DIWS Policy & Procedures

Summary of Policies:

Please read the full policies in their entirety below this section. This list only meant to highlight some of our most relevant/ frequently referenced policies here at DIWS. 

1. Once intake forms are submitted, our staff will verify your insurance eligibilty. 

   • This does not guarantee coverage. We are unable to definitively verify coverage until we receive the ERA from your insurance provider.

   • Clients can always check eligibility/ coverage by calling their insurance provider themself.

2. Payment is due at the time of service (co-payment, co-insurance, private pay fee for service, etc) and/ or when we receive an ERA back from your Insurance Company. 

   • Failure to provide payment at the time of service may result in a $25 "CC Decline" / "Past Due Fee"

   • Failure to pay for two or more consecutive co-payments/ services may result in a disruption of services. 

3. Appointment Cancellations MUST BE made with 48 hours notice.

   • Failure to provide 48 hour notice may result in being charged a $75 "Missed Appointment Fee"

   • Exceptions can be made for medical emergencies (supported by doctor's note)

4. Cancellations MUST BE made through Therapy Portal, written email/ message to Provider/ Office, or via phone call to an office administrator directly. 

5. Dispute of any charges must be made within 30 days of the charge.

Complete Policies and Procedures of Dynamic Intervention Wellness Solutions

This form is called a Consent for Services (the "Consent"). Your therapist, counselor, or other health professional ("Provider") has asked you to read and sign this Consent before you start therapy. Please review the information carefully. If you have any questions, contact the office or your Provider.

OUR PRACTICE

Dynamic Intervention, LLC is a licensed family therapy practice that has provided services to the community since 2007. Our staff consists of Licensed Clinical Social Workers (LCSW) and Licensed Master Social Workers (LMSW) who are all licensed to practice in New York State. In few cases, we do have Master of Social Work Student Interns who conduct sessions under the supervision of a LCSW. In New York State, LMSW's and MSW Interns are only authorized to practice clinical social work under supervision of an LCSW. You should understand that the supervisor is responsible for the diagnosis and treatment of each client and the supervisor is professionally responsible for the services provided by the LMSW. Therefore, any information regarding your treatment will be shared with the supervisor of a LMSW. At Dynamic Intervention Wellness Solutions, our LMSW's are under the direct supervision of the clinical director, Jacqueline Muller, LCSW-R. Should you have any questions or concerns regarding the practice of your LMSW, please contact Jackie at (845)702-1042 or Jackie@diwsny.com.

THE THERAPY PROCESS

Therapy is a collaborative process where you and your Provider will work together on equal footing to achieve goals that you define. This means that you will follow a defined process supported by scientific evidence, where you and your Provider have specific rights and responsibilities. Therapy generally shows positive outcomes for individuals who follow the process. Better outcomes are often associated with a good relationship between a client and their Provider. To foster the best possible relationship, it is important you understand as much about the process before deciding to commit.

Therapy begins with the intake process. First, you will review your Provider's policies and procedures, talk about fees, identify emergency contacts, and decide if you want health insurance to pay your fees depending on your plan's benefits. Second, you will discuss what to expect during therapy, including the type of therapy, the length of treatment, and the risks and benefits. If your Provider is practicing under the supervision of another professional, your Provider will tell you about their supervision and the name of the supervising professional. Third, your provider will form a treatment plan with you, including the type of therapy, how often you will attend therapy, your short- and long-term goals, and the steps you will take to achieve them. Over time, you and your Provider may edit your treatment plan to be sure it describes your goals and steps you need to take. After intake, you will attend regular therapy sessions at your Provider's office or through video, called telehealth. Participation in therapy is voluntary - you can stop at any time. At some point, you will achieve your goals. At this time, you will review your progress, identify supports that will help you maintain your progress, and discuss how to return to therapy if you need it in the future.

TELEHEALTH SERVICES

To use telehealth, you need an internet connection and a device with a camera for video. Your Provider can explain how to log in and use any features on the telehealth platform. If telehealth is not a good fit for you, your Provider will recommend a different option. There are some risks and benefits to using telehealth:

Risks

• Privacy and Confidentiality. You may be asked to share personal information with the telehealth platform to create an account, such as your name, date of birth, location, and contact information. Your Provider carefully vets any telehealth platform to ensure your information is secured to the appropriate standards.

• Technology. At times, you could have problems with your internet, video, or sound. If you have issues during a session, your Provider will follow the backup plan that you agree to prior to sessions.

• Crisis Management. It may be difficult for your Provider to provide immediate support during an emergency or crisis. You and your Provider will develop a plan for emergencies or crises, such as choosing a local emergency contact, creating a communication plan, and making a list of local support, emergency, and crisis services.

Benefits

• Flexibility. You can attend therapy wherever is convenient for you.

• Ease of Access. You can attend telehealth sessions without worrying about traveling, meaning you can schedule less time per session and can attend therapy during inclement weather or illness.

Recommendations

• Make sure that other people cannot hear your conversation or see your screen during sessions.

• Do not use video or audio to record your session unless you ask your Provider for their permission in advance.

• Make sure to let your Provider know if you are not in your usual location before starting any telehealth session, in case of an emergency.

CONFIDENTIALITY

Your Provider will not disclose your personal information without your permission unless required by law. If your Provider must disclose your personal information without your permission, your Provider will only disclose the minimum necessary to satisfy the obligation. However, there are a few exceptions.

• Your Provider may speak to other healthcare providers involved in your care.

• Your Provider may speak to emergency personnel.

• If you report that another healthcare provider is engaging in inappropriate behavior, your Provider may be required to report this information to the appropriate licensing board. Your Provider will discuss making this report with you first, and will only share the minimum information needed while making a report. If your Provider must share your personal information without getting your permission first, they will only share the minimum information needed. There are a few times that your Provider may not keep your personal information confidential.

• If your Provider believes there is a specific, credible threat of harm to someone else, they may be required by law or may make their own decision about whether to warn the other person and notify law enforcement. The term specific, credible threat is defined by state law. Your Provider can explain more if you have questions.

• If your Provider has reason to believe a minor or elderly individual is a victim of abuse or neglect, they are required by law to contact the appropriate authorities.

• If your Provider believes that you are at imminent risk of harming yourself, they may contact law enforcement or other crisis services. However, before contacting emergency or crisis services, your Provider will work with you to discuss other options to keep you safe.

RECORD KEEPING

Your Provider is required to keep records about your treatment. These records help ensure the quality and continuity of your care, as well as provide evidence that the services you receive meet the appropriate standards of care. Your records are maintained in an electronic health record provided by TherapyNotes. TherapyNotes has several safety features to protect your personal information, including advanced encryption techniques to make your personal information difficult to decode, firewalls to prevent unauthorized access, and a team of professionals monitoring the system for suspicious activity. TherapyNotes keeps records of all log-ins and actions within the system.

COMMUNICATION

Your provider will provide you with the best method of communication outside of sessions. Please discuss this with your provider during your session. You have several options:

Phone Call/ Texting/Email

• Each provider has their own office phone number. While texting/ phone calls may be useful for quick updates (running late to an appointment, confirming an appointment same day, etc). Texting and email are not secure methods of communication and should not be used to communicate personal information.

• You may choose to receive appointment reminders via text message or email. You should carefully consider who may have access to your text messages or emails before choosing to communicate via either method.

Therapy Portal Messanger

TP Messanger is a method of secure communications and is the best way to communicate personal information, though no method is entirely without risk. Your Provider will discuss options available to you. If you decide to be contacted via non-secure methods, your Provider will document this in your record.

Social Media/Review Websites ARE NOT VALID METHODS OF COMMUNICATION

• If you try to communicate with your Provider via these methods, they will not respond. This includes any form of friend or contact request, @mention, direct message, wall post, and so on. This is to protect your confidentiality and ensure appropriate boundaries in therapy.

• Your provider may publish content on various social media websites or blogs. There is no expectation that you will follow, comment on, or otherwise engage with any content. If you do choose to follow your Provider on any platform, they will not follow you back.

If you see your Provider on any form of review website, it is not a solicitation for a review. Many such sites scrape business listings and may automatically include your Provider. If you choose to leave a review of your Provider on any website, they will not respond. While you are always free to express yourself in the manner you choose, please be aware of the potential impact on your confidentiality prior to leaving a review. It is often impossible to remove reviews later, and some sites aggregate reviews from several platforms leading to your review appearing other places without your knowledge.

FEES AND PAYMENT FOR SERVICES

(PLEASE READ THIS SECTION CAREFULLY)

You are required to pay for services rendered and other administrative fees that are not covered by insurance. If you choose not to use insurance, you will be provided with private-pay rates prior to beginning therapy. If you are using insurance for your sessions, you should confirm with your insurance if part or all of your services may be covered. Please note that Dynamic Intervention does not have any control over what services your insurance carrier chooses to cover, or what plan benefits you have. It is recommended that you contact your insurance company directly if you have any questions about your plan benefits/ coverage.

No-Show and Late Cancellation Fees

• DIWS REQUIRES 48 HOURS NOTICE TO CANCEL/RESCHEDULE APPOINTMENTS

• Cancellations/Reschedule requested received with LESS than 48 hours will result in a late-cancellation fee of $75.00.

• No Show/Missed Appointments are also subject to the same $75.00 fee.

Your insurance does not cover Missed Appointment/Late Cancellation/Administrative Fees. We understand that emergencies happen.If you’d like to appeal a fee, please e-mail the office with documentation(i.e.,doctor’s note) and we will review on a case-by-case basis. DIWS sends appointment reminder emails and text messages, as a courtesy, to make sure you are always aware of upcoming appointments. However, it is the client’s responsibility to keep track of all appointments scheduled and provide adequate notice when they need to alter an appointment. Please let the office know if your contact information changes and we can update that for you at any time. If you've forgotten about an appointment, give us a call! If there is time, your provider may still be able to see you. However, this is not guaranteed.

Balance Accrual

FULL PAYMENT IS DUE AT THE TIME OF YOUR SESSION.

• If you are unable to pay, tell your Provider before your session begins. The Practice may be able to offer payment plans or a sliding scale. If not, your Provider may help connect you to alternative community-based services that may better suit your financial needs.

• Any balance due will continue to be due until paid in full and any unpaid balance will result in a Past Due Fee of $25 for every 30 days it is past due (i.e. 30 days past due = a $25 fee will be added to the balance, 60 days past due = an additional $25 fee being added to the balance, etc.). If necessary, your balance may be sent to a collections service or small claims court.

Administrative Fees

• There will be a $25 non-refundable fee if your card is declined for any reason. Please let us know if you need to update your payment information prior to your appointment.
• Your Provider may charge administrative fees for writing a letter or report at your request; consulting with another healthcare provider or other professional outside of normal case management practices; or for preparation, travel, and attendance at a court appearance. These fees are listed in the fee agreement. Payment is due in advance.

Insurance Benefits

• Before starting therapy, you should confirm with your insurance company if:

  • Your benefits cover the type of therapy you will receive;

  • Your benefits cover in-person and telehealth sessions;

  • You may be responsible for any portion of the payment;

  • Your Provider is in-network or out-of-network.

  • Your insurance requires prior authorization

Sharing Information with Insurance Companies

• If you choose to use insurance benefits to pay for services, you will be required to share personal information with your insurance company. Insurance companies keep personal information confidential unless they must share to act on your behalf, comply with federal or state law, or complete administrative work.

Covered and Non-Covered Services

• When your Provider is in-network, they have a contract with your insurance company. Your insurance plan may cover all or part of the cost of therapy. You are responsible for any part of this cost not covered by insurance, such as deductibles, copays, or coinsurance. You may also be responsible for any services not covered by your insurance.

• When your Provider is out-of-network, they do not have a contract with your insurance company. You can still choose to see your Provider; however, all fees will be due at the time of your session to your Provider. Your Provider will tell you if they can help you file for reimbursement from your insurance company. If your insurance company decides that they will not reimburse you, you are still responsible for the full amount.

Payment Methods

The practice requires that you keep a valid credit or debit card on file. This card will be charged for the amount due at the time of service and for any fees you may accrue unless other arrangements have been made with the practice ahead of time. It is your responsibility to keep this information up to date, including providing new information if the card information changes or the account has insufficient funds to cover these charges. As a reminder, all declined transactions are subject to a $25 non-refundable fee.

COMPLAINTS/ DISPUTE OF CHARGES

If you have any concerns or disagreement regarding billing or the conduct of your provider, please contact the office via email (office@diwsny.com). Dispute of any charges must be made within 30 days of the charge. Please note, that Dynamic Intervention is not responsible for setting your copayment/coinsurance/deductible. If your dispute is regarding any of those charges, you must first contact your insurance company and have them issue a new Electronic Remittance to our office if there were any discrepancies.

Acknowledgment

Please read the following carefully.

As you may know, insurance benefits and coverage for services can be complicated. We do our best to verify benefits and estimate a patient’s responsibility prior to the service date. However, changing copays, unmet deductibles, uncovered services, and missed appointment fees can quickly raise a patient’s account balance. In order to streamline our billing and payment system and prevent large balances for our patients, we have instituted a REQUIRED CREDIT CARD ON FILE policy at our practice for all appointments and payment is due at the time of service. 

1. We will bill your insurance company first and upon their determination of benefits, we will charge your credit card only the amount listed as "patient responsibility". You are not required to use the credit card on file if you would prefer to use an alternative form of payment, however you must CALL OR E-MAIL THE OFFICE TO MAKE OTHER ARRANGEMENTS BEFOREHAND.

2. Circumstances in which your card may be charged include, but are not limited to:

   1. Deductible and co-insurance amounts
      - These amounts are determined by your insurance company and are non-negotiable. We will charge the card on file once we received the explanation of benefits from your insurance company.

   2. Any non-covered services and/or denial of services
      - It is the patient's responsibility. to notify the office of any insurance changes. Any non-covered sessions will be charged the full amount per session.

   3. Missed or inaccurate co-payments
      - We charge the copay that is listed on the front of your card. However, the card may be outdated and may not show current information.

   4. Missed or canceled sessions without a 48-hour notice

3. If the credit card we have on file for you changes, we require that you notify us immediately by phone or email. If we run your credit card and it is declined for any reason, we reserve the right to charge an additional $25 fee if we are not able to run a new credit card by the end of business day on the day of your appointment. Any new credit card will be subject to the financial policy listed here and may be used with the same authorization as the original card. 

4. If there is a problem with your bill or claim and it is brought to our attention after your credit card payment processes, we will investigate the matter as quickly as possible. If it is determined that you have been overcharged, we will refund the overcharged amount to the same card in a timely manner.

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.

Dynamic Intervention, LLC. (the “Practice”) is committed to protecting your privacy. The Practice is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. The Practice is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains the Practice's legal duties and privacy practices and your rights regarding PHI that we collect and maintain.

YOUR RIGHTS

Your rights regarding PHI are explained below. To exercise these rights, please submit a written request to the Practice at the address noted below.

To inspect and copy PHI.

• You can ask for an electronic or paper copy of PHI. The Practice may charge you a reasonable fee.

• The Practice may deny your request if it believes the disclosure will endanger your life or another person's life. You may have a right to have this decision reviewed.

To amend PHI.

• You can ask to correct PHI you believe is incorrect or incomplete. The Practice may require you to make your request in writing and provide a reason for the request.

• The Practice may deny your request. The Practice will send a written explanation for the denial and allow you to submit a written statement of disagreement.

To request confidential communications.

• You can ask the Practice to contact you in a specific way. The Practice will say “yes” to all reasonable requests.

To limit what is used or shared.

• You can ask the Practice not to use or share PHI for treatment, payment, or business operations. The Practice is not required to agree if it would affect your care.

• If you pay for a service or health care item out-of-pocket in full, you can ask the Practice not to share PHI with your health insurer.

• You can ask for the Practice not to share your PHI with family members or friends by stating the specific restriction requested and to whom you want the restriction to apply.

To obtain a list of those with whom your PHI has been shared.

• You can ask for a list, called an accounting, of the times your health information has been shared. You can receive one accounting every 12 months at no charge, but you may be charged a reasonable fee if you ask for one more frequently.

To receive a copy of this Notice.

• You can ask for a paper copy of this Notice, even if you agreed to receive the Notice electronically.

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 exercise your rights.

To file a complaint if you feel your rights are violated.

• You can file a complaint by contacting the Practice using the following information:

Dynamic Intervention, LLC.

3 Market Street

Wappingers Falls, NY 12590

P:(845)702-1042 | F: (845)702-8434

Office@diwsny.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 www.hhs.gov/ocr/privacy/hipaa/complaints/.

• The Practice will not retaliate against you for filing a complaint.

To opt out of receiving fundraising communications.

• The Practice may contact you for fundraising efforts, but you can ask not to be contacted again.

OUR USES AND DISCLOSURES

1. Routine Uses and Disclosures of PHI

The Practice is permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The Practice typically uses or shares your health information in the following ways:

To treat you.

• The Practice can use and share PHI with other professionals who are treating you.

• Example: Your primary care doctor asks about your mental health treatment.

To run the health care operations.

• The Practice can use and share PHI to run the business, improve your care, and contact you.

• Example: The Practice uses PHI to send you appointment reminders if you choose.

To bill for your services.

• The Practice can use and share PHI to bill and get payment from health plans or other entities.

• Example: The Practice gives PHI to your health insurance plan so it will pay for your services.

2. Uses and Disclosures of PHI That May Be Made Without Your Authorization or Opportunity to Object

The Practice may use or disclose PHI without your authorization or an opportunity for you to object, including:

To help with public health and safety issues

• Public health: To prevent the spread of disease, assist in product recalls, and report adverse reactions to medication.

• Required by the Secretary of Health and Human Services: We may be required to disclose your PHI to the Secretary of Health and Human Services to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.

• Health oversight: For audits, investigations, and inspections by government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.

• Serious threat to health or safety: To prevent a serious and imminent threat.

• Abuse or Neglect: To report abuse, neglect, or domestic violence.

To comply with law, law enforcement, or other government requests

• Required by law: If required by federal, state or local law.

• Judicial and administrative proceedings: To respond to a court order, subpoena, or discovery request.

• Law enforcement: For law locate and identify you or disclose information about a victim of a crime.

• Specialized Government Functions: For military or national security concerns, including intelligence, protective services for heads of state, or your security clearance.

• National security and intelligence activities: For intelligence, counterintelligence, protection of the President, other authorized persons or foreign heads of state, for purpose of determining your own security clearance and other national security activities authorized by law.

• Workers' Compensation: To comply with workers' compensation laws or support claims.

To comply with other requests

• Coroners and Funeral Directors: To perform their legally authorized duties.

• Organ Donation: For organ donation or transplantation.

• Research: For research that has been approved by an institutional review board.

• Inmates: The Practice created or received your PHI in the course of providing care.

• Business Associates: To organizations that perform functions, activities or services on our behalf.

3. Uses and Disclosures of PHI That May Be Made With Your Authorization or Opportunity to Object

Unless you object, the Practice may disclose PHI:

To your family, friends, or others if PHI directly relates to that person's involvement in your care.

If it is in your best interest because you are unable to state your preference.

4. Uses and Disclosures of PHI Based Upon Your Written Authorization

The Practice must obtain your written authorization to use and/or disclose PHI for the following purposes:

Marketing, sale of PHI, and psychotherapy notes.

*Dynamic Intervention, LLC will never market or sell personal information.

OUR RESPONSIBILITIES

• The Practice is required by law to maintain the privacy and security of PHI.

• The Practice is required to abide by the terms of this Notice currently in effect. Where more stringent state or federal law governs PHI, the Practice will abide by the more stringent law.

• The Practice reserves the right to amend Notice. All changes are applicable to PHI collected and maintained by the Practice. Should the Practice make changes, you may obtain a revised Notice by requesting a copy from the Practice, using the information above, or by viewing a copy on the website Dynamicinterventionllc.com.

• The Practice will inform you if PHI is compromised in a breach.

This Notice is effective on 1/1/2022.