Practice Policies
Rewrite Therapy Co., PLLC
Effective date: August 13, 2026

This document covers our HIPAA Notice of Privacy Practices, financial policies, and your right to a Good Faith Estimate. Please keep a copy for your records. If you have questions about anything here, reach out to your therapist or contact us directly. See below.

HIPAA Notice of Privacy Practices

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

This notice applies to Rewrite Therapy Co., PLLC. Effective date: August 13, 2026.

Rewrite Therapy Co. is committed to protecting and respecting the privacy of your Protected Health Information (PHI). We want you to understand your rights and our obligations under state and federal privacy law, including:

  • The Illinois Mental Health and Developmental Disabilities Confidentiality Act (IMHDDCA)

  • Illinois law regarding treatment records, confidentiality, and reporting requirements

  • The federal Health Insurance Portability and Accountability Act (HIPAA)

  • United States federal law

  • The ethical code of the American Counseling Association (ACA)

Our Responsibilities

  • We're required by law to maintain the privacy and security of your protected health information.

  • We'll notify you promptly if a breach or suspected breach may have compromised your information.

  • We'll follow the privacy practices described in this notice and give you access to it.

  • We won't share your information beyond what's described here unless you give us written permission — and you can withdraw that permission at any time.

  • We'll abide by this notice until we adopt a new one, and we'll provide you a copy if that happens.

  • We'll give you a copy of this notice.


    Your Rights as a Client

  • Get a copy of your health and billing records (we may charge a reasonable fee for this).

  • Ask us to correct your records if they're incorrect or incomplete. We'll respond within 60 days and may decline the request.

  • Request confidential communication — for example, asking us to contact you a specific way or send mail to a different address. We'll accommodate all reasonable requests, and must agree if telling us otherwise would put you in danger.

  • Ask us to limit what we use or share. You can tell us not to share certain information for treatment, payment, or operations. You can also choose to have us share information with family, friends, or others involved in your care or payment, and you can tell us what to do in a disaster relief situation. We're not required to agree if it would negatively affect your care, and we never share your information for marketing or sale without your permission.

  • Get a list of disclosures — an accounting of who we've shared your information with and why, going back up to six years. This doesn't include disclosures for treatment, payment, or operations, or ones you specifically requested. One accounting per year is free; additional requests may carry a reasonable fee.

  • Ask us not to share information with your insurer if you're paying out of pocket for that service.

  • Get a paper copy of this notice at any time.

  • Choose someone to act on your behalf if you've given them medical power of attorney or they're your legal guardian. We'll confirm their authority before taking action.

  • Opt out of any marketing or fundraising communications.

Filing a Complaint

If you believe your privacy rights have been violated, you can file a complaint with us or with the U.S. Department of Health and Human Services.

  • With our practice: Contact Savannah (savannah@rewritetherapyco.com) or Lexi (lexi@rewritetherapyco.com). All complaints must be in writing.

  • With HHS: Write to 200 Independence Ave, SW, Washington DC 20201; call 1-877-696-6775; or visit hhs.gov/hipaa/filing-a-complaint/what-to-expect/index.html.

We will never retaliate against you for filing a complaint.

How We Use Your Protected Health Information

Most commonly, we use or share your information to:

  • Treat you - for example, coordinating with other providers directly involved in your care

  • Run our practice - scheduling, communicating with you, and general operations

  • Bill for services - including processing insurance claims when applicable

Less commonly, we may use or share information when legally required — for example, to report suspected abuse, neglect, or domestic violence; report adverse medication reactions; support public health and safety; prevent a serious threat to someone's safety; support government or health oversight functions; respond to workers' compensation claims; comply with a court order or law enforcement request; or respond to legal proceedings.

What We Will NOT Do With Your Information

  • We will not use your PHI for marketing without your written permission.

  • We will not share psychotherapy notes without your express written authorization, except in rare legally required circumstances.

  • We will not sell your health information.

Financial Policies

Payment

Payment is due in full at the time of service. Session fees are automatically charged to the payment method on file after each session. If a charge doesn't go through, we'll notify you, and you'll need to provide an alternate payment method before your next session. We don't allow unpaid balances to carry forward, and an outstanding balance may affect your ability to schedule future appointments. If you're the parent or guardian of a minor client, you're responsible for all associated fees.

Cancellations and No-Shows

We ask for at least 24 hours' notice if you need to cancel or reschedule. If you miss a session or cancel/reschedule with less than 24 hours' notice, you'll be charged $160 - the full session fee, not your copay or coinsurance. If you reach out to your therapist outside of business hours, your notice still counts as long as it's given at least 24 hours before your appointment.

Insurance

We work with clients who use insurance and clients who pay privately.

If you're using insurance, you're responsible for understanding your own coverage and for any costs insurance doesn't cover. As a courtesy, we'll provide an estimated verification of benefits before your first appointment and file claims on your behalf. Claims can take a few weeks to process, and your actual coverage may differ from our initial estimate — our billing team will let you know if anything unexpected comes up. If your insurance is out-of-network, it's your responsibility to request a receipt (superbill) from your therapist or our billing team if you plan to seek reimbursement.

Good Faith Estimate for Health Care Items and Services

You have the right to receive a "Good Faith Estimate" explaining how much your care is expected to cost. Under federal law, health care providers must give patients who don't have insurance, or who aren't using insurance, an estimate of the expected bill for services.

  • You have the right to a Good Faith Estimate for the total expected cost of any non-emergency item or service, including related costs.

  • Your provider must give you this estimate in writing at least 1 business day before your appointment. You can also request one anytime, even before scheduling.

  • If your bill is at least $400 more than your Good Faith Estimate, you have the right to dispute it.

  • Keep a copy of your Good Faith Estimate for your records.

For questions or more information, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Questions or Concerns