CAPITAL INTERNAL MEDICINE ASSOCIATES, P.C.
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.
Effective Date: April 2, 2003
Last Revised: April 17, 2019
This Notice of Privacy Practices is being provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It describes your right to access and control your protected health information along with our legal duty to protect this information. Your “protected health information” means any of your written and oral health information, including demographic data that can be used to identify you. This is health information that is created or received by your health care providers, and that relates to your past, present or future physical or mental health or condition.
USES AND DISCLOSURES OF HEALTH INFORMATION
The practice may use your protected health information for purposes of providing treatment, obtaining payment, and conducting healthcare operations without prior authorization from you. Disclosures of your protected health information for purposes described in this Notice may be made in writing, orally, or by facsimile.
We may use your health information to provide you with medical care in our offices, your home, or any other facility in which you receive medical care. We may provide your information to others who participate in your medical care, such as hospitals, other physicians, nursing homes, physicians and other healthcare providers, pharmacies, laboratories, emergency services, therapists and other involved providers or organizations.
We may use and disclose your protected health information, as needed, to receive payment for services we provide to you or to assist others who care for you to get paid for that care. For example, we may share your health information with a billing company or with your insurance plan to obtain prior approval for tests, procedures or specialists and/or to seek plan coverage for your care.
We may use and disclose your protected health information, as necessary, for our healthcare business operations. This includes quality assessment and improvement activities to identify where we can improve our care and services. This may also include employee review activities, training programs in which students, trainees, or practitioners in health care learn under supervision, or accreditation, certification, licensing or credentialing activities. We may disclose your information to get legal, auditing, accounting, medical transcription and other services necessary for business management and planning purposes as long as those who perform these services agree to protect the privacy of that information.
OTHER USES AND DISCLOSURES
We may use or disclose your protected health information for the following:
To remind you of an appointment by mail via postcard, phone messages, e-mail, voicemail messages), to inform you of health-related benefits or services that may be of interest to you, sign-in sheets, computerized appointments, encounter forms, or newsletters.
REQUIRED BY LAW
We will disclose your protected health information when we are required to do so by any Federal, State or local law, in the circumstances further described below:
RISKS TO PUBLIC HEALTH
We may disclose your protected health information for the following purposes:
- to prevent, control or report disease, injury or disability as permitted by law
- to conduct public health surveillance, investigations and interventions as permitted or required by law
- to collect or report adverse events and product defects such as product recalls
- to notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease as authorized by law
- to report to an employer information about an individual who is a member of the workforce as legally permitted or required.
ABUSE OR NEGLECT
We may notify government authorities if we believe that a patient is the victim of abuse or neglect only when specifically required or authorized by law or when the patient agrees to the disclosure.
SPECIFIED GOVERNMENT FUNCTIONS
In certain circumstances, the Federal regulations authorize us to use or disclose your protected health information to specified government functions relating to military and veterans, national security and intelligence activities, protective services for the President and others, medical suitability determinations, correctional institutions, and law enforcement custodial situations.
YOUR FAMILY AND FRIENDS
We may disclose information to family members and others involved in the patient’s healthcare or payment for their care under certain circumstances. If you are present and able to make decisions, we must either obtain your permission or be able to reasonably infer from the circumstances that you do not object to the disclosure. If you are not present or are not able to consent, we may disclose the information so long as your provider believes it is in your best interest to make the disclosure; you have not otherwise objected to such disclosures; and your provider limits the information disclosed to that which is relevant to the family member or other person’s involvement in your care.
Other than as stated above, we will not disclose your health information without your written authorization. You may revoke your authorization at any time; however, it will not affect any use of disclosure permitted by your authorization while it was in effect.
You have the following rights regarding your health information:
TO INSPECT AND COPY
You may inspect and obtain a copy of your protected health information that is contained in a designated record set for as long as we maintain it. This contains medical and billing records and any other records that your physician and the practice use for making decisions about you. You must submit a written request to the Privacy Officer noted on the last page of this Notice. There may be a fee involved for the costs of copying, mailing or other costs incurred by the practice. Inspection and copying of your medical information will only take place during normal business hours.
Under Federal law, you may NOT inspect or copy the following: psychotherapy notes; any information related to a civil, criminal or administrative action or proceeding; and protected health information that is subject to a law that prohibits access to protected health information. You may have the right to have a decision to deny access reviewed.
We may deny your request if, in our professional judgment, we determine that the access requested is likely to endanger your life or safety or that of another person, or that is likely to cause substantial harm to another person referenced within the information. You have the right to request a review of this decision.
TO REQUEST RESTRICTIONS
You have the right to request restrictions be placed on your protected health information as to what can be used and disclosed and restrictions as to who we may or may not disclose to. We are not required to agree to these disclosures, but if we do, we will abide by our agreement, except in an emergency situation. Under certain situations, we may terminate our agreement to a restriction.
You may request that we communicate with you by alternative means or alternative locations. You must request this in writing to the Privacy Officer. If requesting an alternative location, you must provide explanation of how payments will be handled under the alternative location you requested.
You may request to have your protected health information in a designated set amended. We may deny your request. If we deny your request for amendment, you have the right to file a statement of disagreement with us and prepare a rebuttal. You must make these requests in writing, providing a reason to support the request, and address your request to the Privacy Officer.
You have the right to request a list of instances in which we disclosed your protected health information to another party. This applies to disclosures made for purposes other than for treatment, payment or health care operations as described in this Notice. We are not required to account for disclosures you requested or authorized by signing a form. Requests must be made to the Privacy Officer in writing and should specify the time period for the accounting. We are not required to provide an accounting for disclosures that take place prior to April 14, 2003. Accounting periods must not exceed six years. We will provide the first accounting during any 12-month period without charge. Subsequent requests may be subject to a reasonable fee.
The practice is required by law to maintain the privacy of your health information and to provide you with this Notice of our duties and privacy practices. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all protective health information that we maintain. If the practice changes its Notice, we will post the new Notice in prominent locations in our facilities and on our website, at https://www.cimamed.com/.
QUESTIONS AND COMPLAINTS
You have the right to express complaints to the practice and to the Secretary of Health and Human Services if you believe your rights have been violated. You may make complaints to the practice by contacting the Privacy Officer verbally or in writing or to the Secretary of Health and Human Services in writing. We will provide you with this address upon request. We encourage you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
CONTACT PERSON/PRIVACY OFFICER
The practice’s contact person for all issues regarding patient privacy and your rights under the Federal privacy standard is the Privacy Officer.
Privacy Officer: CIMA Medical Records Supervisor
Telephone: (517) 374-7600 ext. 155 Fax: (517) 374-1142
Address: 3955 Patient Care Dr., Suite A, Lansing, MI 48911
INSURANCE, POLICY, AND PROCEDURES
Please be advised that patients are ultimately responsible for the payment of their bills. As a service to our patients we are pleased to submit insurance claims. Our physicians participate in a large number of insurance plans. Call your insurance company if you have questions regarding our participation with your plan. It is your responsibility to advise us of any requirements of your policy for prior authorization, pre-certification or a second opinion. When a plan requires you to be referred by your primary physician, it is your responsibility to bring this written referral or authorization with you on your visit to our office.(There are thousands of different insurance plans in the tri-county area and to ensure we participate, the safest thing would be to check with your insurance company.)
You will receive preregistration forms in advance of your appointment. The information you provide is confidential and is maintained and utilized in accordance with HIPAA requirements. Please review the following checklist and bring the items that apply to you:
- registration forms sent by our office
- Insurance cards
- Driver’s license
- Relevant information from your referring physician, if applicable
- Written referral voucher from your primary physician, should your insurance require it
- A family member or friend that you wish to be informed about your condition
When you arrive, a receptionist will complete your registration at the front desk. We require a 24 hour notice of any cancellation and we will be happy to reschedule your visit.
When you call and request to speak with a physician or nurse, we will do our best to return your call the same day. However, as a policy, we do not interrupt regular office patient care with non-emergency phone calls. Our staff will return emergency calls immediately and other calls as soon as possible.
If you have an emergency after hours, please call 517-374-7600 and select the option for our on-call physician. At your discretion, you may elect to call 911 and request to be taken to the McLaren Greater Lansing Emergency Room.
When you require renewal of a prescription, please call us at least 48 hours in advance of your requirement. Please have the pharmacy phone number available when you call.
FEES, BILLING, AND INSURANCE
We are aware that healthcare costs are a sensitive issue to our patients. Please do not hesitate to contact us and discuss any concerns you may have about our billing policies.
You will find that our office fees are competitive with those charged by other internal medicine practices throughout the Tri-County area.
Our office will submit your insurance claim. If you have co-pays and/or deductibles, please pay at the time of your office visit. If you have no insurance, payment will be expected at the time of your office visit.
Our billing staff is available to discuss charges and establish payment plans on an individual basis. Patients who disregard bills or make no effort to discuss their circumstances may be subject to having their overdue bills sent to a collection agency. To avoid such problems, we urge you to work with the billing staff to establish payment plans that are compatible with your circumstance. Our billing staff can be reached at extension (517) 372-3985.