the provider and facility do not have an agreement with your plan. Getting care from this provider
or facility could cost you more.
If your plan covers the items(s) or service(s) you are getting, Federal law protects you from higher bills:
1. When you get emergency care from out-of-network providers and facilities
2. When an out-of-network provider treats you at an in-network hospital or ambulatory surgical center without your knowledge or consent.
Ask your healthcare provider or patient advocate if you need help knowing if these protections apply to
If you sign this form, you may pay more because:
1. You are giving up your protections under the law.
2. You may owe the full costs billed for items and services received.
3. Your health care plan might not count any of the amount you pay towards your deductible and out-of-pocket limit. Contact your health plan for more information.
You shouldn’t sign this form if you didn’t have a choice of providers when receiving care. For example, if
a doctor was assigned to you with no opportunity to make a change.
Before deciding whether to sign this form, you can contact your health plan to find an in-network
provider or practice. If there isn’t one, your health plan might work out an agreement with another
provider or practice.
Please see below for your cost estimate.
Estimate of What You Could Pay: $9,100
Patient Name: ______________
Out-of-Network Facility Name: HP Psychotherapy, LLC
Total cost estimate of what you may be asked to pay: It is your ethical right to determine your goals for
treatment and how long you would like to remain in therapy unless you are pursuing mandatory treatment.
Your provider has the right to refer you to another appropriate provider if treatment frequency cannot be
agreed upon. Please see the breakdown of possible fees below.
1. Review your detailed estimate. See below for a cost estimate for each item or service.
2. Call your health plan. Your plan may have better information about how much of these services are reimbursable.
3. Questions about this notice and estimate? Call 678-561-3399 or e-mail: firstname.lastname@example.org
4. You have the right to dispute the charges if they are $400 over the estimate. Please note: no-show and late cancellation fees, as well are emergency sessions are not included in the estimate. You understand that if you are in clinical need of emergency services and/or do not comply with the practice’s cancellation and no-show policy, the estimate will be more. If you choose to use the dispute resolution process within the U.S. Department of Health and Human Services (HHS), you must start the process within 120 calendar days of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on the Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount. To learn more information and get a form to start the process go to: www.cms.gov/nosurprises.
Prior Authorizations or Other Care Management Limitations:
Except in an emergency, your health plan may require prior authorization (or other limitations) for certain
items and services. This means you may need your plan’s approval that it will cover an item or service
before you receive them. If prior authorization is required, please ask your health plan about what
information is necessary to get coverage.
More Information About Your Rights and Protections:
https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billingproviders-facilities-health.pdf for more information about your rights under Federal law.
By signing this form, I give up my Federal consumer protections and agree I might pay more for
With my signature, I am saying that I agree to get the items or services from the practice, HP Psychotherapy, LLC, and Hannah Paull, PsyD, NPI Number: 1033721113.
With my signature, I acknowledge that I am consenting of my own free will and am not being
coerced or pressured. I also understand the following:
1. I am giving up some consumer billing protections under Federal law.
2. I may get a bill for the full charges for these items and service or have to pay out-of-network cost-sharing under my health plan.
3. I was given written notice explaining that my provider or facility isn’t in my health plan’s network, the estimated cost of services, and what I may owe if I agree to be treated by this provider or facility.
4. I received the notice either on paper or electronically.
5. I fully and completely understand that some or all amounts I pay might not count towards my health plan’s deductible or out-of-pocket limit.
6. I can end this agreement by notifying the provider or facility in writing before getting services.
Important: You don’t have to sign this form. However, if you don’t sign this form, this provider of
facility might not treat you.
Employer Identification Number: 85-4541201
NPI Number: 1033721113
Patient’s Name: ______________
Patient’s DOB: ______________
Current Diagnostic Code(s): ______________
*For new patients, a diagnosis will be provided upon intake and they will receive an updated document
with a diagnostic code.
Out-Of-Network Provider and Facility Name: Hannah Paull, PsyD / HP Psychotherapy, LLC
The amount below is only an estimate; it is not an offer or contract for services. This estimate shows the
full estimated cost of the items or services listed. It doesn’t include any information about what your
health plan may cover. This means that the final cost of services may be different than this estimate.
Contact your health plan to find out how much, if any, your plan will pay and how much you may
have to pay.
Patient Name: _______
At this time, all services are conducted virtually. Additional modifiers that you will see on your superbill
may include “GT” or “95” to represent telehealth services. The place of service (in-office “10” vs. telehealth “02”) is not delineated above since the charges are the same.
Patients are required to pay for services at the time that they are provided.
Total Cost: $175 for every session billed for CPT code 90837. If a patient were to attend weekly psychotherapy with 0 cancellations over the course of a year, the cost would be estimated at $9,100 annually (if there are no cancellations, holidays, vacations or missed appointments). The cost of this estimate of out-of-pocket costs would be if a patient paid out-of-pocket without any insurance coverage or reimbursement based on out-of-network benefits. This cost does not reflect any no-show or late cancellation fees.
Total Estimated Cost: The total estimated cost cannot be pre-determined as every patient is different,
and their treatment needs may vary over the course of the year. As such, we provide you with the above
estimate reflecting weekly, 50 minutes sessions for 52 weeks (1 year, every week). Please speak to your
provider and review your treatment plan to determine the recommended frequency of services and specific services that will be provided.
1. There may be additional items or services that are recommended as part of the treatment plan that will be scheduled separately and are not reflected on this Good Faith Estimate.
2. The information provided in this Good Faith Estimate is only an estimate and the actual items, services, or charges may differ from the Good Faith Estimate in that the Practice cannot determine the exact number of sessions/services a patient will receive during the course of treatment.
3. Treatment plans are reviewed approximately every 90 days and the frequency of treatment is also reviewed at that time.
4. Patients will be provided with a Good Faith Estimate at the start of each year, or additionally upon their request.
5. The information here does not require any private pay patient to obtain psychotherapy services or other services from us. It simply provides informed consent to the patient should they choose to with the Practice, of estimated costs.
6. There is no guarantee that insurance will cover any part or all of the charges billed. Ultimately, it is up to the insured individual or their parent/guardian to determine if the services are covered by their insurance company, given that providers and the practice are out-of-network.