Rosenberg Urgent Care NOTICE OF PRIVACY PRACTICES AND FINANCIAL RESPONSIBILITY POLICY
Effective Date: January 1, 2024
Rosenberg Urgent Care is committed to protecting the privacy of your health information and ensuring clear communication about your financial responsibilities for services rendered. This combined Notice of Privacy Practices and Financial Responsibility Policy outlines how we protect your Protected Health Information (PHI) and explains your obligations for payment. Please review this information carefully, and feel free to contact our Compliance Officer with any questions.
I. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION (PHI)
A. Permitted Uses and Disclosures
Treatment: Your PHI may be used and disclosed to coordinate and manage your medical treatment among healthcare providers.
Payment: We use your PHI to bill and obtain payment for healthcare services. For example, we may share necessary details with your health plan to confirm coverage.
Healthcare Operations: PHI may support business activities like quality assessments, investigations, and training. Examples include using a sign-in sheet, calling you by name, and contacting you with appointment reminders or test results.
Required or Permitted by Law: We may disclose PHI for legal requirements, including public health reporting, legal proceedings, or other lawful uses.
B. Uses and Disclosures Requiring Opportunity to Object
Family and Others Involved in Your Care: If you agree or do not object, PHI may be shared with those involved in your care. We may also use professional judgment to disclose information in emergencies.
Disaster Relief Efforts: PHI may be disclosed to authorized entities during a disaster to coordinate notifications.
C. Other Uses and Disclosures
Marketing or sale of PHI to third parties requires your written authorization, which can be withdrawn at any time in writing.
II. FINANCIAL RESPONSIBILITY
- Claims Submission and Payment Timelines
Rosenberg Urgent Care will submit claims to your insurance company for services. It can take up to 30 days to receive an Explanation of Benefits (EOB) and payment. If payment is delayed, we will follow up for up to 90 days from the date of service. Additional delays of up to 45 days may occur if reprocessing is necessary. Review your EOB promptly and notify our office of any discrepancies.
- Insurance Verification and Patient Responsibility
We verify insurance benefits and submit claims electronically; however, it is your responsibility to provide accurate insurance details at each visit. Any balance unpaid by your insurance within 90 days will become your financial responsibility. Delayed payments may be subject to collection if not addressed promptly.
- No-Show and Cancellation Policy
Appointments must be canceled or rescheduled at least 24 hours in advance. If you fail to provide this notice, a $25 no-show fee will apply. This fee is not covered by insurance and must be paid before rescheduling. Contact us if an emergency prevented you from attending, and we may waive this fee at our discretion.
- Payment Arrangements
If unable to pay your balance by the due date, contact us to discuss payment plans. All arrangements must be set up before the balance becomes past due to prevent service interruptions. Unpaid accounts may be referred to a collection agency, and any associated fees will be your responsibility.
III. YOUR INDIVIDUAL RIGHTS
You have several rights regarding your health information, including the right to request alternative communications, restrict certain uses, and request amendments if you believe your records are inaccurate. Contact our Compliance Officer to learn more about your privacy rights or obtain a copy of this notice.
IV. EFFECTIVE DATE AND CHANGES TO THIS NOTICE
Effective Date: January 1, 2024
Changes to This Notice: This policy may be updated. The latest version will be available at our office and on our website.
Acknowledgment of Receipt
I have reviewed Rosenberg Urgent Care’s Notice of Privacy Practices and Financial Responsibility Policy and understand I may request a copy at any time.