This notice describes how psychological and medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

I. Uses and Disclosures for Treatment, Payment and Health Care Operations

Mosaic Bloom Counseling may use or disclose your protected health information (PHI) for treatment, payment, and health care operations purposes with your consent.

To help clarify these terms, here are some definitions:

"PHI" refers to information in your health record that could identify you.

"Treatment, Payment and Health Care Operations"

Treatment is when Mosaic Bloom Counseling provides, coordinates or manages your health care and other services related to your health care. An example of treatment would be when your therapist consults with another health care provider, such as your family physician or another mental health provider.

Payment is when Mosaic Bloom Counseling obtains reimbursement for your health care. Examples of payment are when we disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.

Health Care Operations are activities that relate to the performance and operation of the practice. Examples include quality assessment, business-related matters such as audits and administrative services, and case management and coordination.

"Use" applies only to activities within our practice, such as sharing, examining, and analyzing information that identifies you.

"Disclosure" applies to activities outside of our practice, such as releasing, transferring, or providing access to information about you to other parties.

II. Digital Communications and Telehealth Privacy

Mosaic Bloom Counseling uses modern technology to provide accessible care while protecting your privacy:

Secure Communications:

Our encrypted client portal is the primary method for sharing sensitive information

Video sessions use HIPAA-compliant platforms

Standard email and text messages are limited to basic scheduling matters

Electronic records are encrypted and stored securely

Virtual Session Privacy:

Find a private location for telehealth sessions

Use secure internet connections (not public WiFi)

Do not record sessions without explicit permission

Ensure session privacy on both ends

III. Insurance and Payment Practices

Payment and Insurance Information:

When you use insurance benefits at Mosaic Bloom Counseling, we work to balance your privacy with insurance requirements. We currently accept Aetna insurance and handle all billing directly with them.

Required Insurance Disclosures:

We must share certain information with Aetna to process your claims and verify coverage. This includes basic session details, diagnostic codes, and treatment summaries. All information is shared through secure, HIPAA-compliant systems.

Your Rights and Choices:

Using Insurance Benefits: By choosing to use your Aetna coverage, you authorize us to share required information for billing and claims processing.

Self-Pay Option: If you prefer not to use insurance, you may pay privately for services. This gives you more control over what information is shared.

Mixed Payment Arrangements: For some services, you may choose to use insurance while paying privately for others.

Insurance Reviews and Audits:

Occasionally, Aetna may review records to verify services. We participate in these reviews as required while advocating for your privacy. We inform you if Aetna requests a review of your records.

IV. Uses and Disclosures Requiring Authorization

Mosaic Bloom Counseling must obtain your written authorization before releasing your PHI for purposes outside of treatment, payment, and health care operations. This includes:

Releasing information to other healthcare providers

Sharing information with family members

Using information for marketing purposes

Releasing psychotherapy notes

You may revoke authorizations in writing at any time. However, revocation is not effective for actions already taken under previous authorization.

V. Uses and Disclosures with Neither Consent nor Authorization

Mosaic Bloom Counseling may use or disclose PHI without your consent or authorization in the following circumstances:

Child Abuse: We must report suspected child abuse or maltreatment to appropriate authorities.

Health Oversight: We must provide information for professional conduct investigations by the Pennsylvania State Board.

Judicial Proceedings: If you are involved in a court proceeding, we may be required to disclose PHI by court order.

Serious Threat to Health or Safety: We may disclose information to protect you or others from serious harm.

Worker's Compensation: If you file a worker's compensation claim, we must provide relevant records.

VI. Multi-Jurisdictional Practice Considerations

As a practice licensed in multiple jurisdictions (PA, DE, NJ, ID, and Alberta, Canada):

Your PHI is protected under both U.S. HIPAA regulations and applicable Canadian privacy laws

Each jurisdiction may have specific reporting requirements

Records are maintained according to the highest standard across all applicable jurisdictions

Privacy protections follow you regardless of your location within our service areas

VII. Patient's Rights

You have the right to:

Request restrictions on PHI use and disclosure

Receive confidential communications by alternative means

Inspect and copy your health record

Amend your health record

Receive an accounting of disclosures

Obtain a paper copy of this notice

VIII. Social Media and Online Presence

To maintain professional boundaries and protect your confidentiality:

We cannot accept friend requests or connections on personal social media

We cannot acknowledge if you are a client on any platform

Please be mindful of your own privacy if leaving online reviews

Online messages through social media platforms are not monitored

IX. Questions and Complaints

If you have questions or concerns, please contact:

Marquita Bolden, LCSW, RSW

8302 Old York Road, Suite B1

Elkins Park, PA 19027

267-227-0122

mbolden@mosaicbloomcounseling.com

If you believe your privacy rights have been violated, you may file a complaint with:

Office for Civil Rights

US Department of Health and Human Services

150 S. Independence Mall West

Suite 372, Public Ledger Building

Philadelphia, PA 19106-9111

Email: ocrcomplaint@hhs.gov

You have specific rights under the Privacy Rule. Mosaic Bloom Counseling will not retaliate against you for exercising your right to file a complaint.

X. Signature

I have read and I agree to the NOTICE OF PRIVACY PRACTICES