• HIPAA Notice of Privacy Practices

    HIPAA Notice of Privacy Practices for Stephanie Toyias, MSW, LICSW, SAC*

    Your Information. Your Rights. Our Responsibilities.

    This notice describes how protected health information (“PHI”) about you may be used and disclosed and how you can get access to this information. Please review it carefully.

    Your Rights

    You have the right to:

    • Get a copy of your paper or electronic medical record

    • Correct your paper or electronic medical record

    • Request confidential communication

    • Ask us to limit the information we share

    • Get a list of those with whom we’ve shared your information

    • Get a copy of this privacy notice

    • Choose someone to act for you

    • File a complaint if you believe your privacy rights have been violated

    Your Choices

    You have some choices in the way that we use and share information regarding:

    • Tell family and friends about your condition

    • Provide disaster relief

    • Include you in a hospital directory

    • Provide mental health care

    • Market our services and selling your information

    • Raise funds

    Our Uses and Disclosures

    We may use and share your information as we:

    • Treat you

    • Run our organization

    • Bill for your services

    • Help with public health and safety issues

    • Do research

    • Comply with the law

    • Respond to organ and tissue donation requests

    • Work with a medical examiner or funeral director

    • Address workers’ compensation, law enforcement, and other government requests

    • Respond to lawsuits and legal actions

    To the extent that we have your substance use disorder patient records, subject to 42 CFR part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.

    Your Rights

    When it comes to your PHI, you have certain rights. This section explains your rights and some of our responsibilities to help you.

    Get an electronic or paper copy of your medical record

    • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

    • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

    Ask us to correct your medical record

    • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

    • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

    Request confidential communications

    • You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address.

    • We will say “yes” to all reasonable requests.

    Ask us to limit what we use or share

    • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no,” for example, if it could affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment.

    • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

    Get a list of those with whom we’ve shared information

    • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

    • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

    Get a copy of this privacy notice

    You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

    Choose someone to act for you

    • If someone has authority to act as your personal representative, such as if someone has your medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

    • We will make sure the person has this authority and can act for you before we take any action.

    File a complaint if you feel your rights are violated

    • You can complain if you feel we have violated your rights by contacting our Privacy Officer: Stephanie Toyias, MSW, LICSW, SAC by phone at 617-582-2737 or email at connect@stephanietoyias.com

    • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/hipaa/filing-a-complaint/

    • We will not retaliate against you for filing a complaint.

    Your Choices

    For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

    In these cases, you have both the right and choice to tell us to:

    • Share information with your family, close friends, or others involved in your care or payment for your care

    • Share information in a disaster relief situation

    • Include your information in a hospital directory

    If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

  • Stephanie Toyias, MSW, LICSW, SAC does not Discriminate

    Stephanie Toyias, MSW, LICSW, SAC is committed to ensuring that there is no discrimination against individuals with disabilities on the basis of disability in the full and equal enjoyment of its course, services, and programs. In furtherance of this commitment, Stephanie Toyias, MSW, LICSW, SAC offers reasonable accommodations in an accessible manner to individuals with disabilities. Stephanie Toyias, MSW, LICSW, SAC formats (large print, audio, accessible electronic formats, other formats)

    • Telehealth and/or in-home psychotherapy treatment for patients with disabilities who would otherwise be unable to come to the office

    • Will make reasonable efforts necessary to accommodate other disabilities or service access issues, including but not limited to, assisting in finding a provider who is able to provide treatment in the patient’s native language, or seek appropriate interpretation services.

    If you need these services, contact Stephanie Toyias, MSW, LICSW, SAC at 617-572-2737 or connect@stephanietoyias.com.

    If you believe that Stephanie Toyias, MSW, LICSW, SAC has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, religion, disability, or sex (including pregnancy, sexual orientation, gender identity, and sex characteristics), you can file a grievance with: Stephanie Toyias, MSW, LICSW, SAC at POBox 95074 Zip code 02568 or via Patient Feedback Form. You can file a grievance by mail, fax, or email. You can also file a complaint at www.ada.gov or civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available by calling 1-800-368-1019, 1-800-537-7697 (TDD https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail at: U.S. Department of Health and Human Services 200 Independence Avenue, SW, Room 509F, HHH Building Washington, D.C. 20201. Complaint forms: http://www.hhs.gov/ocr/office/file/index.html.

  • You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost

    Under the law, health care providers need to give patients who do not have insurance an estimate of their bill for health care items and services before those items or services are provided.

    • You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

    • If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.

    • If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.

    • Make sure to save a copy or picture of your Good Faith Estimate and the bill.

    For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1- 800-985-3059.

    Your Rights and Protections Against Surprise Medical Bills

    What is “balance billing” (sometimes called “surprise billing”)?

    When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

    “Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

    “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

    You’re protected from balance billing for:

    Emergency services

    If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

    Certain services at an in-network hospital or ambulatory surgical center

    When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

    If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

    You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

    When balance billing isn’t allowed, you also have these protections:

    You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.

    Generally, your health plan must:

    • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).

    • Cover emergency services by out-of-network providers.

    • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.

    • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

    If you think you’ve been wrongly billed, contact the federal phone number for information and complaints at: 1-800-985-3059. Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.

    For more information regarding state specific laws, please refer to your state’s specific No Surprises Act legislation. For additional questions please reach out to the Compliance Hotline at 1-800-308-0994.

  • Upon scheduling an initial consultation, you will be provided the above forms to sign as well as the following forms: Informed Consent, Practice Policies, and Informed Consent for Telemedicine.