PRIVACY PRACTICES
Last updated: January 31, 2024
HIPAA NOTICE OF PRIVACY PRACTICES FOR BERGESEEN GROUP
Effective date: April 4, 2024
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.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides standards for how medical information should be used and disclosed by healthcare providers, health plans, and other covered entities. Bergeseen Group (“BG”) is a counseling and advisory provider that both directly delivers mental health services through its personnel as well as contracts with other counselor and advisors to deliver mental health services. We provide each of our users with this information and ask each of our users to acknowledge receipt of our HIPAA Notice of Privacy Practices for BG, which discloses our practices for personal information gathering and dissemination. Please note that by registering on the Jane App website (the “Site”) or by using the services provided by BG, together with any independent contracted affiliates (together “BG”, “we”, “our” or “us”), you accept the practices described in this Notice of Privacy Practices. If you do not agree to this Notice, please do not use the Site or BG’s services. IF YOU ARE UNDER 13 YEARS OF AGE, PLEASE DO NOT USE OR ACCESS OUR SITE.
What information do we collect from users and how is it used?
Registration: Before using some of our services, we need you to register with the Site and provide your name, email address, a password, and other personal details. We request this information for identification purposes, to communicate with you, and to improve the functioning of certain services. By providing us with your email address, you consent to receiving information from us through the email you provide us, including protected health information which is private to you and protected by HIPAA. For more information on the information we collect, you can also review our Terms of Use (www.bergeseen.com/terms-of-use/) and Privacy Policy (www.bergeseen.com/privacy-policy/). You may also be asked to complete other forms (e.g. intake forms, consent forms, etc.) depending on the services you choose.
Forms: To fully use our offerings, you may need to fill out forms that ask for or contain personal information such as your name, contact information, health, and other personal information. By providing us with your mobile phone number, you consent to receiving information from us by text or voicemail, including in the case of voicemail, protected health information.
Client Records: In order for us to get you the best care, we may ask you to provide us with your medical records, for which we will obtain a signed authorization from you. We may also ask you for a description of symptoms, a medical history, lifestyle descriptions and information on the progress of your treatment from your provider either over the phone, by email, or through our Site. In addition, if you see a provider that is employed by BG, we will maintain a client record that contains the details of the care you receive from BG.
Correspondence: If you correspond with us via email or text, we may gather in a file specific to you the information that you submit.
Outcomes: We may periodically send you surveys to collect your feedback on the outcomes of your counseling and/or advisory. Understanding outcomes is central to our mission of providing effective, evidence-based care, and data can help inform BG’s approach to treatment and assessment of progress. We anonymize and convert individual outcome scores into improvement levels, and then aggregate those in reporting across an entire population. We will store the above described categories of information for as long as needed to provide our services, and as required to comply with our legal obligations (including those under HIPAA), resolve potential or actual disputes, improve the quality of our services, or enforce our agreements.
In addition, your provider may capture independent counseling and/or advisory notes, which would be subject to his or her separate HIPAA privacy practices.
How does BG use and disclose protected health information about you that we collect?
BG will collect protected health information (“PHI”) and other private information, which includes but may not be limited to your name, age, gender, contact information, problems you are seeking help for, and progress and outcomes of your treatment, from you and will use or share it for the following purposes:
Treatment: We may provide your PHI and other private information to other professionals or programs that provide treatment to you with your written consent.
Run our Organization: We can use and share your PHI to support our business operations, that is to run our organization, improve our offerings to clients, improve your care and the coordination of your care, and contact you when necessary, such as using your PHI to manage your treatment and services.
Billing and Payment: If you decided to seek reimbursement for BG’s services through your employer, insurance, health plan, government payer, or any other third-party service, BG will provide you with the information requested but cannot control or guarantee the confidentiality or privacy of PHI and other private information you submit or release to these aforementioned parties.
Other Uses: We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: “Your Rights Under HIPAA”. The following are ways we may share your information:
§ Help with public health and safety issues: We can share health information about you for certain situations such as reporting suspected abuse, neglect, or domestic violence; preventing or reducing a serious threat to anyone’s health or safety; reporting adverse reactions to medications; preventing disease; and helping with product recalls.
§ Comply with the law: We will share information about you if state or federal laws require it.
§ Respond to organ and tissue donation requests: We can share health information about you with organ procurement organizations.
§ Work with a medical examiner or funeral director: We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
§ Address workers’ compensation, law enforcement, and other government requests: We can use or share health information about you for workers’ compensation claims; for law enforcement purposes or with a law enforcement official; with health oversight agencies for activities authorized by law; for special government functions such as military, national security, and presidential protective services.
§ Respond to lawsuits and legal actions: We can share health information about you in response to a court or administrative order, or in response to a subpoena.
You have both the right and the choice to tell us to share your PHI or private information with your family, close friends, or others involved in your care and/or share your PHI or private information in a disaster relief situation. If you are not able to tell us your preference, we may go ahead and share your information if we believe it is in the interest of your safety or the safety of others.
BG reserves the right to release collected information to law enforcement or other government officials, as we, in our sole and absolute discretion, deem necessary or appropriate.
What are your rights regarding your protected health information?
You have certain rights regarding PHI and other private information that we maintain about you, including rights to:
§ Get an electronic or paper copy of your client record: You can ask to see or get an electronic or paper copy of your client record and other health or private information we have about you. To request a copy of your records, select “Access” on our HIPAA Rights Form here. We will provide a copy or a summary of your PHI and private information, usually within 30 days of your request.
§ Ask us to correct your client and other records: You can ask us to correct health or other information about you that you think is incorrect or incomplete. To request that we correct your records, select “Amendment” on our HIPAA Rights Form here. 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 or office phone) or to send mail to a different address. We will say, “yes” to all reasonable requests. To request confidential communications, select “Restrictions/Confidential Communications” on our HIPAA Rights Form here.
§ Ask us to limit what we use or share: You can ask us not to use or share certain health and/or private information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. To request restrictions, select “Restrictions/Confidential Communications” on our HIPAA Rights Form here.
§ 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 6 years prior to the date you ask, who we shared it with, and why. We will include all 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. To request an accounting, select “Accounting of Disclosures” on our HIPAA Rights Form here.
§ 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 you have given someone 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 selecting “Complaint” on our HIPAA Rights Form here. You can also 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 “What to Expect”. We will not retaliate against you for filing a complaint.
What are BG’s responsibilities with my information?
We are required by United States federal law (HIPAA), state law, and WHAT OTHERS to maintain the privacy and security of your PHI and other private information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your PHI or other private information. We must follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see: “Notice of Privacy Practices”.
How will I know about changes in the Notice of Privacy Practices?
BG reserves the right to update this Notice of Privacy Practices from time to time. Please visit this page periodically so that you will be apprised of any changes. The policies indicated in this Notice will remain effective, even if you are no longer using our Site or services.
At times, BG may work with a third party contracted provider to deliver services to you. To the extent that there is a conflict between BG’s Notice of Privacy Practices and that of a third party contracted provider regarding how your PHI or private information will be handled, the Notice of Privacy Practices that is more restrictive regarding the use, access and disclosure of your PHI will apply.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with Bergeseen Group at info@bergeseen.com or with the Secretary of the United States Department of Health and Human Services. You will not be penalized or retaliated against in any way for making a complaint.
Department of Health and Human Services
Office of Civil Rights
1-800-368-1019/TDD: 1-800-537-7697
How to contact us?
If you have any questions about this Notice or your privacy rights or wish to obtain a form (see below) to exercise your rights as described above, you may contact Bergeseen Group at info@bergeseen.com
Forms Available
Notice of Privacy Practices
Patient Request to Restrict Use or Disclosure of Protected Health Information
Authorization for Use and Disclosure of Medical Info
Patient Request to Amend Protected Health Information
Patient Request for Access to Protected Health Information
Revocation of Authorization to Release Personal Health Information