Andrea Arrieta is currently an in-netwrok provider for Mayo insurance company. As an in-network provider, Andrea Arrieta will submit for payment. Please note that you may have a co-pay that is due at the time of your appointment.

Upon request clients that do not have Mayo, can receive a super bill to submit to their insurance company as an out of network provider.

Services may be covered in full or in part by your health insurance or employee benefit plan. Contact your insurance provider to verify your benefits coverage and eligibility by asking the following questions:

Do I have mental health insurance benefits?
Do I have out of network provider coverage?
What is my deductible and has it been met?
How many sessions per year does my health insurance cover?
What is the coverage amount or percentage per therapy session?
What types of mental services does my health insurance cover (e.g. individual, family, and/or group psychotherapy)?
Is approval required from my primary care physician?

Payment in full is due at your appointment. Cash, check and credit cards (Visa, Mastercard, Discover, & American Express) accepted for payment.

Please note that if you have Mayo insurance you may have a Co-pay for visits that will be due at your appointment.

If you do not show up for your scheduled therapy appointment, and you have not notified us at least 24 hours in advance, you will be required to pay the full cost of the session. Please note that most insurance companies will not cover the cost of a late cancelation and clients will be expected to pay the cost of the session.

In 1996 the Health Insurance Portability and Accountability Act (HIPAA) was signed into law. After that time administrative rules were written by the federal Department of Health and Human Services to implement the act. As a provider of psychotherapy services under insurance programs I am obligated to follow these rules and laws. The following notice is required by HIPAA and contains my implementation of rules and laws under the HIPAA statues and state law. Please note that most of what is contained in this document is defined by both state and federal statutes. As such, I have little control or flexibility in the way that these statutes are implemented.

It is also important to note that the HIPAA statues only apply to services that are delivered under your medical insurance program. For example, these do not necessarily apply to services that are delivered under an Employee Assistance Program, Workman's Compensation Plan, or the medical benefits under an automobile insurance plan if you were injured in an accident.

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. THIS NOTICE IS PART OF THE INFORMED CONSENT PROCESS AND IS INTENDED TO BE USED IN CONJUNCTION WITH THE "INFORMED CONSENT FOR ASSESSMENT, TREATMENT AND PROFESSIONAL SERVICES" DOCUMENT. THERE IS INFORMATION IN BOTH DOCUMENTS ABOUT PRIVACY AND CONFIDENTIALITY. BOTH DOCUMENTS SHOULD BE REVIEWED AND UNDERSTOOD BEFORE YOU AGREE TO START YOUR COUNSELING.

II. IT IS MY LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI).
I am legally required to insure the privacy of your PHI. 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. I am required to provide you with this Notice about my privacy procedures. This Notice must explain when, why, and how I would “use” and/or “disclose” your PHI. “Use” of PHI occurs when I share, apply, utilize, examine, or analyze information within my practice; PHI is “disclosed” when I release, transfer, give, or otherwise reveal it to a third party outside my practice. With some exceptions, I 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, I am always legally required to follow the privacy practices described in this Notice. Please note that I reserve the right to change the terms of this Notice and my privacy policies at any time. Any changes will apply to PHI already on file with me. Before I make any important changes to my policies, I will immediately change this Notice and post a new copy of it in my office. You may also request a copy of this Notice from me, or you can view a copy of it in my office.

As a psychotherapist under HIPAA, two different kinds of PHI may be involved: medical records and psychotherapy notes. Medical records include treatment plans, assessments, symptoms, diagnoses, clinical tests and examinations, progress in treatment, patient functionality, and modalities and frequency of treatment. Psychotherapy notes are optional at the therapist's discretion, and contain more personal and sensitive information that is used by the therapist in the process of treatment. Psychotherapy notes have special protections under HIPAA. Depending on the nature and subject of the counseling I may or may not keep psychotherapy notes on your case, and there may be sometimes when I use or write these and others when they are not deemed necessary. In general where PHI is referred to in this notice it should be interpreted to mean medical records, not psychotherapy notes. It will be noted in this document where PHI includes psychotherapy notes, or where other provisions apply to psychotherapy notes.

III. HOW I MAY USE AND DISCLOSE YOUR PHI.
I 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 my uses and disclosures, with some examples.

A. Uses and Disclosures Related to Treatment, Payment, or Health Care Operations That Do Not Require Your Prior Written Consent. I may use and disclose your PHI without your consent for the following reasons:
1. For Treatment. I 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, I may disclose your PHI to her/him in order to coordinate your care.
2. For Health care operations. I may disclose your PHI to facilitate the efficient and correct operation of my practice. Examples: Quality control - I 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. I may also provide your PHI to my attorneys, accountants, consultants, and others to make sure that I am in compliance with applicable laws.
3. To Obtain Payment for treatment. I may use and disclose your PHI to bill and collect payment for the treatment and services I provided you. Example: I might send your PHI to your insurance company or health plan in order to get payment for the health care services that I have provided to you. I could also provide your PHI to business associates, such as billing companies, claims processing companies, and others that process health care claims for my office. Your insurance company or managed care organization can not require me to release information from the psychotherapy notes in order to authorize or pay for treatment services. This is a new protection for patients under HIPAA. However, they can and often do require the release of other PHI including diagnoses, treatment plan, clinical test results, response to treatment, compliance with treatment, mental and functional status, medications prescribed, and modalities and frequency of treatment. I have no knowledge about or control over what happens to your PHI once it has been released to an insurance company. You should be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk to confidentiality, privacy, or to future eligibility to obtain health of life insurance. If you chose to use your medical benefits I am obligated to supply them your PHI.
4. Other disclosures. I may also disclose your PHI to others without your consent in certain situations. Examples: Your consent isn't required if you need emergency treatment provided that I attempt to get your consent after treatment is rendered. In the event that I try to get your consent but you are unable to communicate with me (for example, if you are unconscious or in severe pain) but I think that you would consent to such treatment if you could, I may disclose your PHI.

B. Certain Other Uses and Disclosures Do Not Require Your Consent. I 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.
2. 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. Note: this may include the disclosure of information contained in my psychotherapy notes.
3. 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 I determine that disclosure is necessary to prevent the threatened danger. Note: this may include the disclosure of information contained in my psychotherapy notes.
4. If disclosure is mandated by the Arizona Child Abuse and Neglect Reporting law. For example, if I have a reasonable suspicion of child abuse or neglect. Note: this may include the disclosure of information contained in my psychotherapy notes.
5. If disclosure is mandated by the Arizona Elder/Dependent Adult Abuse Reporting law. For example, if I have a reasonable suspicion of elder abuse or dependent adult abuse. Note: this may include the disclosure of information contained in my psychotherapy notes.
6. If disclosure is compelled or permitted by the fact that you tell me of a serious/imminent threat of physical violence by you against a reasonably identifiable victim or victims. Note: this may include the disclosure of information contained in my psychotherapy notes.
7. 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.
8. If disclosure is required by the Arizona Board of Behavioral Health Examiners as a result of a complaint or other investigation. This includes the disclosure of information contained in psychotherapy notes.
9. If a lawsuit is filed against me by you or by someone on your behalf, PHI, including psychotherapy notes, may be disclosed in a court proceeding as part of my defense.
10. For Workers' Compensation purposes. I may provide PHI in order to comply with Workers' Compensation laws. The HIPAA privacy regulations and protections do not apply to services provided under workman's compensation insurance.
11. Appointment reminders and health related benefits or services. Examples: I may use PHI to provide appointment reminders. I may use PHI to give you information about alternative treatment options, or other health care services or benefits I offer.
12. 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.
13. 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 my compliance with HIPAA regulations.
14. If disclosure is otherwise specifically required by law.

C. 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 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.

D. Other Uses and Disclosures Require Your Prior Written Authorization. In any other situation not described in Sections IIIA, IIIB, and IIIC above, I 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 I haven't taken any action subsequent to the original authorization) of your PHI by me.

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 my possession, or to get copies of it; however, you must request it in writing. If I do not have your PHI, but I know who does, I 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, I may feel I must deny your request, but if I do, I will give you, in writing, the reasons for the denial. I will also explain your right to have my denial reviewed. If you request copies of your PHI, I will charge you $.25 per page. Instead of providing the PHI you requested, I 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. Psychotherapy notes are intended for the sole use of the therapists providing your care. Please note that the right to view or get copies of your PHI may not include access to psychotherapy notes.

B. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask that I limit how I use and disclose your PHI. While I will consider your request, I am not legally bound to agree. If I do agree to your request, I 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 I am legally required or permitted to make.

C. The Right to Choose How I Send 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). I am obliged to agree to your request providing that I can give you the PHI, in the format you requested, without undue inconvenience.

D. The Right to Get a List of the Disclosures I Have Made. You are entitled to a list of disclosures of your PHI that I have made. The list will not include uses or disclosures to which you have already consented, such as 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. I will respond to your request for an accounting of disclosures within 60 days of receiving your written request. The list I 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. I will provide the list to you at no cost, unless you make more than one request in the same year, in which case I 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 I 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 my receipt of your request. I may deny your request, in writing, if I find that: the PHI is (a) correct and complete, (b) forbidden to be disclosed, (c) not part of my records, or (d) written by someone other than me. My 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 I approve your request, I will make the change(s) to your PHI. Additionally, I will tell you that the changes have been made, and I 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 also have the right to request a paper copy of it, as well.

V. HOW TO COMPLAIN ABOUT MY PRIVACY PRACTICES
If, in your opinion, you think that I may have violated your privacy rights, or if you object to a decision I made about access to your PHI, you are entitled to file a complaint with the person listed in Section VI below. You may also send a written complaint to the Secretary of the Department of Health and Human Services at 200 Independence Avenue S.W. Washington, D.C. 20201. I will take no retaliatory action against you if you file a complaint about my privacy practices.

VI. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE
OR TO COMPLAIN ABOUT MY PRIVACY PRACTICES
If you have any questions about this notice or any complaints about my privacy practices, or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact me at: 602.989.1808.

VII. EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on March 20, 2013, and replaces previous notices.

VIII. Privacy Officer
Our Privacy Officer is Andrea Arrieta. The Privacy Officer can: (a) answer your questions about our privacy practices; (b) accept any complaints you have about our privacy practices; and (c) give you information on how to file a complaint. You can contact the Privacy Officer at 602.989.1808.

If you wish, you may pay fees electronically – through funds transfer or using a payment card -- using Square

Please Be Aware of the Following:
Andrea Arrieta MC, LPC/Bounce Back Abilities have a duty to uphold your confidentiality, and thus wish to make sure that your use of the above payment services is done as securely and privately as possible.

After using any of the above services to pay your fees, that service may send you receipts for payment by email or text message. These receipts will include our business name, and would indicate that you have paid for a therapy session.

It is possible the receipt may be sent automatically, without first asking if you wish to receive the receipt. Andrea Arrieta MC, LPC/Bounce Back Abilities is unable to control this in many cases, and may not be able to control which email address or phone number your receipt is sent to.

Consequently, before using the above service to pay for your session(s), please think about these questions:
At which email address or phone numbers have I received these kinds of receipts before?
Are any of those addresses or phone numbers provided by my employer or school? If so, the employer or school will most likely be able to view the receipts that are sent to you.
Are there any other parties with access to these addresses or phone numbers that should not be seeing these receipts? Would there be any danger if such a person discovered them?

In addition to these possible emails or text messages, payments made by credit card will appear on your credit card statement as being made to write your business name as it appears on credit card statements. Please consider who might have access to your statements before making payments by credit card.

Health Savings Accounts and Flexible Spending Accounts
If you are using a Health Savings Account (HSA) or Flexible Spending Account (FSA) payment card, please be aware that even if your payment goes through and is authorized at the time that we run your card, there is a possibility that your payment could later be denied. In the event of this happening, you are responsible for ensuring that full payment is made by other means.

When you need to contact Andrea Arrieta MC, LPC/Bounce Back Abilities for any reason, these are the most effective ways to get in touch in a reasonable amount of time:

1) By phone (602.989.1808) You may leave messages on the voicemail, which is confidential.
2) By secure text message (see below for details)
3) By secure email (see below for details)
4) By the secure contact page on the website (see below for details)

If you wish to communicate with Andrea Arrieta MC, LPC/Bounce Back Abilities by normal email or normal text message, please read and complete the Consent For Non-Secure Communications form about the potential confidentiality risks of doing so.


Andrea Arrieta MC, LPC/Bounce Back Abilities subscribes to the following service(s) that can allow clients to communicate more privately through the use of encryption and other privacy technologies. None of them cost money, but each requires some setup before they can be used. Please inquire if you would like to use any of these services:

1) Encrypted email via the secure "client portal" of the website
2) Secure text messaging via qliq soft. This service can be used on a computer or smartphone.
3) A secure contact page on the website. You can type and send encrypted messages through this page. (www.andreaarrieta.com)
4) Secure online video chat via the website.

If you need to send a file such as a PDF or other digital document, please send using the secure email service on the website or FAX it to 314.467.4629

Social Media
Please refrain from making contact with Andrea Arrieta MC, LPC/Bounce Back Abilities using social media messaging systems such as Facebook Messenger or Twitter. These methods have very poor security and Andrea Arrieta MC, LPC/Bounce Back Abilities is not prepared to watch them closely for important messages from clients. Per the American Counseling Association Ethical Guidelines Andrea Arrieta MC, LPC/Bounce Back Abilities is unable to friend clients through social media.

It is important that clients and Andrea Arrieta MC, LPC/Bounce Back Abilities be able to communicate and also keep the confidential space that is vital to therapy. If you have any concerns regarding Andrea Arrieta MC, LPC/Bounce Back Abilities preferred communication methods please communicate those concerns.

Response Time
Andrea Arrieta MC, LPC/Bounce Back Abilities may not be able to respond to client messages and calls immediately. For voicemails and other messages, clients can expect a response within 3 business days during office hours (9:00 am - 5:00 pm). Andrea Arrieta MC, LPC/Bounce Back Abilities may occasionally reply more quickly, after office hours, or on weekends. Please be aware that this will not always be possible.

Be aware that there may be times when Andrea Arrieta MC, LPC/Bounce Back Abilities is unable to receive or respond to messages, such as when out of cellular range or out of town.

Emergency Contact
If you are ever experiencing an emergency, including a mental health crisis, please call the crisis line at (602) 222-9444

If you need to contact Andrea Arrieta MC, LPC/Bounce Back Abilities about an emergency, the best method is:
By phone 602.989.1808
If you cannot reach Andrea Arrieta MC, LPC/Bounce Back Abilities by phone, please leave a voicemail
You can also follow up with a secure text message via the secure "client portal" on the website.

Please note that SMS (normal phone text messages) are not designed for emergency contact. SMS text messages occasionally get delayed and on rare occasions may be lost. So, please refrain from using SMS as your sole method of communicating with Andrea Arrieta MC, LPC/Bounce Back Abilities in emergencies.

Disclosure Regarding Third-Party Access to Communications
Please know that if you use electronic communications methods, such as email, texting, online video, and possibly others, there are various technicians and administrators who maintain these services and may have access to the content of those communications. In some cases, these accesses are more likely than in others.

Of special consideration are work email addresses. If you use your work email to communicate with Andrea Arrieta MC, LPC/Bounce Back Abilities, your employer may access our email communications. There may be similar issues involved in school email or other email accounts associated with organizations that you are affiliated with. Additionally, people with access to your computer, mobile phone, and/or other devices may also have access to your email and/or text messages. Please take a moment to contemplate the risks involved if any of these persons were to access the messages we exchange with each other.

I have read and understand the Communications Policy

Andrea Arrieta MC, LPC/Bounce Back Abilities keeps and stores client records in a record-keeping system produced and maintained by Counsol. This system is “cloud-based,” meaning the records are stored on servers which are connected to the Internet. Here are the ways in which the security of these records is maintained:

Andrea Arrieta MC, LPC/Bounce Back Abilities has entered into a HIPAA Business Associate Agreement with Counsol. Because of this agreement, Counsol is obligated by federal law to protect these records from unauthorized use or disclosure.

The computers on which these records are stored are kept in secure data centers, where various physical security measures are used to maintain the protection of the computers from physical access by unauthorized persons.

I have read the Electronic Records Disclosure:
Counsol employs various technical security measures to maintain the protection of these records from unauthorized use or disclosure.
Consider finding descriptions of security measures on the company’s website and including them here.

Andrea Arrieta MC, LPC/Bounce Back Abilities has its own security measures for protecting the devices used to access these records:

On computers, Andrea Arrieta MC, LPC/Bounce Back Abilities employs firewalls, antivirus software, passwords, and disk encryption to protect the computer from unauthorized access and thus to protect the records from unauthorized access.

With mobile devices, Andrea Arrieta MC, LPC/Bounce Back Abilities uses passwords, remote tracking, and remote wipe (include any other security measures you use on your mobile devices) to maintain the security of the device and prevent unauthorized persons from using it to access records.

Here are things to keep in mind about the record-keeping system:
While the record-keeping company and Andrea Arrieta MC, LPC/Bounce Back Abilities both use security measures to protect these records, their security cannot be guaranteed.
Some workforce members at Counsol, such as engineers or administrators, may have the ability to access these records for the purpose of maintaining the system itself. As a HIPAA Business Associate, Counsol is obligated by law to train their staff on the proper maintenance of confidential records and to prevent misuse or unauthorized disclosure of these records. This protection cannot be guaranteed, however.

The record-keeping company keeps a log of my transactions with the system for various purposes, including maintaining the integrity of the records and allowing for security audits.