Patient Resources

PAYMENT  & INSURANCE POLICY

Payment is required at the time of service. Accepted forms of payment are cash, check, and debit/credit cards (Visa/MC).

INSURANCE: OUT OF NETWORK

I am an out of network provider for most insurance plans including Blue Cross Blue Shield PPO, POS and Indemnity Plans, HPHC and Tufts PPO and POS Plans.  It is your responsibility to contact your insurance provider and to work directly with your insurance provider to determine if using “out of network” benefits is an option for you.  It this is a benefit that you can use, I can submit the appropriate paperwork for you.  Your reimbursement amount is based on your particular policy, your deductibles, etc.

Please check your insurance coverage carefully by asking the following questions:

  • Do I have out-of-network mental health insurance benefits? (In-network benefits do not apply to my services).
  • What is my deductible and has it been met?
  • How many sessions per year does my health insurance cover?
  • What is the reimbursement amount that will be paid to me for each session when I submit my claims?

CANCELLATION POLICY

If you are unable to attend an appointment, please provide at least 24 hours advanced notice.  Since I am unable to use your appointment time for another client, please note that you will be billed for the entire cost of your scheduled appointment if it is not timely cancelled, unless such cancellation is due to illness or an emergency.

For cancellations made with less than 24 hour notice (unless due to illness or an emergency) or a scheduled appointment that is completely missed, you will be billed for the full session fee.

DOWNLOAD: PAYMENT AND CANCELLATION POLICY

PRIVACY AND CONFIDENTIALITY – HIPAA COMPLIANT

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

Your health record contains personal information about you and your health. This information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how Milana Mazurkevich, LICSW may use and disclose your PHI in accordance with applicable law, including the Health Insurance Portability and Accountability Act (“HIPAA”), regulations promulgated under HIPAA including the HIPAA Privacy and Security Rules, and the NASW Code of Ethics. It also describes your rights regarding how you may gain access to and control your PHI.

HOW MILANA MAZURKEVICH, LICSW MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

For Treatment: Milana Mazurkevich, LICSW may share your personal health information with other designated treatment providers including doctors, nurses, registered dieticians, case managers, and treatment facilities involved in your care for any/all of the following: coordination of care; care quality improvement; case management; customer service evaluation/improvement. This includes consultation with clinical supervisors or other treatment team members.

For Payment: Milana Mazurkevich, LICSW may use and disclose your personal health information so that payments can be received for the treatment services provided to you. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities.

As a social worker licensed in this state and as a member of the National Association of Social Workers, it is my practice to adhere to more stringent privacy requirements for disclosures without an authorization.

Without Authorization

Following is a list of the categories of uses and disclosures permitted by HIPAA without an authorization. Applicable law and ethical standards permit Milana Mazurkevich, LICSW to disclose information about you without your authorization only in a limited number of situations.

  • Child Abuse or Neglect: Milana Mazurkevich, LICSW may disclose your PHI to a state or local agency that is authorized by law to receive reports of child abuse or neglect.
  • Medical Emergencies: Milana Mazurkevich, LICSW may use or disclose your PHI in a medical emergency situation to medical personnel only in order to prevent serious harm. Milana Mazurkevich, LICSW will try to provide you a copy of this notice as soon as reasonably practicable after the resolution of the emergency.
  • Duty to Warn and Protect: When a client discloses intentions or a plan to harm another person, as a mental health professional, Milana Mazurkevich, LICSW is required to warn the intended victim and report this information to the proper legal authorities. In cases in which the client discloses or implies a plan for suicide, mental health professionals are required to notify legal authorities and make reasonable attempts to notify the family of the client.
  • Verbal Permission: Milana Mazurkevich, LICSW may also use or disclose your information to family members that are directly involved in your treatment with your verbal permission.

DOWNLOAD: PRIVACY AND CONFIDENTIALITY POLICY