Privacy & Insurance

Privacy Policy

Privacy Policy (HIPAA)

The Health Insurance Portability and Accounting Act of 1996 (HIPAA) was passed by the U.S. Congress to address several issues related to health insurance. One of the concerns was assuring privacy and control of patient health information by medical professionals. Please read this policy. You will be asked to sign this HIPAA Privacy Statement at your first office visit as part of our policy to comply with HIPAA requirements.CAPITAL INTERNAL MEDICINE ASSOCIATES, P.C.

Effective Date: April 14, 2003

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 rights to access and control your protected health information along with our legal duties to these rights. 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 provider, and that relates to your past, present or future physical or mental health or condition.


The practice may used 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. For example:


We will disclose your protected health information when we are required to do so by any Federal, State or local law.


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.


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.


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.


We may disclose your protected health information to your family member or close friend if it is directly relevant to involvement in your care or payment related to your care. You may object from these disclosures, however in the exercise of our professional judgment, if we feel that it is in the best interest of your care, we may disclose your protected health information.

Other than as stated above, we will not disclose your health information other than with 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:


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 uses 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 preceding; 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.


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 healthcare 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 provide a copy of the revised Notice either by mail or in-person contact.


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.


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: Amit Ghose M.D.
Telephone: (517) 374-7600 | Fax: (517) 374-1142
Address: 3955 Patient Care Dr., Suite A, Lansing, MI 48911
Capital Internal Medicine Associates, P.C.

Insurance, Policy & 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.


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.