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What you Should Know…

As a client, you should be aware of policies that affect your protected health information as well as understand your rights when it comes to this information. Please review the following page. If after review, you have additional questions, we are happy to provide clarification during your appointment.

Your client Rights Explained…

In order to provide transparency to our clients, we have provided you with information regarding your protected health information and client rights. Please review the following information carefully.

HIPAA and what this means for you

We understands that your medical and health information is deeply personal and we take this very seriously. We take multiple steps to ensure the protection of your information. The federal Health Insurance Portability and Accountability (HIPAA) law and the Texas Medical Records Privacy Act (TMRPA) serve to help protect your personal health information (PHI).

Under HIPAA and TMRPA, you have the following patient privacy rights:

  • Right to know how your PHI will be used and shared In general:

    • A provider must give you written notice of the uses and disclosures of your PHI and, in the event that your PHI is improperly accessed or breached, must provide you notice of that event.

    • Your permission is not required if the sharing of your PHI is related to your treatment, payment, health care operations or performing certain insurance or health care maintenance organization functions.

  • Right to ask to review and obtain a copy of health records from most providers (and health care plans). Be aware:

    • Most providers and plans have a form you can use to request your records.

    • Providers and plans are permitted by law to charge for the reasonable costs of copying and mailing your records but may not charge a retrieval fee.

    • In limited cases, such as if your provider believes that information in the file may endanger you, you may not be able to obtain all of your information.

    • If the provider has an electronic health records system capable of fulfilling the request, your records must be provided to you no later than the 15th business day after you submit your written request.

  • Right to request that your health records be corrected or amended. Be aware:

    • Once you have made such a request, the provider or health plan must respond and if they do not agree with your requested corrections, must notify you in writing and explain why your request was denied. You have the right to submit a statement or disagreement that the provider or plan must add to your record.

  • Right to limit the use or sharing of your protected health information for marketing purposes. In general:

    • If your PHI is used or disclosed to send a marketing communication through the mail, that mailing must include the name and toll free number of the entity which sent you the marketing communication and an explanation of your right to have your name removed from the sender's mailing list.   

    • Your PHI cannot be used or shared for marketing communications like sales calls or advertising without your authorization in writing. Certain exceptions apply to this including face to face communications between a provider and an individual.

Read more about HIPAA, the HIPAA Privacy Rule and the HIPAA Security Rule on the Department of Health and Human Services' website. Read the Texas Medical Records Privacy Act.

How to Request your Healthcare Records:

You have a right to request a copy of your healthcare records or the records of your child. Texas providers are required to provide records to you within 15 business days after receipt of a written request for electronic transmission of records. Should you request records in a different format, you may be charged a nominal fee. Client records are maintained by Inner Mosaic Therapy for 7 years.

Current clients: Records Request can be uploaded to your client portal by requesting directly from your provider, calling our office directly at (254) 831-4646, or by emailing info@innermosaictherapy.com. In the request, be sure to include the specific records you wish to have released. The document must be signed and submitted via your portal.

Previous clients: Complete a Records Request form by clicking on the link below. If you were a minor at the time of services, but are now an adult age 18 or older, you must request your own records. Your parent/guardian can no longer request your records. If you are unable to utilize the link or are uncomfortable doing so, please email us at info@innermosaictherapy.com or call our main phone line to speak to a provider.

Sec. 181.102.  CONSUMER ACCESS TO ELECTRONIC HEALTH RECORDS.(a)  Except as provided by Subsection (b), if a health care provider is using an electronic health records system that is capable of fulfilling the request, the health care provider, not later than the 15th business day after the date the health care provider receives a written request from a person for the person’s electronic health record, shall provide the requested record to the person in electronic form unless the person agrees to accept the record in another form.
(b)  A health care provider is not required to provide access to a person’s protected health information that is excepted from access, or to which access may be denied, under 45 C.F.R. Section 164.524.

Records Requests

How to File a Complaint

Texas HB4224 requires healthcare entities to provide the following information should you decide to file a complaint. If you feel a healthcare provider has violated Federal or State policies regarding your protected health information (PHI), you may file a complaint with

By mail:
Marisa Smith, Regional Manager
Office for Civil Rights - Region VI
U.S. Department of Health and Human Services
1301 Young Street, Suite 1169
Dallas, TX 75202

By fax:
(202) 619-3818

OCR's Customer Response Center:
(800) 368-1019

Complaints against a licensed professional may be submitted to the Texas Behavioral Health Executive Council (BHEC) on an approved complaint form, which may be downloaded from the Forms and Publications website here: https://bhec.texas.gov/how-to-file-a-complaint/.  Alternatively, you may call or write to request the complaint form be mailed to you using the information listed below:


1801 Congress Ave., Ste. 7.300
Austin, Texas 78701
(512) 305-7700
Enforcement@bhec.texas.gov
Investigations/Complaints 24-hour, toll-free system: (800) 821-3205

If you have any questions regarding the complaints process, we are happy to answer your questions and provide clarification.

No Surprises Act & Good Faith Estimate

Under Section 2799B-6 of the No Surprises Act, health care providers must give clients who do not have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. This does not apply to those utilizing insurance for services.

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. This estimate is not a final bill, but rather what you can expect in regard to our fees for services.

You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service. For our clients, this estimate will be provided to you with your intake paperwork. If you have questions regarding the Good Faith Estimate, please reach out to your provider or our main phone line for assistance or clarification.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Ensure you save a copy or picture of your Good Faith Estimate you received from your provider.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.