This notice describes how your medical information may be used and disclosed, and how you can access that data. Please read it carefully and consider all its content before making your decisions based on it.
At our office, we are dedicated to upholding the confidentiality and security of your protected health information (PHI). This includes any data identifying you that pertains to past, present or future physical or mental health conditions; treatments received; or payments related to those treatments.
Your Medical records may contain important medical information. Gain Access to Them Now
Your right to inspect or obtain copies of your medical record and other health information held about you is unquestionable, with requests made via electronic or paper formats being accepted and delivered within 30 days at most (and subject to reasonable costs-based fees).
If you believe that your health information is incorrect or incomplete, you can file a written request for corrections to it. Your request may be granted; in other cases it may not. In such instances, written explanation will be provided within 60 days.
Requests that we reach out to you in specific ways or send communications to specific addresses will be considered on a case-by-case basis and accommodated as appropriate.
Your information may be used and shared for treatment, payment and healthcare operations purposes. Not all requests can be granted but consideration will be given in each instance. If services were paid out-of-pocket in full you may request that their related data not be shared with any health plan unless legally mandated.
You are entitled to request a list of disclosures made of your health information within the last six years that do not relate directly to treatment, payment and healthcare operations or certain other permitted uses; one request per year will be provided free of charge; however additional requests may incur fees.
At any time, even after agreeing to receive it electronically, you may request a printed version of this notice.
If you assign someone medical power of attorney or assign legal guardianship rights over you, that individual can exercise those rights and make decisions regarding your health information, provided appropriate documentation has been presented.
If you believe your privacy rights have been infringed upon, you can file a formal complaint with our organization or with the U.S. Department of Health and Human Services Office for Civil Rights. Filing will not impact the quality of care or result in retaliation from anyone involved.
For certain types of health information, you have the power to direct us on how it should be shared. You may direct us:
If you are unable to communicate your preferences, information may be shared if it is determined to be in your best interest or necessary to prevent serious harm
The following uses and disclosures require your written authorization:
You may revoke your authorization at any time in writing.
Your health information can often be utilized or shared in one or more of these ways:
Treatment
Information may be shared with healthcare providers involved in your care to ensure appropriate treatments.
Payment
Your information can be used to bill and collect payment from health plans or other entities.
Healthcare Operations
Information can be used to manage healthcare services, enhance care quality, and administrative activities more efficiently.
In accordance with applicable laws, your information may also be used or shared for:
We are required by law to maintain the privacy of your information and to notify you in the event of a breach that may compromise its security.
We reserve the right to periodically modify and amend these terms of this Notice, with any updates taking immediate effect and being made available upon request and posted on our website.
Emergency care or treatment provided from an out-of-network provider at an in-network facility typically does not result in balance billing charges.
Balance billing occurs when providers charge you the difference between what your health plan covers and their full charges for services provided outside their network. This typically applies to out-of-network providers.
If you require emergency services, any charges over and above your in-network cost-sharing amount (i.e. co-payments, coinsurance premiums or deductibles) cannot exceed what has been established through cost sharing arrangements or without your written permission to waive it. This protection remains in place unless written waiver consent is granted in advance.
When receiving treatment at an in-network hospital or ambulatory surgical center, certain providers (anesthesiologists, radiologists or pathologists) may fall outside of your cost-sharing agreement and cannot exceed its limits for billing. In these instances, their balance billing cannot exceed in-network cost-sharing amounts.
You are not required to receive out-of-network care
You are not required to waive balance billing protections
Your health plan must cover emergency services without prior authorization
Payments made toward these services count toward your in-network deductible and out-of-pocket limits
We are required to:
Without your written approval, we will never use or disclose your data in ways not described here.
