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.

The Health Insurance Portability & Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you, the patient, significant new rights to understand and control how your health information is used. We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. HIPAA provides penalties for covered entities that misuse personal health information.

As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.

• Treatment means providing, coordinating, or managing health care and related services, by one or more health care providers. An example of this would include a physical examination.

• Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collections activities, and utilization review. An example of this would be sending a bill for your visit to your insurance company for payment.

• Health care operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service. An example would be an internal quality assessment review.

• We may call your home or other designated location and leave a message on voicemail in reference to any items that assist the practice in carrying out its services, such as appointment reminders, insurance items and any calls pertaining to my clinical care, including laboratory results among others.

• We may mail to your home or other designated location any items that assist the practice in carrying out services, such as appointment reminder cards and patient statements.

• We may email appointment reminders and patient statements.

• We may text message appointment reminders and patient statements.

• We may access and share information with our partners for the purposes of facilitating care so long as we maintain HIPAA compliant business associate agreement.

• We may access any pertinent health information database in which we have a business associate agreement or other registration including but not limited to multistate PDMP, CRISP, EPIC Care Everywhere, or any other relevant database in which Lukas Behavioral Health has access.

• We may create and distribute de-identified health information by removing all references to individually identifiable information.

Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Privacy Officer.

• The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosure to family members, other relatives, close personal friends, or any other person identified by you. We are, however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.

• The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.

• The right to inspect and copy your protected health information.

• The right to amend your protected health information.

• The right to obtain a paper copy of this notice from us upon request.

This notice is effective as of January 19th, 2023 and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may request a written copy of a revised Notice of Privacy Practices from this office.

You have recourse if you feel that your privacy protections have been violated. You have the right to file written complaints with our office, or with the Department of Health & Human Services, Office of Civil Rights, about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint.

Please contact the following for more information: The U.S. Department of Health & Human Services Office of Civil Rights - Address: 200 Independence Avenue, S.W. Washington, D.C. 20201 -  Phone: (202) 619-0257 - Toll Free: 1-877-696-6775

Lukas Behavioral Health (LBH) offers telehealth services as an option for patients deemed clinically appropriate and eligible by both the treating provider and LBH. The same practice policies—including those regarding attendance, cancellations, payments, and patient conduct—apply equally to telehealth services.

What is Telehealth?

Telehealth allows patients to receive care through secure, two-way audio and video communication. It may include review of health records, medical consultations, therapy, education, and the exchange of diagnostic or health-monitoring data. Technologies used by LBH meet federal and industry standards for encryption and privacy protection.

Expected Benefits

• Improved access to care, especially in remote areas

• Increased efficiency in diagnosis and treatment

• Access to specialists not available locally

Potential Risks

While telehealth is generally safe and effective, it carries some risks:

• Technical issues may cause delays or inadequate transmission of information

• In rare cases, limited access to medical records may impact clinical decision-making

• Though unlikely, privacy breaches may occur if security protocols are compromised

Patient Responsibilities & Requirements

Technological Requirements Patients are responsible for ensuring they have the following prior to each session:

• A stable internet connection

• A functioning device with a camera and microphone

• Access to a private, well-lit, and quiet location

• Ensure equipment is functional and appropriate settings in place for use of video and audio prior to appointment time

Confidentiality & Privacy Commitments To protect your confidentiality, you must:

• Conduct sessions in a private location, free from background noise and distractions

• Avoid using public or unsecured Wi-Fi

• Not take screenshots, videos, or audio recordings during the session

• Not post session content on social media or public platforms

Legal Reminder: In Maryland, it is unlawful to record a private conversation without the consent of all parties involved.

Session Conduct Expectations

• Log-in promptly upon receipt of invite or 10 minutes prior to scheduled session time. 

• Dress as you would for an in-person appointment

• Do not attend sessions under the influence of alcohol, cannabis, or any non-prescribed substance

• Sessions will be ended if drug or alcohol use is suspected

Location & Licensing Patients must be physically located in Maryland or a state in which their provider is licensed at the time of service.

Insurance & Billing Coverage for telehealth varies by insurer. Patients are responsible for verifying coverage in advance and are liable for the full service rate if not covered.

Service Disruptions

If a session is disrupted due to technical issues:

• The provider will attempt to reconnect within 5–10 minutes

• If reconnection fails, LBH will contact the patient by phone or email to reschedule or complete the session by alternate means (e.g., phone, if clinically appropriate)

• Missed sessions due to avoidable technical issues may be subject to the standard no-show or late cancellation policy

Controlled Substances

Telehealth cannot be used to initiate new prescriptions for controlled substances without a prior in-person exam. Continued prescriptions require an in-person visit at least once every 12 months. All controlled substances policies apply equally to telehealth patients.

Emergency Protocols

Because telehealth providers are not physically present:

• Patients must provide an emergency contact and the address where they will be during each session

• In case of a psychiatric or medical emergency, LBH will contact local emergency services and/or the patient’s emergency contact

• Patients are strongly encouraged to complete and sign an emergency plan, giving LBH permission to notify emergency services or designated contacts if necessary

Right to Withdraw

Patients may decline or withdraw consent to telehealth services at any time without impacting their right to future care. Patients also have the right to request in-person sessions when available and clinically appropriate.

Lukas Behavioral Health (LBH) maintains strict policies to ensure the safe, ethical, and clinically appropriate prescribing of controlled substances. Controlled substances include, but are not limited to, benzodiazepines, stimulants, and other medications regulated by federal and state law.

General Policy

• No Guarantee of Prescription: The prescription of controlled substances is not guaranteed. A prior prescription by another provider does not obligate an LBH provider to continue it.

• Provider Discretion: Prescribing is based solely on clinical judgment and in accordance with evidence-based guidelines and clinical judgement. LBH providers are neither legally nor ethically obligated to prescribe any controlled medication.

• Appropriate Use Only: Controlled substances are prescribed only for diagnoses and conditions supported by appropriate clinical indications.

Benzodiazepine-Specific Guidelines

• LBH does not prescribe benzodiazepines as a primary or sole treatment for anxiety or related disorders.

• Benzodiazepines are only prescribed on an as-needed basis and are not issued for scheduled, routine, or around-the-clock use.

• LBH does not prescribe benzodiazepines for non-psychiatric conditions (e.g., chronic pain, insomnia, seizure disorders, etc).

Therapy & Treatment Compliance

• Patients prescribed a controlled substance must actively participate in therapy as recommended by their prescriber.

• Patients must comply with all treatment plans, including non-controlled medications and interventions.

Drug Testing & Monitoring

• Patients on any controlled substance will be required to undergo baseline and random drug testing.

• Failure to comply with testing or failing a test (i.e., evidence of non-prescribed substances or prohibited use) may result in:

  • Immediate discontinuation of controlled medications

  • Placement of a Controlled Substance Restriction in the patient’s medical record

Prohibited Substance Use

• Patients are strictly prohibited from using marijuana, alcohol, or any other controlled substance not prescribed by their LBH provider while receiving controlled substances.

• LBH providers actively monitor controlled substance use through the state Prescription Drug Monitoring Program (PDMP).

Diversion Policy

• Diversion, defined as sharing, selling, or otherwise distributing prescribed medication to another individual, or using the medication in a manner inconsistent with the prescribed use, is illegal and strictly prohibited.

• Evidence of diversion will result in:

  • Immediate Controlled Substance Restriction

  • Possible termination of care

  • Mandatory reporting to law enforcement or child protective services, if applicable

Controlled Substance Restriction

• A Controlled Substance Restriction (CSR) is a permanent flag that LBH and its providers may place in the patient’s medication record when a patient:

  • Violates controlled substance policies

  • Fails to comply with treatment or testing requirements

  • Is determined by clinical evaluation to be high risk for misuse or abuse

• This record may be shared with other providers (as authorized by the patient) to support continuity of safe care and appropriate prescribing.

Egregious Violations & Grounds for Termination

LBH takes patient safety and community health seriously. The following egregious actions may result in immediate termination from care at Lukas Behavioral Health:

• Attempting to obtain multiple prescriptions for the same or similar controlled substances from multiple providers (“doctor shopping”)

• Requesting or receiving prescriptions on behalf of another person

• Repeated violations of LBH controlled substance policies, including multiple missed drug screens, inappropriate or inconsistent refill requests, consistent non-adherence to treatment plans, or misuse of prescribed medications

• Any attempt to falsify medical records, forge prescriptions, or manipulate clinical protocols

• Any attempt to threaten, bribe, or otherwise coerce a prescriber into prescribing a controlled substance. 

Termination from care due to such violations will be documented in the patient record and communicated to the patient in writing. In cases involving safety concerns, LBH may also notify appropriate authorities and provide a list of alternative behavioral health resources for continuity of care.

Lukas Behavioral Health (LBH) maintains a Zero Tolerance Policy for any form of aggression, violence, harassment, or other inappropriate conduct toward staff, providers, patients, or visitors. All individuals entering our practice—whether patients or guests—are expected to behave respectfully and professionally at all times.

Prohibited Conduct

The following behaviors are strictly prohibited and may result in immediate action:

• Physical violence or physical threats

• Verbal abuse, including yelling, intimidation, or threats of harm

• Sexual harassment or assault, including unwelcome sexual remarks or contact

• Racial, ethnic, gender-based, or discriminatory remarks

• Harassment of any kind, including repeated unwanted communication or behavior

• Disparagement, slander, or defamation of staff or providers, whether in person or via online platforms, including social media

Consequences of Violating This Policy

If a patient engages in any of the above conduct, the following actions may occur:

1. Controlled Substances:

   • If the patient is prescribed a controlled substance, it may be discontinued immediately if clinically safe to do so.

   • If immediate discontinuation is not medically appropriate, the patient may instead be provided with a limited supply of non-controlled or essential medications (up to 90 days) to allow for transition of care, at the discretion of the provider.

   • A Controlled Substance Restriction will be applied to the patient’s medical record.

2. Discharge from the Practice:

   • The patient will be formally discharged from Lukas Behavioral Health.

   • A transitional supply of non-controlled medications (up to 90 days) may be offered when clinically necessary to ensure continuity of care.

3. Legal Action:

   • LBH may notify law enforcement and/or pursue criminal or civil action, depending on the nature and severity of the conduct.

4. Third-Party Misconduct:

   • If a family member, support person, or guest of the patient engages in prohibited conduct, that individual will be permanently banned from all LBH locations.

   • Repeated incidents may result in the patient’s own discharge from the practice as well.

5. Prohibited Communication & Harassment:

   • Contacting LBH staff or providers outside of approved communication channels is strictly prohibited.

   • Making defamatory or harassing statements about LBH staff or providers on public forums, including social media, may be considered slander, libel, or harassment, and is grounds for immediate discharge and possible legal action.

   • LBH maintains a separate Social Media and Communications Policy which all patients are expected to adhere to.

Lukas Behavioral Health (LBH) and its providers are not obligated to complete, certify, or sign any forms, letters, or other documentation—regardless of the reason or request. The completion of such documentation is done solely at the discretion of the treating provider and only when it is determined to be clinically or legally necessary and appropriate.

Eligibility Criteria for Documentation Requests

• Documentation requests will not be considered unless the patient has been actively engaged and compliant with their treatment plan for a minimum of six (6) consecutive calendar months.

• Exceptions may be made only at the provider’s discretion based on clinical necessity.

Scope of Documentation

This policy applies to, but is not limited to:

• Disability, FMLA, or leave of absence forms

• Academic or workplace accommodation letters

• Housing letters or requests for special accommodations

• Return-to-work or medical clearance documents

• Legal documentation, court-related statements, or third-party forms

Emotional Support Animals (ESAs)

• Lukas Behavioral Health and its providers do not provide letters of accommodation for Emotional Support Animals (ESAs) under any circumstances.

Psychiatric Service Dogs (PSDs)

• Psychiatric Service Dogs (PSDs) are protected under the Americans with Disabilities Act (ADA) and therefore do not require documentation or provider certification. As such, LBH does not issue letters for PSDs.

Service Fees and Payment Policy

• All documentation services, when provided, are subject to out-of-pocket service fees, which are not billable to insurance.

• Documentation will not be released until all applicable fees are paid in full.

• The current fees are listed in our Service Fee Schedule.

Provider Discretion

All documentation decisions will take into account:

• The accuracy and completeness of clinical information

• The provider’s ethical and legal responsibilities

• Whether the request aligns with the goals and purpose of treatment

Lukas Behavioral Health maintains a strict attendance policy to support access to care, provider availability, and safe medication management. Missed appointments and late cancellations reduce our ability to serve all patients effectively and are taken seriously.

NO SHOW POLICY

A No Show is defined as missing a scheduled appointment without notifying the office before the close of business on the same day. Confirmation of the appointment is not required for this policy to apply.

Policy Enforcement:

• No Shows are strictly prohibited, except for rare and verifiable extenuating circumstances.

• After two (2) No Shows, the patient may be discharged from the practice.

  • Upon discharge, the patient may receive up to 3 months of non-controlled medications and up to 1 month of controlled medications, if eligible under our Controlled Substance Policy.

• No Show fees apply and are the full responsibility of the patient. These are not covered by insurance and must be paid in full to receive medication refills.

• Upon a No Show, patients may request up to 10 days of medication only after paying the No Show fee and rescheduling. No further refills will be issued until the patient is seen.

  • If the rescheduled appointment is also missed, no further refills will be provided until an in-person or telehealth visit is completed.

LATE CANCELLATION POLICY

A Late Cancellation is defined as cancelling an appointment less than 24 hours before the scheduled appointment time.

Policy Enforcement:

• Three (3) late cancellations may result in discharge from the practice, following the same medication bridge provisions as listed above.

• Late Cancellation fees apply and are the patient’s financial responsibility, not billable to insurance.

• Upon a late cancellation, up to 10 days of medication may be provided only after payment of the Late Cancellation Fee and rescheduling.

  • If the rescheduled appointment is missed, no further medication will be issued until the patient is seen.

EXCEPTIONS TO NO SHOW & LATE CANCELLATION POLICIES

LBH understands that rare, unavoidable events may interfere with attendance. The following exceptions may be considered legitimate if verifiable and communicated promptly:

1. Medical emergency requiring urgent care or hospitalization

2. Death or critical illness of an immediate family member

3. Severe weather or natural disaster affecting safe travel

4. Accident or mechanical failure en route to the appointment

5. Public transportation shutdown without reasonable alternatives

6. Court-ordered appearance or legal detention

7. Documented psychiatric emergency or crisis

8. Unexpected childcare crisis with no immediate backup

Note: LBH may request supporting documentation. Exceptions are granted at the discretion of clinical and administrative leadership and are never guaranteed!

APPROPRIATE CANCELLATIONS

• Appointments cancelled more than 24 hours in advance will not be subject to any fees.

• Patients may request up to 10 days of medication as a bridge until the rescheduled appointment.

  • If the rescheduled appointment is missed, no further refills will be issued until the patient is seen.

LATE ARRIVAL POLICY

Patients should arrive 15 minutes prior to their scheduled appointment time.

• Late arrival is defined as arriving after the scheduled appointment time.

• Excessive lateness may result in forfeiture of the appointment and assessment of a Late Cancellation Fee.

• It is at the provider’s discretion whether to see a patient who arrives late.

If running late or unable to attend: Please contact the office as soon as it is safe and reasonable to do so. If we receive notice before close of business on the day of the missed appointment, the absence may be documented as a Late Cancellation instead of a No Show.

TELEHEALTH ATTENDANCE POLICY

Patients attending via telehealth must:

• Log in at least 10 minutes prior to their scheduled appointment

• Ensure they are in a prepared for the session in accordance with the Telehealth Treatment Policy

Failure to comply may result in the appointment being cancelled and marked as a Late Cancellation, subject to associated fees.

FLEXIBLE SCHEDULING NOTICE

LBH reserves the right to shift appointment start times by up to 15 minutes earlier or later than the originally scheduled time without prior notice.

• Patients arriving within 15 minutes of their scheduled time will not be counted as late if the provider's schedule was adjusted internally.

To ensure uninterrupted care and efficient billing, Lukas Behavioral Health requires all patients to adhere to the following payment policy:

General Payment Terms

• All payments are due at the time of service. This includes, but is not limited to:

  • Co-pays

  • Co-insurance

  • Deductibles

  • Self-pay fees

  • Any other out-of-pocket charges

• Full payment is expected unless prior arrangements are made and approved in writing by LBH administration.

• Payment arrangements are not guaranteed and are made solely at the discretion of the LBH administrative team.

Card on File Policy

As part of our commitment to convenience and timely processing, all patients are required to maintain an active credit or debit card on file with Lukas Behavioral Health.
This card may be used to:

• Pay for any balances due at the time of service

• Automatically charge outstanding co-pays, co-insurance, or uncovered amounts once insurance has processed

• Settle missed appointment, no-show, or late cancellation fees as outlined in our Attendance Policy

Patients will be notified before any charge is processed for anything other than the scheduled visit co-pay. Cards are stored securely using encrypted, PCI-compliant payment processing systems.

Insurance Responsibility

• Patients are responsible for confirming the accuracy and status of their insurance coverage.

• If coverage is terminated, denied, or delayed, the patient will be fully responsible for any balance due.

• It is the patient's responsibility to notify our office promptly of any changes in insurance to avoid service disruptions or unexpected costs.

Returned Payments, Chargebacks, and Declined Cards

• A $30.00 fee will be charged for any declined payments, returned checks, or insufficient funds, in addition to the original balance due.

• If a patient initiates a chargeback or reverses a payment with their bank or credit card company:

  • Services may be suspended or terminated

  • LBH reserves the right to pursue recovery of the full balance, including legal and administrative costs

  • The patient's status with the practice will be re-evaluated, and discharge may occur as a result

Overdue Balances and Collections

• Balances more than 30 days past due may be subject to late fees in accordance with our posted Service Fee Schedule.

• Any unpaid balances over 90 days past due may be sent to a third-party collections agency. The patient/guardian will be responsible for:

  • The outstanding balance

  • Any collection agency fees

  • Legal and court costs incurred in the recovery of the debt

Accepted Forms of Payment

• Credit Card

• Debit Card

• Cash

• Check

We appreciate your understanding and cooperation in helping us maintain an efficient and transparent billing process. If you have questions or concerns regarding this policy or your account, please contact our office prior to your next visit.

How to Contact Us

Phone: 

• You may contact our office by calling (301) 876-4889 during normal business hours: Monday–Friday, 9:00 AM–5:00 PM (excluding holidays or posted office closures).

• Due to high call volumes, you may be prompted to leave a voicemail. All voicemails are monitored and returned as soon as possible.

Client Portal

• For non-urgent messages and general communication with providers or staff, please use the secure Client Portal included in our electronic health records system. 

• This is the preferred method for written communication and ensures your privacy is protected.

⚠️ If you are experiencing a medical or psychiatric emergency, please dial 911 or go to the nearest emergency room immediately. Additional emergency contact instructions are outlined in our Client Emergencies section of this policy.

Mailing Address

• Primary Location:
  Lukas Behavioral Health
  618 N Mechanic St.
  Cumberland, MD 21502

• Addresses for additional office locations are available on our website.

Electronic Communication Policy

To protect your confidentiality and ensure professional boundaries, LBH enforces the following guidelines regarding digital communication:

Email

• Not recommended for communication related to treatment.

• Should only be used if explicitly instructed by LBH staff.

• Practice email inboxes may not be routinely monitored.

• Appointment reminders may be delivered via automated email systems.

Text Messaging

• The only approved use of text messaging is through our automated reminder system.

• LBH staff and providers are not permitted to engage in client communication via personal text or social messaging apps (e.g., WhatsApp, Facebook Messenger, Instagram DMs).
  
  

Electronic Communication Disclaimer

Please note:

• Emails and texts are not secure or confidential 

• Emails may become part of your treatment record if relevant to care.

• We strongly encourage clients to use phone or portal communication to ensure secure, HIPAA-compliant interactions.

• Inappropriate or boundary-crossing communication via email or social media may result in termination of care.

Prohibited Contact and Communication

We value the therapeutic relationship and strive to maintain clear, ethical, and professional boundaries. The following actions are strictly prohibited and may result in immediate termination of services:

Threatening or Abusive Behavior

• Includes verbal threats, hostile or aggressive language, or intimidating conduct toward staff, providers, or others affiliated with LBH. 

Inappropriate External Contact & Social Media

• If you see an LBH staff member in public, they will not acknowledge you unless you initiate contact, to protect your privacy.

• Friend or contact requests on social media platforms will not be accepted.

• Attempting to access personal social media accounts of staff or providers (e.g., sending messages, following private profiles, viewing personal content) is a violation of policy and may result in discharge.

• Clients may not use social media platforms to disparage or harass providers or staff. These actions may be considered harassment, slander, or defamation, and may lead to legal action in addition to termination of services.

Personal or Business Relationships

• Personal or business relationships between clients and staff/providers are strictly prohibited.

• We cannot act as your friend, business partner, or social contact.

• All relationships must remain therapeutic and professional to protect the integrity of treatment.

Gifts, Bartering, or Service Trades

• LBH and its staff do not accept gifts, offer bartering arrangements, or engage in trades of services under any circumstances.
  
  

We thank you for your cooperation in maintaining a safe, respectful, and professional therapeutic environment for everyone.

Minor Clients (Clients under the age of 18)

Treatment of Minor Clients Under the Age of 12 in Maryland 

As a parent or guardian of a child under the age of 12, you have specific rights regarding access to your child’s records and information pertaining to their treatment. You are entitled to request a copy of your child’s file or to obtain more detailed information about the services and treatment they are receiving at Lukas Behavioral Health. If you have any questions or need assistance, don't hesitate to get in touch with the Practice to discuss. Some other important points to know:

• Trust plays a crucial role in the therapeutic relationship, and it's important for minor clients to feel safe and comfortable when sharing their thoughts and feelings. To ensure this, the provider will engage in discussion with both you and your child about what information can be shared with you. Additionally, we will establish clear guidelines to follow throughout the therapy process, which will be set before therapy begins. This approach aims to create a secure environment for open communication.

• In certain exceptional situations, we may need to restrict access to a file or the release of information if we have concerns that doing so could potentially harm the minor client or put them in jeopardy. Should such a situation arise, we will be sure to communicate our reasoning to you.

Treatment of Minor Clients Aged 12 and Older in Maryland 

At Lukas Behavioral Health, we greatly appreciate the involvement of parents and guardians in the therapeutic journey of our minor clients. We believe that the support and consent of parents can play a crucial role in the minor’s success in psychotherapy. However, it is essential to acknowledge that Maryland law permits minors aged 12 and older to independently consent to mental health treatment and services when deemed appropriate by the clinical judgment of their therapist. We strive to balance this legal provision with the importance of parental involvement to ensure the best outcomes for our young clients. 

We ask parents/guardians and minor clients aged 12 and older also to understand the following:

• We understand the importance of respecting the rights and well-being of young individuals seeking mental health treatment while also being receptive to input from parents/guardians. We take into consideration the unique circumstances of each minor client aged 12 or older. Our priority is to ensure that any decision to commence treatment is made with the best interest of the client in mind. Prior to initiating treatment, we carefully assess the situation and make a thoughtful determination of how Lukas Behavioral Health can best support each client.

• Under Maryland law, Lukas Behavioral Health is permitted but not required to provide parents/guardians with information about treatment needed or provided to the minor clients. As a general rule, we seek to preserve the minor’s confidentiality when possible. However, there may be certain times when we feel that we need to advise parents/guardians of certain things, especially in situations where there is potential danger or risk to the minor or others.

• We will discuss any potential need for disclosure with both the minor client and their parents/guardians in advance. 

• When treating minor clients with parental consent, we will want to have open discussions with both the minor and the parents/guardians about what information can be shared and to establish mutually agreed-upon ground rules for the therapeutic relationship. 

• Additionally, it should be noted that if a parent/guardian has provided consent for treatment, the minor cannot override this decision, as parents legally have the authority to seek therapy for their child.

Supervision of Minors

• For safety and liability reasons, Lukas Behavioral Health requires that parents or legal guardians stay on the premises with their minor children (under the age of 18) during in-office appointments. 

• We acknowledge that there may be instances where parents or guardians need to leave the premises during a minor’s therapy session. However, it is mandatory for all parents to inform the therapist and/or Lukas Behavioral Health staff prior to departure. 

• Should a parent or guardian need to step away, they must remain reachable via cell phone at all times and return at least five minutes prior to the conclusion of the appointment. In the event of an emergency or other urgent situation, parents or guardians are required to return to the office promptly.  

• Adhering to these guidelines is essential for maintaining a smooth experience for all parties involved and ensuring that we deliver the highest level of service.

Custody Orders

When treating minors subject to a custody order, the following rules apply:

• Joint Legal Custody: If both parents share legal custody, either parent may typically consent to treatment. However, we strongly encourage both parents to be involved whenever possible.

• Sole Legal Custody: If only one parent holds legal custody, documentation (e.g., court order) must be provided confirming this status.

• Court Restrictions: If there are any court orders restricting one parent’s access to treatment or records, a copy of the relevant order must be submitted to our office.

• Custody Agreements: LBH reserves the right to review custody agreements or parenting plans prior to initiating treatment of a minor. Treatment may be delayed if clarification is needed.

Failure to provide appropriate documentation may delay or prevent treatment from being initiated.

Disputes Between Parents

LBH will not become involved in disputes between parents regarding:

• Whether a child should participate in therapy

• The appropriateness of treatment

• Disagreements over diagnosis, medication, or treatment approach

• Access to records

We do not mediate between parties or provide recommendations on custody or parenting time. If such involvement becomes necessary, families should consider seeking out the services of a forensic evaluator or court-appointed expert.

Records Access for Parents

Unless otherwise restricted by court order:

• Both legal parents have the right to access their minor child's medical and mental health records.

• However, LBH may limit access to progress notes, psychotherapy notes, or sensitive information when disclosure is deemed clinically inappropriate or potentially harmful to the client’s wellbeing.

Testimony, Custody Evaluations, and Legal Involvement

Lukas Behavioral Health does not provide custody evaluations, parenting assessments, or serve as expert witnesses in custody litigation.

• LBH will not provide letters of support for one parent over another in legal proceedings.

• Our clinicians will not testify in court regarding custody, visitation, or family legal disputes.

• If a provider is subpoenaed or legally compelled to participate in a custody or legal matter, all legal fees and time away from the practice will be charged in accordance with our Legal Matters & Testimony Policy (see: $500 per half day / $1,000 per full day, plus preparation and travel fees).

Clinician Discretion

LBH providers reserve the right to:

• Refuse treatment or pause services if custody or consent is unclear or in active dispute in a manner that restricts or prohibits reasonable delivery of care

• Decline participation in legal proceedings or custody conflicts

• Terminate treatment if boundaries are violated or if the therapeutic relationship is compromised due to parental conflict

At Lukas Behavioral Health, our prescribers strive to ensure that all patients receive an adequate supply of medications during their scheduled appointments to last until their next visit. It is the patient’s responsibility to monitor medication supply and request refills in a timely manner when necessary.

General Refill Policy

• All refill requests must be submitted at least 5–7 business days before running out of medication.

  • This allows sufficient time for clinical review, coordination, and provider approval.

• Failure to request medication refills in advance may result in missed doses, which can affect your treatment and safety.

• Multiple calls or messages will not expedite the process and may delay your request due to increased administrative workload. Please submit only one request and allow time for processing.

How to Request a Refill

Refill requests may be submitted using the following methods:

• Medication Refill Voicemail Line

• Secure Patient Portal Message

To avoid delays, be sure to include the following information in your message:

• Full name and date of birth

• Medication name(s) and current dosage(s)

• Preferred pharmacy (if different from your usual one)
  Contact information in case clarification is needed

Controlled Substance Refill Policy

Controlled substances (e.g., stimulants, benzodiazepines) are subject to strict legal and clinical guidelines:

• Controlled substances will only be prescribed for a maximum of 30 days at a time, regardless of appointment frequency.

• Refills without a follow-up appointment are not guaranteed and are issued solely at the discretion of the prescriber, based on patient compliance and clinical appropriateness.

• Patients must request controlled substance refills at least 5–7 business days before the medication runs out.

• Lukas Behavioral Health does not prescribe Schedule II medications for more than a 30-day supply under any circumstance.

Missed Appointment Refill Requests

Refill requests made after a No Show or Late Cancellation will be addressed according to the terms outlined in the Attendance Policy.

• In most cases, refills will be limited or denied until the patient is seen for a follow-up appointment.

• Patients may be provided a short supply (up to 10 days) only after payment of any applicable fees and successful rescheduling of the missed appointment.

Please note: Medication refills are part of your clinical treatment and are managed in coordination with your provider. Failure to attend appointments, comply with treatment plans and recommendations, or follow refill procedures may result in medication delays or denial of future prescriptions.

If you are experiencing an emergency or crisis—including but not limited to suicidal or homicidal thoughts, active plans to harm yourself or others, or symptoms of a psychiatric emergency—you must immediately:

• Call 911, or

• Go to the nearest emergency department

As an outpatient practice, Lukas Behavioral Health is not equipped to manage emergency situations in real-time. Your safety, and the safety of those around you, is our top priority. Emergency services are best positioned to offer immediate support and intervention.

Once you are stable and safe, please contact our office as soon as possible to:

• Notify us of what occurred, and

• Schedule a follow-up or discharge planning appointment

Crisis Resources

Below are additional resources for urgent mental health support when immediate danger is not present but professional guidance is still needed:

National

• Suicide & Crisis Lifeline: Call or text 988 | 988lifeline.org

Statewide (Maryland)

• Maryland Crisis Hotline: 1-800-422-0009

Local Resources

Garrett County

• Garrett County Behavioral Health: 301-334-7680

• After-Hours Crisis Line: 301-501-3515

Allegany County

• Western Maryland Regional Medical Center Crisis Line: 240-964-1399

• Family Crisis Resource Center (domestic violence & trauma): 301-759-9244

Washington County

• Mobile Crisis Team: 240-625-2246

Baltimore City

• Baltimore Crisis Response: 301-783-0011

After-Hours Contact Protocol

Lukas Behavioral Health offers limited after-hours coverage for non-emergency concerns:

• After-hours coverage is available between 5:00 PM and 8:00 PM, Monday through Friday.

• Calls during these hours may be answered live, but are primarily screened via voicemail by an on-call staff member.

• If you leave a voicemail, include your full name, date of birth, a brief reason for the call, and a safe callback number.

⚠️ Please note: On-call staff cannot prescribe medications, manage emergencies, or conduct therapeutic interventions over the phone.

If your concern constitutes a mental health emergency, do not wait for a return call. Contact 911 or go to the nearest emergency department.

Client Records Request Policy

You have the right to request a copy of your medical record at any time. To do so:

• Submit your request in writing to our administrative team by using our Medical Records Request Form, which is available upon request. 

• There is no charge for electronic copies of records. The current per page fee for printed records can be found in our Service Fee Schedule. 

Under Maryland Law, LBH must provide access to your medical records within 21 working days of your written request. This deadline is binding and applies to all patients unless the request is clearly and lawfully exempt (e.g., court-ordered restrictions or clear danger to the patient’s safety).

Release Forms & Fees:

• Records may be sent in electronic or paper form, depending on the method of request and patient preference.

• Administrative fees may apply in accordance with Maryland Health-General §4–304.
  Patients may request that records be sent directly to another healthcare provider at no charge.

Third-Party Requests

If a third party (e.g., insurance company, legal office, school, employer) requests your records:

• We must receive your signed Release of Information (ROI) before records are shared, except where otherwise required by law.
  All requests will be reviewed for compliance with HIPAA, state law, and professional ethics.

• Requests from legal entities (attorneys, courts, etc.) may require additional verification or court orders.

• Records fees for printed copies may still apply, unless otherwise prohibited by law. 

Subpoenas, Testimony, and Legal Matters

Lukas Behavioral Health generally does not participate in legal matters or provide testimony as part of custody, civil, or criminal proceedings. Our clinicians are here to support mental health, not to serve as expert witnesses or as disability or forensic evaluators.

In the event a clinician is legally compelled to testify or provide documentation under subpoena or court order:

• The requesting party (or their legal representative) will be responsible for the full cost of the provider’s time and preparation.

• Our standard legal compliance fee is $300 per hour, for any necessary preparation, document review, travel time, and all time related to court appearances, depositions, etc. Any additional expenses incurred such as lodging, airfare, or other travel related expenses must be prepaid in addition to the hourly fee. 

• A minimum non-refundable deposit may be required before any participation is confirmed.

Death or Incapacity of a Provider

In the rare event that your assigned provider becomes incapacitated or deceased:

• Lukas Behavioral Health will make every effort to notify you as soon as possible.

• You will be offered a transfer of care to another qualified provider within the practice or provided assistance with referrals outside the organization.

• Your medical records will remain protected and accessible per HIPAA and state law.

Exceptions to Confidentiality

While we are committed to maintaining the confidentiality of your protected health information, the following exceptions apply under law and ethical guidelines:

1. Mandated Reporting: Suspected abuse or neglect of a child, elderly person, disabled adult, or vulnerable individual.

2. Duty to Protect: If there is a credible threat of harm to yourself or others, we are obligated to act, which may include notifying emergency contacts, law enforcement, or initiating involuntary hospitalization.

3. Court Orders/Subpoenas: If ordered by a court or appointed legal authority (e.g., guardian ad litem).

4. Regulatory Oversight: Disclosures required by licensing boards or government agencies during investigations or audits.

5. Litigation or Complaints: If a formal complaint is filed against LBH or its staff, or if the client initiates legal action.
   Operational Needs: Disclosures to staff, agents, or contractors involved in your care (e.g., billing, scheduling, coordination of care).

6. Clinical Supervision: If your therapist is under clinical supervision, their supervisor may review your treatment for quality assurance.

7. Consultation: Your provider may consult with other licensed professionals to ensure the best clinical outcomes. Identifying information is minimized during these consultations.

Supervision of Clinicians

Some clinicians at LBH may practice under supervision as part of their professional licensing requirements. If your provider is under supervision:

• You will be notified in writing and/or verbally during intake.

• You will be provided with the name and contact information of their licensed supervising clinician.

• All supervisors are bound by the same standards of confidentiality and ethics as your provider.

Lukas Behavioral Health is committed to delivering safe, ethical, and effective care. However, there may be circumstances in which it becomes necessary to discontinue services with a client. This policy outlines the conditions under which a patient may be discharged and the procedure for requesting readmission.

Grounds for Discharge

Patients may be discharged from care for any of the following reasons:

• Nonadherence to the treatment plan, including refusal to engage in clinically recommended services or follow safety recommendations

• Violation of Patient Care Policies, including but not limited to the Attendance Policy, Controlled Substance Policy, Zero Tolerance Policy, and Payment Policy

• Lack of contact or missed appointments for a period of 6 months or more, unless otherwise prearranged

• At the patient’s request, in writing or verbally communicated to staff or providers

• At the discretion of executive management, when continued treatment is determined to be clinically or administratively inappropriate or infeasible

Discharge Procedure

When a patient is discharged:

• A formal notice of discharge will be provided via patient portal or postal mail

• Medication refills may be provided, as appropriate, in accordance with LBH’s Medication Refill Policy and the Controlled Substance Policy. Typically:

  • Up to 90 days of non-controlled medications may be issued

  • Up to 30 days of controlled medications, if clinically appropriate and in good standing

• A referral list of local providers will be available upon request to support continuity of care

Eligibility for Readmission

Patients discharged due to a policy violation are not eligible for readmission for a minimum of 12 months from the date of discharge. Readmission after this period is not guaranteed and is subject to:

• Review and approval by executive management

• A documented pattern of behavioral, clinical, or compliance improvement

• Availability of appropriate clinical services

How to Request Readmission

Patients seeking readmission must:

1. Submit a new intake request via our online intake portal or at one of our office locations

2. Include any relevant information about prior treatment history and reason for reengagement

3. Await formal review and decision from management, which may take up to 10 business days

LBH reserves the right to deny readmission based on past clinical history, policy violations, current risk factors, or lack of provider availability.

Lukas Behavioral Health is committed to providing accessible and equitable care to all patients, including individuals who are deaf, hard of hearing, or use American Sign Language (ASL) as their primary mode of communication. In accordance with the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act, and other applicable laws, LBH provides interpreter services as a reasonable accommodation to ensure effective communication in clinical settings.

Availability of Interpreter Services

LBH offers on-demand virtual ASL interpreter services at no cost to the patient for any clinical interaction, including therapy sessions, medication management, intake evaluations, and follow-up appointments.

• Interpreter services are available in real-time using secure video platforms integrated with our telehealth systems.

• These services are available for both in-person and virtual appointments.

Patient Rights Under the ADA

Under the ADA and related laws:

• Patients have the right to effective communication with healthcare providers.

• Healthcare practices are legally required to provide auxiliary aids and services, including qualified ASL interpreters, at no cost to the patient.

• LBH will never charge or bill patients directly for interpreter services provided as a reasonable accommodation.

• Patients cannot be required to provide their own interpreter or bring a family member or friend to interpret, although they may choose to do so voluntarily.

Use of Preferred or Personal Interpreters

LBH maintains a Contract and Business Associate Agreement with our interpreter service to ensure HIPAA and security compliance, therefore, we cannot employ or elect to utilize other services. 

However, patients have the right and may choose to use their own interpreter (e.g., family member, friend, or privately contracted ASL interpreter) at their own expense.

• LBH strongly recommends the use of a qualified, impartial interpreter, especially for complex or sensitive clinical matters.

• If a patient requests to use their own interpreter, LBH staff may ask for a brief written acknowledgment of that choice and will still offer a professional interpreter at no cost.

• Minors may not serve as interpreters under any circumstance.

Insurance Billing and Financial Responsibility

• LBH may bill the patient’s insurance for interpreter services where permitted and appropriate.

• Regardless of insurance coverage, patients will never be billed for any portion of the cost of ADA-required interpreter services that are provided by LBH. However, LBH is not responsible for another interpreter hired by the patient. 

Requests and Scheduling

Patients are encouraged to notify LBH at the time of scheduling if interpreter services are needed. While on-demand services are typically available, advance notice helps ensure seamless coordination.

Interpreter services can be requested:

• During scheduling via phone or client portal

• By informing the provider or front desk during routine contact

Questions or Concerns

If you have questions about your right to communication assistance or experience any issues related to interpreter services, please contact our office. 

You may also file a complaint with the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services.

– The No Surprises Act –

No Surprises Act Overview

Beginning January 1, 2022, the federal No Surprises Act protects patients from surprise medical bills from an out-of-network provider, out-of-network facility, or out-of-network air ambulance provider. The law aims to help both insured and uninsured patients understand and plan for health care costs in advance of care and to minimize unforeseen — or surprise — medical bills. 

Patients with Insurance

Insured patients are protected from receiving surprise medical bills resulting from out-of-network care at an in-network facility for emergency services and for certain scheduled services without prior patient consent.

Patients with Medicare, Medicaid, or other Government Insurances

Individuals with Medicare, Medicare Advantage, Medicaid, Indian Health Services, Veteran Affairs health care, or TRICARE insurance plans are not covered under the No Surprises Act because these federal insurance programs have existing protections in place to minimize large, unforeseen bills.

Uninsured Patients

Uninsured patients or patients who are not using insurance to pay for their care have a right to understand the costs related to their care.  Providers are required to provide a good faith estimate of their potential bill for medical services (when scheduled at least three days in advance). 

What is “balance billing” (sometimes called “surprise billing”)?

When you get emergency care by an out-of-network provider or facility or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. 

Out of Network

“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit. 

Surprise Billing

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

Protections

You’re protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services. 

Certain services at an in-network hospital or ambulatory surgical center 

When you get services from an in-network hospital or ambulatory surgical center, certain providers may still be out-of-network. In these cases, the most that these providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist or intensivist services. These providers cannot “balance bill” you and may not ask you to give up your protections to not be “balance billed”. If you get other services at these in-network facilities, out-of-network providers cannot “balance bill” you, unless you give written consent and give up your protections. 

You are never required to give up your protections from balance billing. You also are not required to get out-of-network care. You can choose a provider or facility in your plan’s network. 

Maryland-specific balance billing protections

If you are in a Health Maintenance Organization (HMO) governed by Maryland law, you may not be “balance billed” for services covered by your plan, including ground ambulance service. If you are in a PPO or EPO governed by Maryland law, hospital-based or on-call physicians paid directly by your PPO or EPO (assignment of benefits) may not balance bill you for services covered under your plan and can’t ask you to waive your balance billing protections.

If you use ground ambulance services operated by a local government provider who accepts an assignment of benefits from a plan governed by Maryland law, the provider may not “balance bill” you.

You also have these protections:

You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly. 

Generally, your health plan must: 

• Cover emergency services without requiring you to get approval for services in advance (prior authorization). 

• Cover emergency services by out-of-network providers. 

• Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits. 

• Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit. 

Good Faith Estimates

Uninsured and self-pay patients have a right to receive a good faith estimate ahead of scheduled nonemergency health care services. A good faith estimate shows the cost of items and services that are reasonably expected for the scheduled service. The estimate is based on information known at the time the estimate was created and can include costs related to your visit such as medical tests, imaging studies, medications, and hospital fees.

If you think you have been wrongly billed, you may contact the Health Education and Advocacy Unit (HEAU) of Maryland’s Consumer Protection Division:

Health Education and Advocacy Unit

 Office of the Attorney General

 200 St Paul Place, 16th Floor

 Baltimore, Maryland 21202

 Phone: 410-528-1840 or toll-free 1-877-261-8807 

 En español: 410-230-1712

 Fax: 410-576-6571

 Email: heau@oag.state.md.us

 Website: https://www.marylandattorneygeneral.gov/Pages/CPD/HEAU   

If you think your health plan processed your claim incorrectly, you may contact the Maryland Insurance Administration:

Maryland Insurance Administration

 Life and Health Complaints Unit

 200 St Paul Place, Suite 2700

 Baltimore, Maryland 21202

 Phone: 410-468-2000 or toll free 1-800-492-6116 

 Fax: 410-468-2260

 Website: http://www.insurance.maryland.gov 

Visit https://www.cms.gov/nosurprises for more information about your rights under federal law. 

Visit www.marylandattorneygeneral.gov or www.insurance.maryland.gov for more information about your rights under Maryland law.