Privacy Practices
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Perennial Counseling LLC
4954 E 56th St Ste 2, Indianapolis, IN 46220
317-676-2200
SJ@perennialcounselingindiana.com
EFFECTIVE DATE OF THIS NOTICE This notice went into effect on 9/8/2025.
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. MY PLEDGE REGARDING HEALTH INFORMATION:
I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to:Make sure that protected health information (“PHI”) that identifies you is kept private.
Give you this notice of my legal duties and privacy practices with respect to health information.
Follow the terms of the notice that is currently in effect.
I am also required by law to provide you with adequate notice of your rights and my legal duties if I create or maintain records protected by 42 C.F.R. Part 2.
I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.
II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.
If your records are protected under 42 C.F.R. Part 2, certain uses and disclosures permitted by HIPAA for treatment, payment, and health care operations are materially limited by the stricter standards of those regulations. Furthermore, information disclosed pursuant to these rules may be subject to redisclosure by the recipient and may no longer be protected by federal privacy standards.
Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.
Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. However, for records protected by 42 C.F.R. Part 2, such records or testimony relaying their content shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless you provide specific written consent or a court order is issued in accordance with 42 C.F.R. Part 2.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
Psychotherapy Notes. I do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:
a. For my use in treating you.
b. For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
c. For my use in defending myself in legal proceedings instituted by you.
d. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.
e. Required by law and the use or disclosure is limited to the requirements of such law.
f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
g. Required by a coroner who is performing duties authorized by law.
h. Required to help avert a serious threat to the health and safety of others.Substance Use Disorder (SUD) Counseling Notes. I may also maintain “SUD counseling notes,” which are notes recorded by a substance use disorder provider documenting the contents of a counseling session. Any use or disclosure of these notes requires your separate written authorization, which cannot be combined with a consent for other types of records. You can revoke your consent at any time except to the extent that I have already acted upon it to disclose these notes in accordance with your initial authorization.
Marketing Purposes. As a psychotherapist, I will not use or disclose your PHI for marketing purposes.
Sale of PHI. As a psychotherapist, I will not sell your PHI in the regular course of my business.
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION.
Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
For health oversight activities, including audits and investigations.
For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.
For law enforcement purposes, including reporting crimes occurring on my premises.
To coroners or medical examiners, when such individuals are performing duties authorized by law.
For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
For workers’ compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers’ compensation laws.
10 Appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.
Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
Fundraising. If I intend to use or disclose your records protected by 42 C.F.R. Part 2 for fundraising for my benefit, I will provide you with a clear and conspicuous opportunity to opt-out before any such use or disclosure occurs.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.
The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.
The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” and “SUD counseling notes” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost based fee for doing so.You also have the right to request an accounting of disclosures specifically for your substance use disorder records protected under 42 C.F.R. Part 2.
The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost based fee for each additional request.
The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.
The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.
Acknowledgement of Receipt of Privacy Notice
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By checking the box below, you are acknowledging that you have received a copy of HIPAA Notice of Privacy Practices.
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Good Faith Estimate & No Surprises Act
Your Right to Know the Cost of Your Care
Perennial Counseling is a self-pay mental health practice. We do not accept or bill health insurance.
Under the federal No Surprises Act, individuals who are uninsured or who choose not to use health insurance to pay for their care have the right to receive a Good Faith Estimate (GFE) of expected charges for scheduled health care services.
A Good Faith Estimate is an estimate of the expected cost of services you are scheduled to receive. It is not a bill and is not a guarantee of the final cost of care.
What You Can Expect from Perennial Counseling
When you schedule services with Perennial Counseling, you will receive information about the expected cost of your services.
You may also request a Good Faith Estimate before scheduling services.
Because psychotherapy is an individualized service and treatment needs may change over time, an estimate is based on the services that are reasonably expected to be provided at the time the estimate is prepared.
If your anticipated frequency or type of services changes, your Good Faith Estimate may be updated.
Current Self-Pay Rates
50-minute session: $150
80-minute session: $220
110-minute session: $290Limited sliding-scale appointments may also be available. Rates are discussed before services are scheduled.
When Will I Receive My Estimate?
If you schedule services at least 10 business days in advance, you generally must receive your Good Faith Estimate within 3 business days of scheduling.
If you schedule services 3–9 business days in advance, you generally must receive your Good Faith Estimate within 1 business day of scheduling.
You may also request a Good Faith Estimate before scheduling services. In that situation, the estimate generally must be provided within 3 business days of your request.
Appointments scheduled fewer than 3 business days in advance are not subject to the federal GFE advance-notice requirement.
What Will My Good Faith Estimate Include?
Your Good Faith Estimate will include an itemized estimate of the expected charges for the services that are reasonably expected to be provided.
For ongoing psychotherapy, the estimate may be based on the anticipated frequency and duration of sessions discussed at the time the estimate is prepared.
A Good Faith Estimate does not include services provided by another provider or services that were not reasonably expected at the time the estimate was created.
If Your Bill Is Higher Than Your Estimate
If you receive a bill that is substantially higher than your Good Faith Estimate, you may have the right to dispute the bill through the federal Patient-Provider Dispute Resolution process.
Generally, you may be eligible to dispute a bill if the actual charges are at least $400 more than the estimated charges on your Good Faith Estimate.
For more information about your rights under the No Surprises Act, visit the Centers for Medicare & Medicaid Services website or contact the No Surprises Help Desk at 1-800-985-3059.
Request a Good Faith Estimate
To request a Good Faith Estimate, please contact:
Perennial Counseling
317-676-2200
SJ@perennialcounselingindiana.com
Please include your name and the services you are interested in receiving. You may request an estimate before deciding whether to schedule services.
Please Note
A Good Faith Estimate is based on information available at the time it is prepared. It is not a contract or guarantee of services and does not account for unforeseen circumstances or changes in treatment needs.
If you have questions about your expected costs, please contact Perennial Counseling before scheduling services.
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Website Privacy Policy
Perennial Counseling
Effective Date: 9/8/2025Perennial Counseling respects your privacy and is committed to protecting information you provide through our website.
This Website Privacy Policy explains what information may be collected when you visit the Perennial Counseling website, how that information may be used, and the choices available to you.
This policy applies to information collected through the Perennial Counseling website and does not replace Perennial Counseling’s Notice of Privacy Practices, which describes how protected health information is handled in the context of mental health services.
Information You Choose to Provide
You may voluntarily provide information through our website when you:
Submit a contact or inquiry form.
Request information about counseling services.
Send a message through a website form.
Sign up for communications or resources, if offered.
Otherwise communicate with Perennial Counseling through the website.
Depending on the information you provide, this may include your name, email address, phone number, and information you choose to include in your message.
Please Do Not Submit Sensitive Health Information Through the Website
Our website contact form is intended for general inquiries and scheduling questions.
Please avoid including detailed information about your mental health, medical history, medications, trauma history, or other sensitive health information in a website contact form.
If you become a client, communication involving your protected health information will occur through the designated secure communication methods provided by Perennial Counseling.
How We Use Information
Information submitted through the website may be used to:
Respond to your inquiry.
Answer questions about services.
Communicate about scheduling or availability.
Provide information you have requested.
Respond to requests for consultation or services.
Maintain the security and functionality of the website.
We do not sell personal information submitted through this website.
We do not use information submitted through the website for purposes unrelated to the reason it was provided except as permitted by law or with your consent.
Website Analytics and Cookies
Our website may use cookies, analytics tools, or similar technologies to help us understand how visitors use the website, improve website functionality, and understand general website traffic.
These technologies may collect information such as:
Your IP address.
Browser and device information.
General geographic information.
Pages visited.
The date and time of your visit.
Referring websites.
Interactions with the website.
You may be able to limit or disable cookies through your web browser settings.
If third-party analytics or advertising technologies are used on this website, those third parties may collect information according to their own privacy policies.
Third-Party Websites and Services
The Perennial Counseling website may contain links to third-party websites or services, including scheduling platforms, social media platforms, educational resources, or other websites.
Once you leave the Perennial Counseling website, you are subject to the privacy practices and policies of the third-party website you visit.
Perennial Counseling does not control the privacy practices of third-party websites.
We encourage you to review the privacy policy of any third-party website before submitting personal information.
Communications
If you voluntarily provide your contact information through the website, Perennial Counseling may use that information to respond to your inquiry.
Submitting a website contact form does not establish a therapist-client relationship.
Website communication should not be relied upon for emergencies or urgent mental health concerns.
If you are experiencing an emergency or believe you or someone else is in immediate danger, call 911 or go to the nearest emergency department.
Information Security
Perennial Counseling takes reasonable administrative, technical, and physical measures to protect information within its control.
However, no website, electronic communication, or internet transmission can be guaranteed to be completely secure.
Please do not submit sensitive or confidential health information through an unsecured website form or ordinary email.
Children’s Privacy
This website is intended for adults and families seeking information about counseling services.
Perennial Counseling does not knowingly use this website to collect personal information from children for purposes unrelated to responding to a service inquiry.
Parents or legal guardians seeking services for a minor should contact Perennial Counseling directly.
Changes to This Privacy Policy
We may update this Website Privacy Policy from time to time to reflect changes in our website, services, technology, or applicable laws.
The updated policy will be posted on this page with a revised effective date.
Contact
If you have questions about this Website Privacy Policy, please contact:
Perennial Counseling LLC4954 E 56th St Ste 2, Indianapolis, IN 46220
317-676-2200
SJ@perennialcounselingindiana.com
Effective Date: 9/8/2025