HIPAA NOTICE OF PRIVACY PRACTICES

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. Under the health Insurance Portability and Accountability Act (HIPAA) of July 1, 1997, it is our legal duty to safeguard your protected health information (PHI). If a person has been insured for the past 12 months, a new insurance company cannot refuse to cover the person and cannot impose pre-existing conditions or a waiting period before providing coverage. Our office respects your right to privacy. Information regarding the reason you sought therapy with us is strictly confidential and is used to communicate with your doctor, case worker, and claims representative for payment from your insurer and the Dept. of Labor & Industrial Relation (for Worker’s Comp. claims) or for pre-authorization. Should any other official party request information about you, we would need to see your signed authorization to release information. All other uses of the protected health information will be made only with your authorization and you have the right to revoke such authorization at any time. If a claim is unpaid due to the unavailability of the requested information, then you will be responsible for payment to us. Evaluation reports, treatment plans, copy of prescriptions for the therapy and progress notes are generally mailed to the insurer (case worker) to carry out treatment and receive payment for services. In settlement cases, your attorney can request copies of your file with a written authorization from you. The other party’s attorney will generally subpoena your records. A subpoena is a legal demand with which we must comply. All therapies are on an appointment basis. If you have questions regarding other alternatives, we can give you general information. Your primary care physician will determine what program for you to follow. Marketing: TCM FIT will not use or disclose your PHI for marketing communication without your written authorization. This office may send birthday cards, thank you cards, notice of clinic events, newsletters, and/or appointment reminders. Disclosure: TCM FIT may use or disclose your PHI without your consent or authorization when required by law. Patient Rights Notice of Privacy Policy:  A patient/client may request restrictions on certain uses and disclosure of the protected information.  You have the right to receive confidential communication of protected health information.  You have the right to inspect and request a copy of protected health information and medical records.  You have the right to amend protected information (there is an appeals process).  You have the right to an accounting of disclosures of protected health information. TCM FIT reserves the right to change our privacy policy in accordance with HIPAA, and would send such notice to your last known address if your case is involved. This is in compliance with HIPAA following April 14, 2003 except in emergency treatment situations. If you have questions about this notice or any complaints about our privacy practice please contact our office.

OUR OFFICE POLICY

1. For most cases, we do not bill insurance directly. Patients are expected to take care of their fees as services are rendered. We do not accept responsibility for collecting your insurance claim or for negotiating a settlement of a disputed claim. However, we will gladly prepare a doctor’s statement of charges for you to submit to your insurance carrier for reimbursement.
2. If you need to cancel an appointment, please inform us at least 24 hours in advance to avoid a full charge of service. A missed appointment will also be charged at full fee.
3. There is a service charge of $35 for every returned check.
4. Herbs are not returnable
5. I authorize the release of any medical records and/or any other necessary information to process a claim with my insurance.
6. TCM FIT is in compliance with HIPPA law and regulations

PATIENT CARE FINANCIAL AGREEMENT

Thank you for choosing TCM FIT for your health care needs. We are committed to your improved health by providing appropriate, high quality, comprehensive family health care. While our intension is to assist you, it is your responsibility to ensure that all services rendered by TCM FIT on your behalf are paid in full. In order to understand our Financial Policies we have listed below our financial requirements.

1. Patient without Insurance Coverage: Payment at the time of services is required. Cash, check, and credit cards are accepted payment methods.
2. Patient with Insurance Coverage: We may be an out-of-network provider with your insurance carrier. You will be expected to pay at the time service is rendered.  If you provide us with your insurance information, every 3 visits we will print out an insurance form that you must sign and submit yourself to your insurance company. Your insurance company will reimburse you directly for any amount that is covered by your plan.  Any insurance checks that might be paid to our office in error will be credited to your account promptly or returned to your insurance company for reissue in your name.
3. Workers’ Compensation Claims: Treatment will be provided with a workers’ compensation claim approval. If your employer or their insurance carrier denies your claim, you will be held financially responsible for all charges incurred for services rendered on your behalf. Any quotes given regarding treatment are cash rates – insurance may be billed differently.
4. Auto Injury Claims: Treatment will be billed to the MedPay portion of your auto insurance policy. If your insurance carrier denies your claim due to exhausted benefits or any other reason, you will be held financially responsible for all charges incurred for services rendered on your behalf. No liens will be accepted. Any quotes given regarding treatment are cash rates – insurance may be billed differently.