Dr. Richard Shane—Schedule Sessions

This page presents information health professionals are required to give to clients. At the bottom of this page (below the line of asterisks) is a button to link to a secure page on which to fill out your insurance information. I must receive that completed questionnaire before our first session. I apologize there is so much information below. Our sessions will be much easier than reading this information.

If you don't have time now to read the information below (but please read it when you have time), and you want to go directly to the information form, please click here

Therapeutic Treatment with Richard Shane, Ph.D. - Policies (Part B)

My Practice: My areas of expertise are medication-free relief from sleep difficulties, anxiety, stress, depression and physical pain. While I have trained in psychodynamic, cognitive-behavioral and clinical hypnotherapeutic approaches, I have developed an original system of mind-body healing derived from my experiences with clients, as well as my own self-healing.

Credentials:
B.A., Psychology, Rutgers University, New Jersey (1972)
M.A., Psychology, New School for Social Research, New York (1977)
Ph.D., Health and Human Services, Columbia Pacific University, Novato, California (1991)
Colorado Licensed Professional Counselor (1989), License #50.

I am a Sleep Specialist in private practice, treating insomnia patients referred by over 80 Colorado physicians and psychologists. I am affiliated with Boulder Community Hospital Medical Staff. I am a preferred provider with a number of insurance companies and managed care organizations. For more information on my background, please see About Dr. shane on this website. My resume will be furnished upon request.

Treatment Duration: Treatment usually involves 3-4 sessions, although for particularly difficult conditions, you may request additional sessions. I also recommend one follow-up session, about two months after our final session, to ensure maximum effectiveness. I also offer longer-term psychotherapy.

Session Length and Frequency: Sessions are usually 50-70 minutes long, so please leave that amount of time available. Frequency of sessions is typically once per week.

Confidentiality: The information you discuss during a psychotherapy session is protected as confidential under law (CRS 12,43,214 (l)(d)) with certain limitations:

* It is my policy to report suspected child abuse, without an investigation, to the proper authorities who may investigate.

* If I deem you to be a serious harm to yourself or another, I also may take some action, such as seek an order for your emergency or involuntary commitment, without your consent. Any action I take without your consent will be discussed with you.

* If I am directed by a judge in a court of law (i.e., by subpoena) to reveal information, I must do so. However, it is rare that a court would require breaching confidentiality without your express consent.

* If I am unable to collect my agreed upon fee, I may send your name and address to a collection agency.

* If you file an official complaint or a lawsuit against me, according to Colorado law, your right to confidentiality will be waived.

* If you chose to use your health benefit plan, you will have given your insurance or managed care company consent to obtain required confidential information for the purpose of determining eligibility for reimbursement.

* I may seek consultation from another mental health professional. However, your identity will not be revealed without your consent, and your privacy will be protected by that professional.

* I have hired Paula Ward, of Ward Medical Billing, to process insurance claims. She will have access to limited confidential information. She has signed a legal agreement stating that she will use this information solely for administrative purposes, protecting you from further disclosure.

* When I am away from my office for a few days, I may ask another licensed therapist to cover emergencies for me. Generally, I will tell this therapist only what he or she needs to know for an emergency.

* If I am needed to release certain information to someone else (i.e., your personal physician), I require your written and signed authorization.

Health Care Benefits: In the event that you choose to use your health care benefits and my services are reimbursable under your insurance plan, you will be asked to fill out an insurance information questionnaire which gives me written authorization to release required information. Released confidential information may range from identifying information, diagnosis, dates and types of sessions and charges to a complete assessment with treatment goals and progress reports. My policy is to provide the least amount of information necessary for the purpose of authorizing benefits. I cannot be in control of the storage of confidential information nor access to your confidential information when it is given to a third party.

Medical Treatment: When addressing physical complaints such as (but not limited to) pain or insomnia, my treatment is intended to complement, not replace, treatment from a medical professional. If you continue to have physical complaints, I recommend you also seek treatment from a physician.

Records: Records include identifying information, dates and types of sessions, an assessment and diagnosis, a treatment plan, progress notes, and any consultations or collateral contacts made. Your records will be stored safely with attention to your privacy for at least 10 years as required by Colorado Statute. They will only be released with your written permission and direction. It is my policy to not release an entire record, even with your consent. Instead, I may summarize the content related to the request. You will be granted reasonable access to your record, but not my psychotherapy notes. You may request, in writing, an amendment to your record. If you choose to read your record, it is my policy to be present in order to respond to any questions or confusion you may have about the recordings.

Client Rights:

1. You are entitled to receive further information from me about my training and methods of therapy, the anticipated duration of therapy (if I can determine it beforehand), my fee structure, and areas you request. Please ask if you would like to receive this information.

2. You may always seek a second opinion from another therapist or end therapy at any time.

3. The licensing statute requires me to inform you explicitly of what should be obvious, namely that sexual contact is never appropriate between client and therapist. If sexual intimacy occurs with any professional, it should be reported to the State Grievance Board (address and phone on previous page).

Authorization for Richard Shane, Ph.D., to contact your healthcare provider or the person who referred you to me. This contact is for the following purposes:

At the beginning of treatment, I may send a note (perhaps a thank you for the referral) to that person that you and he have begun treatment.
Upon completion of treatment, I may send a letter mentioning you have completed treatment and suggesting that the healthcare professional discuss with you your experience of this work.
I will not share any information beyond the basic fact that you and he are working together. If it is necessary for me to communicate more information I will present you with an informed consent to sign at the session.
The purpose of this correspondence is to inform the healthcare provider and/or referral source about: 1. The existence of my work. 2. The outcomes that are a result of this work.

Termination of Treatment: Termination will usually be agreed upon mutually, but you are free to discontinue treatment at any time. If you decide to discontinue treatment, I request that you let me know your reason(s)—even if just via phone conversation—as this will help me continue to improve the quality of my work.

In a few special instances I may decide to stop working with you even though you wish to continue. These include a need for special services outside of the area of my competency, prolonged failure to make progress in our work together, or a failure to meet the terms of our fee agreement. Should this occur, I will discuss with you the reason for termination of treatment, and will help you make different plans for yourself, including a referral to a more appropriate resource.

Grievances: If you have any questions concerning the services I offer to you, I request that you first discuss those with me. My practice is regulated by the Colorado Department Of Regulatory Agencies that has a Grievance Board. 1560 Broadway, Suite 1340, Denver, CO 80202, 303-894-7766.

Notification of Privacy Practices of Richard Shane, Ph.D.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. If you have any questions or requests about this notice, please contact me.

My Practice is required by State and Federal law to maintain the privacy of protected health information. In addition, the Practice is required by law to provide clients with this Notice of Privacy Practices explaining our legal duties and privacy practices with respect to your mental health information, and to request that you sign the attached written acknowledgement that you received a copy of this Notice. This Notice describes how the Practice may use and disclose your protected health information. This Notice also describes your rights regarding your protected health information and how you may exercise your rights.

"Protected Health Information, PHI", is information I have created or received about your physical or mental health condition, the health care I provide to you, or the payment for your health care; and identifies you or could be reasonably used to identify you. It includes your identity, diagnosis, dates of service, treatment plan, and progress in treatment.

Uses and Disclosures of Protected Health Information: Permissible Uses and Disclosures Not Requiring Your Written Authorization.

Your Mental Health Information May Be Used and Disclosed In The Following Ways:

Treatment: Your mental health information may be used and disclosed in the provision and coordination of your healthcare. For example, this may include coordinating and managing your health care with other health care professionals. Your mental health information may be used and disclosed when I consult with another professional colleague, or if you are referred for medication, or for coverage arrangements during my absence. In any of these instances only information necessary to complete the task will be provided.

Payment: Your mental health care information will be used to develop accounts receivable information, to bill you, and with your consent to provide information to your insurance company or other third party payer for services provided. The information provided to insurers and other third party payers may include information that identifies you, as well as your diagnosis, dates and type of service, and other information about your condition and treatment, but will be limited to the least amount necessary for the purposes of the disclosure.

Required or Permitted by Law: Your mental health care information may be used or disclosed when I am required or permitted to do so by law or for health care oversight. This includes, but is not limited to:
(a) reporting child abuse or neglect;
(b) when court ordered to release information;
(c) when there is a legal duty to warn or to take action regarding imminent danger to others;
(d) when the client is a danger to self or others or gravely disabled;
(e) when a coroner is investigating the client's death; or
(f) to health oversight agencies for oversight activities authorized by law and necessary for the oversight of the health care system, government health care benefit programs, or regulatory compliance.

Contacting the Client: You may be contacted to remind you of appointments and to tell you about treatments or other services that might be of benefit to you. You and I may communicate via email. Because of the nature of the email system in general, with any non-encrypted email you send to anyone confidentiality cannot be guaranteed.

Crimes on the premises or observed by the provider: Crimes that are observed by the therapist or the therapist's staff, crimes that are directed toward the therapist or the therapist's staff, or crimes that occur on the premises will be reported to law enforcement.

Business Associates: Some of the functions of the practice may be provided by contracts with business associates. For example, some of the billing, legal, auditing, and practice management services may be provided by contracting with outside entities to perform those services. In those situations, protected health information will be provided to those contractors as is needed to perform their contracted tasks. Business associates are required to enter into an agreement maintaining the privacy of the protected health information released to them.

Involuntary Clients: Information regarding clients who are being treated involuntarily, pursuant to law, will be shared with other treatment providers, legal entities, third party payers and others, as necessary to provide the care and management coordination needed.

Family Members: Except for certain minors, incompetent clients, or involuntary clients, protected health information cannot be provided to family members without the client's consent. In situations where family members are present during a discussion with the client, and it can be reasonably inferred from the circumstances that the client does not object, information may be disclosed in the course of the discussion. However, if the client objects, protected health information will not be disclosed.

Emergencies: In life threatening emergencies the practice will disclose information necessary to avoid serious harm or death.

Uses and Disclosures Requiring Your Written Authorization or Release of Information:

Except as described above, or as permitted by law, other uses and disclosures of your mental health information will be made only with your written authorization to release the information. When you sign a written authorization, you may later revoke the authorization in writing as provided by law. However, that revocation may not be effective for actions already taken under the original authorization.

Psychotherapy Notes: These notes will be used only by me and disclosure will occur only under these circumstances: (a) You specifically authorize their use or disclosure in a separate written authorization; or (b) I use them for your treatment; or (c) If you bring a legal action and I have to defend myself; and (e) Certain limited circumstances defined by the law.

Your Rights As A Client:

Additional Restrictions: You have the right to request additional restrictions on the use or disclosure of your mental health information. However, the clinician does not have to agree to that request, and there are certain limits to any restriction, which will be provided to you at the time of your request. Ask your clinician for the Request Form for Protected Health Information.

Alternative Means of Receiving Confidential Communications: You have the right to request that you receive communications from the practice by alternative means or at alternative locations. For example, you may request that bills and other correspondence be sent to an address other than your home address. Ask me for the Request Form.

Access to Protected Health Information: You have the right to inspect and obtain a copy of your protected health information in the mental health and billing record. However, any psychotherapy notes are for the use of your therapist, and are treated differently. If it is thought that access to your mental health records would harm you, your access may be restricted. Ask me for the Request Form for PHI and the appeal process.

Amendment of Your Record: You have the right to request an amendment or correction to your protected health information. If I agree that the amendment or correction is appropriate, I will ensure the amendment or correction is attached to the record. An appeal process is available if I determine the record is accurate and complete as is. Ask me for the Request Form PHI and the appeal process available to you.

Accounting of Disclosures: You have the right to receive an accounting of certain disclosures the practice has made regarding your protected health information. However, that accounting does not include disclosures that were made for the purpose of treatment, payment, or health care operations. In addition, the accounting does not include disclosures made to you, disclosures authorized by you, or disclosures made prior to April 14, 2003. Other exceptions will be provided to you, should you request an accounting. Ask your clinician for the Request Form.

Right to Revoke Consent or Authorization: You have the right to revoke your consent or authorization to use or disclose your mental health information, except for action that has already taken place under your consent or authorization.

Copy of this Notice: To to have a copy of this notice, please print out this page.

I am required to abide by the terms of this Notice, or any amended Notice that may follow. I reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all protected health information that it maintains.

If you believe my practice has violated your privacy rights, you may file a complaint with me You also have the right to complain to the United States Secretary of Health and Human Services by sending your complaint to the Office of Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 515F, HHH Bldg., Washington, D.C. 20201. It is the policy of the Practice that there will be no retaliation for your filing of such a complaint.

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To schedule your appointment: After you have completed the questionnaire (on the next page), please call my office manager Paula at 303-366-0524. (You might want to write down this number to make it easier to call her after you have sent the questionnaire.)

Basic information Questionnaire: On the following page is a basic information questionnaire for you to complete, which will be sent to me via encryption. This usually takes about minutes to complete.

To go to the basic information information questionnaire, click on the button following this paragraph. By clicking on that button, you are acknowledging that you have received the information presented on the web page you're currently looking at—and you agree with it. If there is anything you do not agree with, at the end of the basic information questionnaire there is a box in which you can list any of the items with which you have disagreement. In the session I will discuss this with you to make the information changes necessary for you to indicate your agreement—to then sign that in the session. I must receive the completed questionnaire before the first session.

To go to the basic information questionnaire, please click here

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