ORCHARD HOLISTIC MEDICINE
Fees
Office Visits: Fees for appointments are determined by many factors including time spent, procedures performed and complexity of your health care needs. We can give an estimate for each visit upon patient request. Late patients may be charged for the full price of the appointment.
Insurance: We are in-network with many insurance companies. If you are seeing us as an out of network provider we will bill your insurance company for possible reimbursement upon request.
Laboratory Testing: All laboratory tests will be billed to the patients’ insurance company by the laboratory or billed to the patient if you do not carry insurance. Any remainder balance not covered by the insurance company is the sole responsibility of the patient.
E-Mails: Fees may apply. The doctor is available by e-mail for simple clarification or updates on health status. E-mail is not to be used for sole case management. The doctor will not have your case information in front of them while replying to your e-mail so be sure to include all pertinent information in your e-mail correspondence. If your questions or health needs exceed a simple e-mail reply, we will ask you to make an appointment for an in office visit to address your health care needs. Multiple e-mails sent per day requiring multiple responses will be subject to a fee that will not be billable through insurance. Please allow 24-48 hours (during business hours/days only) to receive your e-mail reply.
Phone Consultations: Variable: $40.00 minimum charge. Phone consultations are provided for established clients only under special circumstances determined by the physician. The minimum fee is charged for any phone consultation up to 15 minutes. Phone consultations that extend beyond 15 minutes will incur a greater charge. This fee is not charged in the following cases: when you require clarification of on-going therapy and when the doctor has asked you to call. If there is any question about this service you are welcome to ask in your call or your email inquiry. The physician will respond to your inquiry within 24 hours; however, due to unexpected medical emergencies a response is sometimes delayed. If the doctor has not responded within 24 hours, please call or email the doctor again.
Copies/Administrative Fees: Copies of patient chart notes or any request that incurs an expense to the clinic will be charged to the client. Fees will be variable depending on the extent of the request.
Appointment Cancellations: Any no-show appointments or appointments canceled without 24 hours notice will be billed $50.00. These fees will be the patient’s responsibility (not billable to insurance). Patients who are very late may not be seen and will be billed for a late cancellation fee.
Payment
Payment is due at the time of service for office visits and pharmacy products that are not covered by insurance. We accept checks, cash, credit card (Visa, Mastercard and Discover) and money orders. Not accepting AMEX at this time. Invoices and receipts are available by request.
Returned Check Fee: There is a $35 fee for each returned check.
Returned Medicine: You may return unopened medicine within thirty days of purchase for a full refund except for the following items: opened items, acidophilus products, suppositories, compounded botanicals and specially ordered or assembled items, which will be refunded 30%.
Please Note: All fees are subject to change and patients will be kept abreast of these changes. If you have any questions regarding these guidelines please feel free to ask. Prior to your first visit, you will be asked to sign a copy of our policies to acknowledge agreement with the clinic policies above.
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 CAREFULLY.
The Health Insurance Portability and 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. 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 you health information and how we may disclose your health information.
We may use and disclose your medical records only for each of the following purposes: treatment, payment and health care operations.
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 collection activities, and utilization review. An example of this would be sending a bill for your visit to an 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 also create and distribute de-identified health information by removing all references to individually identifiable information.
We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
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 reasonable requests on certain uses and disclosures of protected health information, including those related to disclosures 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 receive an accounting of disclosure of protected health information.
The right to obtain a paper copy of this notice from us upon request.
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.
This notice is effective as of June 10, 2002, 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 a formal, written complaint with our office or with the Department of Health and Human Services, Office of Civil Rights, about violations of the provisions of this notice or the policies or procedures of our office. We will not retaliate against you for filing a complaint.
Please contact us for more information, by asking to speak to our Privacy Officer or for written inquiries, note ” attention Privacy Officer.”
For more information about HIPAA or to file a complaint:The U.S. Dept of Health and Human Services Office of Civil Rights
200 Independence Ave. S.W.
Washington D.C. 20201
(202) 619-0257
Toll Free: 1-877-696-6775
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