Legal Notifications

Privacy of Information

This section describes the confidentiality of your medical records, how the information is used, your rights, and how you may obtain this information.

Our Legal Duties

State and federal laws require that we to keep your medical records private. Such laws require that we provide you with this notice informing you of our privacy information policies, your rights, and our duties. We are required to abide these policies until replaced or revised. We have the right to revise our privacy policies for all medical records, including records before policy changes were made. Any changes in this notice will be made available upon request before changes take place. The contents of material disclosed to us in an evaluation, intake, or counseling session are covered by the law as private information. We respect the privacy of the information you provide us and we abide by ethical and legal requirements of confidentiality and privacy of records.

Use of Information

Information about you may be used for diagnosis, treatment planning, treatment, and continuity of care. Both verbal information and written records about a client cannot be shared with another party without the written consent of the client or the client’s legal guardian or personal representative. It is Mountainview Counseling’s policy not to release any information about a client without a signed release of information except in certain emergency situations or exceptions in which client information can be disclosed to others without written consent. Some of these situations are noted below, and there may be other provisions provided by legal requirements.

Duty to Warn and Protect

When a client discloses intentions or plans to harm another person or persons, the healthcare professional as required to warn the intended victim and report this information to legal authorities. In cases in which the client discloses or implies a plan for suicide, the healthcare professional is required to notify legal authorities and make reasonable attempts to notify the family of the client.

Public Safety

Health records may be released for the public interest and safety for public health activities, judicial and administrative proceedings, law enforcement purposes, essential government functions, military, and when complying with worker’s compensation laws.


If a client states or suggests that he or she is abusing a child or vulnerable adult, or has recently abused a child or vulnerable adult, or a child (or vulnerable adult) is in danger of abuse, the healthcare professional is required to report this information to the appropriate social service and/or legal authorities. If the client is the victim of abuse, neglect, violence, or a crime victim, and/or their safety appears to be at risk, we may share this information with law enforcement officials to help prevent future occurrences and capture the perpetrator.

Prenatal Exposure to Controlled Substances

Health care professionals are required to report admitted prenatal exposure to controlled substances that are potentially harmful. 

In the Event of a Client’s Death

In the event of a client’s death, the spouse or parents of a deceased client have a right to access their child’s or spouse’s records.

Judicial or Administrative Proceedings

Health care professionals are required to release records of clients when a court order has been placed.


Parents or legal guardians of non-emancipated minor clients have the right to access the client’s records.

Other Provisions

When the payment for services are the responsibility of the client, or person who has agreed to providing payment, and payment has not been made in a timely manner, collection agencies maybe utilized in collecting unpaid debts. The specific content of the services (e.g., diagnosis, treatment plan, progress notes, testing) is not disclosed. If a debt remains unpaid it may be reported to credit agencies, and the client’s credit report may state the amount owed, the time-frame, and the name of the clinic or collection source.

Insurance companies, managed-care, and other third party payers are given information they request regarding services to the client. Information which may be requested includes type of services, dates/times of services, diagnosis, treatment plan, description of impairment, progress in therapy, and summaries.

Information about clients may be disclosed in consultations with other professionals in order to provide the best possible treatment. In such cases the name of the client, or any identifying information, is not disclosed. Clinical information about the client is discussed. Such progress notes and reports are dictated/typed within the clinic or by outside sources specializing in (and held accountable for) such procedures.

In the event in which the clinic or mental health professionals must telephone client for purposes such as appointment cancellations or reminders, or to give/received other information, efforts are made to preserve confidentiality. Please notify us in writing where we may reach you by phone and how are you would like us to identify ourselves. For example, you might request that when we phone you at home or work, we do not say the name of the clinic or the nature of the call, but rather the mental health professional’s first name only. If this information is not provided to us, we will adhere to the following procedure when making phone calls: first we will ask to speak to the client or guardian without identifying the name of the clinic. If the person answering the phone asks for more identifying information we will say it is a personal call. We will not identify the clinic to protect confidentiality. If we reach an answering machine or voicemail we will follow the same guidelines.

Your Rights

You have the right to request to review or receive your medical files. The procedures for obtaining a copy of your medical information is as follows. You may request a copy of your records in writing with an original (not photocopied) signature. If your request is denied, you will receive a written explanation of the denial. Records for non-emancipated minors must be requested by the custodial parent or legal guardians. The charge for this service is $1 per page plus postage.

You have the right to cancel or release of information by providing us a written notice. If you desire to have your information sent to a location different than our address on file, you must provide this information in writing.

You have the right to restrict which information might be disclosed to others. However, if we do not agree with these restrictions, we are not bound to abide by them.

You have the right to request that information about you be communicated by other means for to another location. This request must be made to us in writing.

You have the right to disagree with the medical records in our files. You may request that this information be changed. Although we might deny changing the record, you have the right to make a statement of disagreement, which will be placed in your file.

You have the right to know what information in your record has been provided to whom. Request this in writing.

If you desire a written copy of this notice you may attain it by requesting it from Mountainview Counseling..


If you have any complaints or questions regarding these procedures, please contact Mountainview Counseling. We will get back to you in a timely manner. You may also submit a complaint to the U.S. Department of Health and Human Services and/or the Georgia Composite Board of Professional Counselors, Social Workers, and Marriage & Family Therapists. If you file a complaint we will not retaliate in any way.

Your Rights And Protections Against Surprise Medical Bills (OMB Control Number: 0938-1401)

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible. 


What is “balance billing” (sometimes called “surprise billing”)? 


When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. 


“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.


“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.  


You’re protected from balance billing for:

Emergency Services


If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.  

Certain Services at an In-Network Hospital or Ambulatory Surgical Center


When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. 


If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your


You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network. 


When balance billing isn’t allowed, you also have these protections:


       You’re only responsible for paying your share of
the cost (like the copayments, coinsurance, and deductible that you would pay
if the provider or facility was in-network). Your health plan will pay any
additional costs to out-of-network providers and facilities directly.


       Generally, your health plan must:

o   Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).

o   Cover emergency services by out-of-network providers.

o   Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.

o   Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.


If you think you’ve been wrongly billed, contact 1-800-985-3059. 

Visit for more information about your rights under federal law.