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Dad’s anxiety has increased tremendously during Covid. Since I can’t go inside as often as I used to, we talk every day, but other than that, there’s minimal going on there - so it’s almost impossible for me to try and help him stay calm. I called his GP (affiliated with the LTC facility) and inquired if he should see a psychologist. The GP said it could be beneficial and she would contact the LTC facility to call in an order. I told the GP that as my father's POA, I wanted to speak with the psychologist first so I can give some background on his current medical status, as well as what changes I’ve noticed in dad.
A week Later the LTC facility contacted me and said they would set up the appointment. I reiterated to them exactly what I told the GP - that I needed to speak with the psychologist BEFORE my dad's appointment (and told them why). The facility said they would relay my request to the psych and let me know when the appointment was scheduled for.
As the weeks pass, I hear nothing (from the facility or the psychologist). I call the facility and ask if the appointment was made because again, I needEd to speak with the psychologist before he meets with dad. I’m assured by the facility that the message was passed along to the psychologist.
A week later, I have my indoor visit with dad (yay! ) While I’m there, I see a piece of paper in dads nightstand with the psychologist’s name, phone #, and affiliation (in LARGE print). Clearly he had already seen my dad (and I was never contacted and had no idea). I contacted dad's facility first and they said they left several messages for the psychologist stating that I wanted to know when the appt was, and I needed to speak with him before he saw dad. Then I contacted the psychologist (now that I had his info on that piece of paper I found in dads room - in large print!) I told the psychologist that I was my father's POA and I wanted a copy of the medical evaluation he did, as well as any notes from their meeting. Psychologist told me that he would need to have dad sign a consent form first. I explained that I was my dad's POA and I did not want him to do this - not to mention it wasn’t necessary because I AM POA. Psychologist suggested we have a telephone conversation to discuss the visit instead - If I didnt want him to have dad sign a consent. I didn’t know what else to do so I agreed to the telephone conversations. After the 2nd visit, the psychologist called me to discuss the visit (as promised). He told me that even though we were have a telephone conversation, he would still have to get dad's consent (Even though initially he told me that the phone call was so he didn’t have to get dads consent). I replied that this was crazy and as POA, I have never had an issue getting medical records for my father before. I was very upset by the psychologist’s blatant disregard for my role as POA, and our call that day was cut short. The next day, I received another call from the psychologist. NOW, he said that he spoke to his regional director, and the calls he would be making to me (the ones he suggested we have after dads appointments)) would be billed as a family counseling session. I said what?! These calls were his (the psychologist’s) idea - not mine. I just wanted the medical notes (and am entitled to them btw since I’m guardian, POA, and dad's health directive). He said the calls take time and they are a form of counseling. I said I didn’t need counseling for myself nor did I ask for it. He told me to think about it. Needless to say, I thought about it and sent an email to the facility, as well as the psychologist, that the visits should stop immediately. I’m so upset by this and feel that business practices of the psychologist should be investigated. Besides this, I hate to say it, but I feel that the LTC facility should be held accountable for this nightmare as well. Does the LTC facility make $ from these visits as well? What actions can I take to get to the bottom of this.

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I don't see where it says her father has dementia. And even if he has dementia that does not entitle her to notes.
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It sounds like the other writers are not on your side. This happened to me as well that they were not on my side. Here's my view. You are right in thinking you needed to talk to the psy first. It only makes sense.
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AlvaDeer Nov 2, 2020
It is the laws that aren't on this side. Review from the link below the legal ramifications under the law.
See below link. Hipaa works differently for mental consults and physical. There are increased protections.
https://www.hhs.gov/hipaa/index.html
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Something to watch, and document:    My mother was the first to experience rehab, so it was a learning experience for all of us.    I don't recall why, but we agreed to have a psychiatrist visit her.    In retrospect, she didn't need to see one; we all had a learning experience, although hers was the most difficult.

The shrink saw her w/o anyone telling us when he would visit.   Since my sister worked as a psychiatric nurse in a mental health hospital, she wanted to be aware of what was going on.    That didn't happen.    What we did discover was the shrink was seeing Mom and we were unaware of the visits, and Mom said he just stopped by and asked how she was.

So we worked out a daily schedule by which one of us (me, my sister or my father) was available at all times, although we gave Mom plenty of private and down time.  I was fortunately there one day when he came in, said hi, asked how Mom was feeling today and left.   That's it!

Monitoring the Medicare notices, I saw he had the audacity to bill for a consult!   So off goes a letter to Medicare advising that he appears to be  billing for services not rendered.    And I documented, obviously, with dates and times.   Eventually Medicare investigated and advised they would be investigating further and taking action.
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I'm not surprised at any of this. Doubtful anyone at the facility really knew what you were asking in the first place, or knew how to deal with your request. The doctors are probably contracted out to a group practice under the umbrella of an even larger group, and--let me guess--you're lucky if you get a phone number for them that reaches a voicemail. Of course you should have access to the notes--you're in charge of all decisions for a person with dementia. Try hiring a geriatric care manager, they may be more familiar with protocols and more importantly, the facility and doctor group may be more willing to deal with the geriatric care manager instead of you. They probably supplied a fax number for the doctor--use it. Faxes and emails keep a record of communications.
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NYDaughterInLaw Nov 3, 2020
I don't see where it says her father has dementia. And even if he has dementia that does not entitle her to notes.
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Basic question: Did you give the psychologist a copy of all the POA/directive/guardianship papers? Otherwise, it's just your word.
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AlvaDeer Nov 1, 2020
See below link. Hipaa works differently for mental consults and physical. There are increased protections.
https://www.hhs.gov/hipaa/index.html
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Your father has anxiety and I don't understand why you feel you are entitled to discuss your dad's psychological evaluation BEFORE he's met with the psychologist. Nothing prevented you from writing a letter making your concerns known to the psychologist before the meeting. The psychologist may have determined that you are interfering in the doctor-patient relationship, and he needs to treat your father, not you. You also are not entitled to the notes - those are not subject to discovery unless there is a lawsuit - and what would you have done with the notes? You seem to have a need to control your father's care at a level that may be overreaching and intrusive. It seems to me that the psychologist rightfully determined that you and your dad needed family counseling. Sorry - I just can't see from what you've written why it was such a problem that the psychologist saw his patient without consulting you first. Some more information to help us understand might be helpful.
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Anna; I went back and read some of your previous posts, because I thought I remembered your name and some kind of fraught relationship with your dad.

From what I read, your dad is an alcoholic and your parents divorced when you were very young. Your dad maintained a once a week sort of relationship with you over the years and things were cordial. But you feel that he regrets how he has spent his life.

You are dad's POA (that is about financials, yes?) and guardian?

You appear to have some insight into dad's issues, but might I suggest that that the psychologist wanted to see her/his client first before getting the adult child's take on what was going on? And if the conversations that you are having with this person go beyond a quick "check in" as to how you perceive dad (I did this on occasion with mom's geriatric psychs, but they were never more than 5 minutes) then yes, they are family counseling and need to be thought of and billed as such.

Anna, any person who is the child of an alcoholic needs Al-Anon/counseling and ongoing support. I'm quite surprised that you are so resistent to it. Please re-think how you are reacting and make peace with the idea that some help for you may ultimately be help for dad.
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OK you have a POA but do you also have your Dad’s Health Care Proxy? It would be important to have for the future in any event. I gather your Dad is in a LTC facility. Can you find out if you can have a private Visiting Nurse complete with PPE come in and help your Dad sign a Health Care Proxy and do an evaluation? A trained Visiting Nurse can be very helpful in evaluating whether your Dad needs some Anti-anxiety medication, can provide records and make recommendations to your Dad’s physician. As a therapist for many years, I find the billing for Family Counseling for a phone call is outrageous! Medicare can pay for a “collateral” phone visit if necessary but most professionals can go ahead and talk to the family if you fax the Health care proxy and Power of Attorney to them. I don’t think this psychologist’s records or notes would be very helpful to you anyway since this person seems like a beginner in the field and it also sounds like they are interested in financial reimbursement more than the patient’s welfare. If you think your Dad needs someone with whom he can talk out his anxiety, a social worker (if the facility employs one) and some mild anti anxiety medication prescribed by your Dad’s physician might be good enough. If you do not feel satisfied with the facility’s response, you can always threaten legal action. Best of luck to you.
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Shane1124 Nov 1, 2020
Kathleen it is because “virtual” visits are in fact visits & are billed as such. Telehealth was being promoted prior to Covid anyway so the codes were already established. It’s a sign of the times.

Plus now in my area no (or very few) therapists are actually seeing patients in person due to Covid. The therapists don’t want to risk a face to face visit due to Covid. It’s billed the same as a telephonic visit you may have with your PCP for something minor like a sinus infection. MD’s don’t have to physically see patients for simple problems to be diagnosed.
Counselling now is done via a laptop or phone with a camera. The PCP offices have the software and give the patient log in instructions. Ditto with mental health professionals.
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Let’s back up for a moment. The psychologist doesn’t know you from Adam. Wouldn’t you want the same protection if roles were reversed and this provider was being just as cautious about releasing your PHI (Private Health Information) to some random person without doing his due diligence to confirm your relationship?

Medical records of anything psych wise (psychiatric, counseling, psychotherapy) are doubly protected under HIPPA. Alva provided the actual wording.

Why not just have your dad sign the consent himself to avoid all the hoopla?

We’re in the middle of a pandemic. Mental health is suffering. Suicides have increased in number. People are getting severe depression from fear of the virus, financial distress, having to teach their kids at home while working full time. The healthcare world has been impacted. Nobody got hurt here. Maybe take a deep breath & realize things could be a lot worse.
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https://www.hhs.gov/hipaa/index.html
Came back in with the hipaa link so you could access the differences in the privacy rights of regular physician versus mental health care.
They differ.
I am afraid that the only way this psychologist could get AROUND Dad not signing is to consider it family counseling.
Wishing you luck.
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How does your POA read? Immediate, Dad does not need to sign anything or Springing, meaning Dad would need to be incompetent, not able to make informed decisions. So if POA states Dad needs to be incompetent and he isn't incompetent, then the doctor needs Dad to sign a form saying its OK to talk to you or give you any kind of info.

And yes, Doctor cannot charge your "talks" to Dads Medicare because Dad was not present. Its fraud. Anytime a doctor talks to you, he can charge for his time.
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AlvaDeer Nov 1, 2020
Yes, and hee hee, Lawyers as well. About the charging to talk to you , I mean.
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HIPPA.Gov has this:
"Psychotherapy notes, also called process or private notes, are notes taken by a mental health professional during a session with a patient. ... These notes are kept separate from medical records and billing information, and providers are not permitted to share psychotherapy notes without a patient's authorization.Jun 8, 2018"
There is much more information about privacy rights and rules on the government site.
So would guess that the licensing board for the psychologist would support him in his decision on how to handle this. But that of course would only be my guess. You may wish to contact them.
Is there a reason that Dad cannot simply sign the form giving this psychologist the right to share private and personal information about a psychological exam? IF Dad is not capable of understanding and signing such a think I wonder if he is in a condition to be actually helped by consults with a psychologist.
As to the LTC and what stipends they may provide to Medical persons serving facilities, that is a good question to ask the Admin. on Monday with a phone call.
Covid is causing such dreadful problems for seniors and families. Wishing you good luck and hoping you will update us. It is too bad they didn't communicate their policies and reasoning upfront earlier. It could have prevented a lot of frustration.
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