Clinical Services and Practice Policies Agreement
Last Updated October 29, 2024
1. General Information
UVPsych, Inc. and its affiliated professionals (collectively, “UVPsych Professionals”, “we”, and “our”) provide technology-enabled and in-person therapy services for adults. This Agreement describes UVPsych Professionals’ services and clinical programs. It is important for you to read this document and discuss any questions you might have with us. UVPsych, Inc. does not provide clinical services; it performs administrative, payment, and other supportive activities for UVPsych Professionals. When you request to receive services from a clinician with UVPsych, those services are outlined by this agreement, as well as the discussions between you and your clinician(s). By agreeing to these terms, you confirm that you have read, understood, and agree to its contents. We reserve the right, at our sole discretion, to change, modify, add, or remove portions of these terms at any time. It is your responsibility to check these terms periodically for changes.
2. Our Services and Technology
When you become a client of UVPsych Professionals (a “Client”), you will be given access to the mobile or desktop application of UVPsych (“the Client360 platform”). The UVPsych App provides personalized content and interactive resources, tools for scheduling appointments, contacting your therapist, and billing, and serves as your hub of information including session notes and records.
You may use the UVPsych App so long as you are over the age of 18 or the legal age of consent in your state, and/or have the necessary capacity or authority to enter binding agreements. By using the UVPsych App, you agree to these Terms and will use the services only in accordance with the terms and conditions herein and all other applicable agreements, information, services, materials, and other content provided by or through the UVPsych App. Your continued use of the UVPsych App following the posting of changes will mean that you accept and agree to the changes.
3. Telehealth Informed Consent - Risks and Benefits
UVPsych Professionals will provide therapy via telehealth using voice calls, video calls, and messaging services. UVPsych Professionals may recommend treatment options as needed. Telehealth therapy is a flexible and convenient way to receive care, but it may not be suitable for addressing certain symptoms or conditions that require in-person sessions or urgent care.
PLEASE NOTE: OUR SUPPORT TEAM DOES NOT ADDRESS MEDICAL EMERGENCIES. IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, ARE CONSIDERING HARMING YOURSELF OR OTHERS, OR ARE OTHERWISE IN IMMINENT DANGER, YOU SHOULD DIAL 911 AND/OR GO TO THE NEAREST EMERGENCY ROOM.
All laws and protections for in-person therapy visits also apply to telehealth sessions. This includes confidentiality of information, access to records, and sharing of information that could identify you personally. You may decide to discontinue telehealth services at any time without losing your health program benefits or rights to future therapy.
4. Session Recording Consent and Usage Policy
By using the Client360 platform for Telehealth services, you consent to the recording of your therapy sessions, which are enabled by default. These recordings are intended to enhance the quality of care and streamline administrative tasks for providers. All recordings are stored in our HIPAA-compliant database, ensuring the privacy and security of your personal health information. Recordings will not be shared or accessed within the platform by any third parties and are strictly limited to authorized personnel for generating session summaries and insights. Robust security measures are in place to protect your recordings from unauthorized access, disclosure, alteration, or destruction, and all recorded sessions are treated with the highest level of confidentiality.
Participation in recorded sessions is voluntary, and you have the option to opt out at the beginning of each session. Opting out of recording will not impact your ability to receive therapy services from us. If you choose not to consent to the recording of your sessions, please inform your provider at the start of the session. You also have the right to withdraw your consent to session recordings at any time by providing written notice. Upon receiving such notice, we will cease any future recordings, though previously recorded sessions will remain subject to the terms outlined in this policy. By continuing to use our platform and services, you acknowledge that you have read, understood, and agreed to these terms.
5. Payment and Billing
Payment is due after each appointment, and UVPsych will charge your card or bank account for the client responsibility. Receipts will be provided after each charge, and a single charge may include fees for multiple appointments (due to billing practices). Your insurance may cover some or all of our services. If you have to pay a deductible, copayment, or coinsurance for your therapy, the usual cost-sharing rules will apply. By providing us with your credit card information, you authorize us to charge your credit card for agreed-upon purchases and save your credit card information for future transactions on your account.
You agree that all third parties who pay any part of your UVPsych Professionals bill shall pay these amounts directly to the UVPsych entities. You understand that you must pay the UVPsych entities any costs not paid by your insurance or other third parties, unless state or federal regulations do not allow this.
6. Refunds
Refund Eligibility: Refunds that UVPsych confirms are owed will be paid for services that were overpaid, duplicate payments, inaccurate billing, services that were not rendered, or if insurance should have been billed. Refunds are subject to verification and approval by UVPsych’s billing department.
Requesting a Refund: To request a refund, you must contact our billing department within 30 days from the date of the original payment or the discovery of the overpayment or non-rendered service. Refund requests can be made by contacting our billing department directly at support@resolute.com. Please provide accurate and complete information, including your name, contact details, payment details, a brief explanation for the refund request, and any relevant supporting documentation.
Refund Processing: Upon receipt of your refund request, we will review the request and initiate the refund process if it meets the eligibility criteria. Refunds will be processed within approximately 5-10 business days from the date of approval. Refunds will be issued using the same payment method used for the original payment, unless otherwise specified and approved by our billing department. Whether or not to grant a refund request is solely within the discretion of our billing department.
Refund Denial: We reserve the right to deny refund requests. Refund requests submitted after the 30-day timeframe will not be considered unless there are extenuating circumstances deemed acceptable by our billing department.
No Refunds for Services Rendered: Refunds will not be issued for services that have been rendered in accordance with the agreed-upon treatment plan or for any charges that are non-refundable for any reason, including, but not limited to, applicable law, regulation, guidance, or agreement. Any disputes regarding services rendered should be addressed separately in accordance with our client dispute resolution process.
Modifications to the Refund Policy: We reserve the right to modify or amend this refund policy at any time without prior notice. Any changes to the refund policy will be effective immediately upon posting the revised Agreement on our website or other appropriate channels.
7. Scheduling and Attendance
We understand you may have to reschedule or cancel an appointment from time to time. We ask that you notify us at least 24 hours in advance of your scheduled appointment. You will be charged for appointments that are not canceled 24 business hours in advance, and appointments to which you are late by 15 or more minutes, as specified on your UVPsych Professional’s booking page and to the extent permitted under applicable laws or payor requirements. Exceptions will be made at the discretion of the UVPsych Professional in case of extenuating circumstances. If you repeatedly miss scheduled appointments, and if UVPsych Professionals are unable to contact you for a period of time, you understand that your agreement with UVPsych may be terminated and you will be removed from UVPsych's platform.
8. Privacy Practices
We must follow federal healthcare privacy and security laws and protect your health information. We work hard to make sure that your personal information is secure. We use standard physical, electronic, and business security methods (such as encryption) to help prevent access to your health information by people who should not see it. But we cannot promise that data sent over the Internet or through a data storage facility will be perfectly secure. So, although we try to protect your personal information, we cannot guarantee the security of any information you send to us. You can read more information about our use of health information and other personal information in our Notice of Privacy Practices (“NPP”): https://www.joinresolutepsychiatry.com/
We may share your health records with the following individuals under the following circumstances:
With your other healthcare providers, either directly or through our participation in health information exchanges, health plans, and for other healthcare treatment, payment, and operations purposes. This may include information relating to genetic tests, substance abuse, mental health, communicable diseases, and other health conditions.
With other individuals involved in your care such as caregivers or family members where we have permission to do so, or in the event of a mental health crisis or other emergency.
As otherwise permitted in our NPP and by applicable law.
By signing below, you agree to let us share your records as described above and acknowledge receipt of the NPP.
9. Communications
As part of providing services, we may communicate with you, including for purposes such as appointment reminders and announcements. If you have provided us with a cell phone number and email address, we may send you SMS text messages and emails. Text messages and emails are not always secure because they travel over networks that we do not control.
By signing below and providing us your cell phone number and email address, you permit us to contact you by SMS text message and email. You may also ask us to stop sending non-appointment-related messages by responding to the messages, including by texting “STOP” or clicking the email link to “unsubscribe,” or by contacting support@joinresolutepsychiatry.com. You understand that you may have to pay data costs to receive SMS text messages that we send to your mobile phone. You may elect not to agree to this section and still receive services from UVPsych Professionals.
10. Complaint Policy
All Clients have the right to communicate complaints regarding their care. Should you wish to make a formal complaint about one of your care providers, you may do so in writing and submit the concern to UVPsych Professionals at support@joinresolutepsychiatry.com.
11. Agreement and Consent
If you have questions about any of the contents of this Agreement, our procedures, or your role in this process, please contact us at support@joinresolutepsychiatry.com. Remember that the best way to ensure quality treatment is to keep communication open and direct with your clinician(s).
By accepting this Agreement, you indicate that you have read and understood this Agreement and that you agree to abide by its terms.