banner
Privacy Policy

Privacy & Financial Policies
Revised 2007

PRIVACY POLICY 
FINANCIAL POLICY & INSURANCE INFORMATION

 

PRIVACY POLICY NOTICE

This Notice Describes How Medical Information About You May Be Used And Disclosed And How You Can Get Access To This Information. Please Review This Notice Carefully.

INTRODUCTION
At Roanoke Neurological Associates we are committed to treating and using your protected health information responsibly. This Notice of Privacy Policies describes the protected health information we collect, and how and when we use and disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective April 23, 2003, and applied to all protected health information that we create or obtain in providing services to you. We protect the privacy of that information in accordance with the Health Insurance Portability and Accountability Act of 1996 ("HIPPA”) and applicable privacy laws.

UNDERSTANDING YOUR PROTECTED HEALTH INFORMATION
Each time you visit Roanoke Neurological Associates, a record of your visit is made. Typically, this record contains your symptoms, examination, and test results, diagnosis, treatment, and a plan for future care or treatment. This record also contains charges and billing documents for the services you receive. This record serves as a:

  • Basis for planning your care and treatment,
  • Means of communication among the many health professionals who contribute to your care,
  • Legal documentation describing the care you received.
  • Means by which you or a third-party payer can verify that services billed were actually provided,
  • Tool in educating health professionals,
  • Source of information for public health officials charged with improving the health of this state and the nation,
  • Source of data for medical research,
  • Source of data for our planning and marketing,
  • Tool with which we can access and continually work to improve the care we render and the outcomes we achieve.

Understanding what is in your record and how your protected health information is used helps you to: ensure its accuracy, better understand who, what, when, where and why others may access your protected health information, and make more informed decisions when authorizing disclosure to others.

YOUR RIGHTS WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION. Although your health record is the physical property of Roanoke Neurological Associates, the protected health information in your record belongs to you. 
You have the right to:

  • Obtain a paper copy of this Notice upon request,
  • Inspect and copy your protected health information as provided by 45 CFR 164.526,
  • Amend your protected health information as provided by 45 CFR 164.526,
  • Obtain an accounting of disclosures of your protected health information as provided by 45 CFR 164.528,
  • Request that communications of your protected health information be made by alternative means or at alternative location as provided by 45 CFR 164.522-we will accommodate all reasonable requests and will notify you if you deny your request,
  • Request restrictions on certain users and disclosures of your protected health information as provided by 45 CFR-164.522-we are not required to agree to a requested restriction, and
  • Revoke your authorization to use or disclose protective health information at any time as described below except to the extent that action has already been taken pursuant to your authorization.

To exercise any oh these rights, submit your request in writing with the required information to the following person: Privacy Officer; 4431 Starkey Road SW; Roanoke VA 240148-0612; (540)342-0211. The Privacy Officer will provide you with assistance on the steps to take to exercise your rights.

OUR RESPONSIBILITIES, Roanoke Neurological Associates is required to:

  • Maintain the privacy of your protected health information as required by law,
  • Provide you with this Notice about our legal duties and privacy practices with respect to protected health information we collect and maintain about you,
  • Abide by the terms of this Notice.

We will post this Notice in our office and, to the extent that we maintain a comprehensive website, on such website. We reserve the right to change or eliminate provisions in our Notice of Privacy Policies and to make the new provisions effective for all protected health information that we maintain and any protected health information that we receive in the future. Should our privacy policies change, we will revise this Notice and post the updated Notice in our office and, as applicable, on our website. You are entitled to receive as revised copy of the Notice by calling and requesting a copy of the Notice or by visiting our office and requesting a copy.

We will not use or disclose your protected health information without your authorization, except as described in this Notice. We will also discontinue use or disclosure of your protected health information after we receive a written revocation of the authorization according to the procedures included in the authorization.

FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions or would like additional information about of privacy policies, you may contact the Privacy Officer at (540)342-0211 or in writing at: 4431 Starkey Road SW; Roanoke VA 24018-0612.

If you believe that your privacy rights have been violated, you can file a complaint with Privacy Officer in writing at: 4431 Starkey Road SW; Roanoke VA 24018-0612. You may also file a complaint to the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing within 180 days of the time when you became aware or should have become aware of the issue giving rise to your complaint. We will not require you to waive the right to file a complaint with the Privacy Officer or the Secretary of the Department of Health and Human Services as a condition of receiving treatment from our office. We will not retaliate against you for filing a complaint with either the Privacy Officer or Secretary of the Department of Health and Human Services. The address for the Secretary of the Department of Health and Human Services is:
Region IV, Office of Civil Rights
U.S. Department of Health and Human Services
61 Forsyth Street, S.W., Suite 3870 
Atlanta, GA 30323-8909 
Telephone: (404) 562-7886
Fax: (404)562-7881
TDD: (404) 331-2867
Email: OCRComplaint@hhs.gov

HOW WE MAY USE AND DISCLOSE YOUR PROTECTIVE HEALTH INFORMATION.   The rest of this Notice describes the ways we may use and disclose your protected health information. Generally, we will only use and disclose your protected health information as authorized by you or as required by law. Although not every specific use or disclosure is listed, the reasons for which we are permitted or required by law to use or disclose your protected health information generally will fall under one of the categories described below. HIPPA generally does not take precedence over State or other applicable privacy laws that provide individuals with greater privacy protections. As a result, when a State law requires us to impose stricter standards to protect your protected health information, we will follow State law instead of HIPPA.

TREATMENT:  We may use or disclose your protected health information to provide health care treatment to you. For example, information from a nurse, physician, or other member of your medical health team will be record in you record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health care team. Members of your health care team will then record the actions they took and their observations. In that way, they physician will know how you are responding to treatment.

We will also provide your physician or subsequent health care provider with copies of various reports that should assist him/her in treating you.

Payment: We may use and disclose your protected health information to obtain payment for services. For example, a bill may be sent to you or your insurance company. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

Health Care Operations: We may use and disclose your protected health information in performing business activities or "health care operations”. For example, members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use your protected health information to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and services we provide.

Business Associates: We may arrange for other individuals and entities, referred to as "Business Associates”, to perform various functions and activities on our behalf and to provide certain services. Examples include physician services in the Emergency Department and Radiology, and certain lab tests. When these services are contracted, we may disclose your protected health information to our Business Associates so that they can perform the job we’ve asked them to do and bill you or your insurance for services rendered. To protect your protected health information, however, we require our business associates to appropriately safeguard your information.

Notification: We may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative, or another person responsible for your care, of your location, your general condition or your death as long as you have agreed to the use or disclosure or have not objected after being given the opportunity. If you are not present or are unable to agree (for example, due to your incapacity or an emergency), then we may use our professional judgment to determine whether the use or disclose is in your best interest.

Communication with family: We may disclose to a family member, other relative, close personal friend or any other person you identify, protected health information relevant to that person’s involvement in your care if you have either agreed to the disclosure or have not objected after being given the opportunity. If you are not present or are unable to agree (for example, due to incapacity or emergency), then we may use our professional judgment to determine whether the use or disclosure is in your best interest.

Research: We may disclose your protected health information to researchers when their research has been approved by an institutional review board (or other applicable privacy board) that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

Funeral Directors: We may disclose your protected health information to funeral directors consistent with applicable law and as necessary to carry out their duties.

Organ Procurement organizations: Consistent with applicable law, we may disclose your protected health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of facilitating organ or tissue donation or transplant.

Appointment Reminders and Treatment Alternatives:  We may contact you to provide you with appointment reminders, information about treatment alternatives, or information about other health related benefits and services that may be of interest to you.

Food and Drug Administration (FDA): We may disclose your protected health information to a representative of the FDA to report adverse effects (with respect to food or dietary supplements) or product defects or problems (including problems with the use or labeling of a product), to conduct post marketing surveillance and to enable product recalls, repairs, or replacement.

Workers’ Compensation: We may disclose your protected health information to the extent necessary to comply with the laws relating to workers’ compensation or other similar programs established by law.

Public Health: We may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Law Enforcement: We may disclose your protected health information for law enforcement purposes in certain circumstances, for example, in response to a valid subpoena or other legal process or to help a law enforcement officer identify or locate certain individuals.

Abuse, Neglect or Domestic Violence: We may disclose your protected health information to appropriate governmental authorities as allowed by law if we believe that you may be a victim of abuse, neglect or domestic violence.

Health Oversight Activities: We may disclose your protected health information so that government agencies can monitor and oversee the healthcare system and government benefit programs and be sure that certain healthcare entities are following regulatory programs or civil rights laws they should.

Judicial or Administrative Proceedings: We may disclose your protected health information as required for judicial and administrative proceedings. For example, if you are involved in a lawsuit or dispute, we may disclose your protected health information in response to a court or administrative order. We may also your protected health information in response to a subpoena, discovery request, or other lawful process from someone else involved in the dispute, but only if efforts are made to tell you about the request or to obtain an order protecting the information requested.

Coroners and Medical Examiners: We may disclose your protected health information to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death or for performing other duties as authorized by law.

To Avert a Serious Threat to Health or Safety: We may use or disclose your protected health information in accordance with applicable law, if we believe the use or disclosure is necessary to prevent or lessen a serious and immediate threat to the health or safety of a person or the public.

Specialized Government Functions: If you are or were a member of the armed forces, we may disclose your protected health information as required by military command authorities. We may also disclose protected health information about foreign military personnel to the appropriate foreign military authority. In addition, we may disclose your protected health information to authorized federal officials for national security and intelligence activities.

Correctional Institutions: If you are an inmate of a correctional institution or in the custody of a law enforcement official, we may release your protected health information to the correctional institution or law enforcement officer if the disclosure is necessary to provide you with health care, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.

Disaster Relief: We may use or disclose you protected health information in order to assist in disaster relief efforts if you have either agreed to the disclosure or have not objected after being given the opportunity. If you are not present or unable to agree (for example, due to incapacity or emergency) then we may use our professional judgment to determine whether the disclosures are in your best interest.

U.S. Department of Health and Human Services: We are required to disclose your protected health information to the Department of Health and Human Services when it is investigating or determining our compliance with HIPPA.

Required by Law: We may use or disclose your protected health information to the extent that such use or disclosure is required by law, and that the use or disclosure is limited to the relevant requirements of such law.

Exception to these Permitted Uses and Disclosures-Communicable Diseases: If you have one of the several specific communicable diseases (for example tuberculosis, syphilis or HIV/AIDS), law requires that information about your disease be treated as confidential, and such information will be disclosed without you written permission only in limited circumstances. We may not need to obtain your permission to report information about your communicable disease to State and local officials, or to otherwise use or disclose information in order to protect against the spread of the disease. Also, we may disclose such information without your consent to health care personnel who provide medical care to you.

Special Provisions for Minors under Virginia Law: Under Virginia law, minors, with or without the consent of a parent or guardian, have the right to consent to services for the prevention, diagnosis and treatment of certain illnesses, including venereal disease and other diseases that must be reported to the State, pregnancy, abuse of controlled substances or alcohol, and emotional disturbance. If you are a minor and you consent to one of these services, you have all the authority and rights included in this Notice relating to that service. In addition, the law permits certain minors to be treated as adults for all purposes. These minors have all the rights and authority included in this Notice for all services.

 

Financial Policy and Insurance Information

Our practice Insurance policies are listed below. Any Specific question may be directed to the Insurance Department. We file your insurance as a courtesy to you, but you are ultimately responsible for all charges. Accounts with a past due balance greater than 60 days from the date of service may be turned over to collections, and a collection fee may be applied.

Participating Insurances:                            

  • Medicare                                                          MAMSI*
  • Medicare replacement plans                              John Deere
  • Anthem BCBS                                                 Southern Health
  • Anthem Healthkeepers*                                    Tricare
  • Cigna                                                               VHN
  • Aetna                                                               Medicaid*
  • United Healthcare                                             Virginia Premier

Patients with Participating Insurances:
We will file a claim for you. If your insurance requires a pre-authorization or referral, it is your responsibility to acquire one. If your insurance plan requires a co-payment, please come prepared to pay. If you have a secondary insurance we will make one attempt to file the claim. If they do not respond within 30 days, balance will be transferred to your responsibility. Any bills remaining after insurance must be paid in full within 30 days from your first statement date. Return appointments will not be possible if balance is outstanding, or payment arrangements have not been made. We will make every attempt to work with you, but we do expect timely payment.

  • Anthem Healthkeepers: This insurance always requires a referral or authorization from your primary care physician. It is your responsibility to acquire one. Please contact our office prior to your appointment to confirm we have your referral on file for date of service, or you will be responsible for all payment.
  • Medicaid: We accept Medicaid/Virginia Premier/ Medallion upon referral from your primary care physician. A valid insurance id card must be presented for everyvisit to this office. Any patient without a valid card and referral will have to reschedule their appointment. If you have a co-pay be prepared to pay, as you will not be seen until paid.
  • MAMSI HMO Plans (MD IPA, Optimum Choice): Any of the HMO policies require referrals. It is your responsibility to acquire one. Please contact our office prior to appointment to make sure your referral is on file for your date of service.

Workers Compensation:
Workers Compensation requires that your visit is pre-authorized. It is your responsibility to make sure that it has been. If Workers Comp denied your claim, you will be responsible for all charges. Return appoints will not be possible if there is an outstanding balance on your account or payment arrangements have not been made.
Some of the information our office requires are as follows:

  • Insurance Authorization for patient to be seen on Referring Physician letterhead.
  • Workers Compensation Claim Number
  • Date of Injury
  • Reason for visit
  • Billing Address for Workers Compensation
  • Claims Adjuster Name and Contact Number

Patients with Out of Network Insurances:
A $50 payment is necessary, and must be paid before you can be seen. We will file a claim to your insurance, but if the insurance required a pre-authorization or referral, it is your responsibility to acquire one. Any bills remaining after insurance must be paid in full within thirty days from the first statement. Return appointments will not be possible if your previous bill has not been paid, or payment arrangements have not been made. A minimum of $25 will be necessary for return visits. We will make every attempt to work with you, but we do expect timely payment.
**If you are scheduled for a procedure please contact our insurance department as a payment plan must be set-up.

**Roanoke Neurological Associates, Inc. reserves the right to not accept any insurance that we do not participate with. If your insurance is not listed as participating we strongly urge you to contact our office in advance of your appointment.

Self-pay Patients or Patients with Insurances that we do not file:

Patients with No Insurance or Insurance that we do not Accept:
A deposit of $150.00 must be paid no less than 2 days prior to the appointment. If the deposit is not received, The Appointment Will Be Cancelled. Please contact the bookkeeper prior to your appointment to make this payment. Return appointments are required to be paid in full the day of the appointment.
If you have insurance that we do not accept we will provide you with an insurance form, which you may use to file your claim to your insurance company.
Insurances we do not accept:

  • West Virginia Medicaid
  • West Virginia Workers Compensation
  • US Department of Labor Worker’s Compensation
  • Healthcare Discount Networks

Procedure Payment Policies for patients who are self-pay or have an insurance that we do not accept:
If you have been scheduled for a procedure, prior payment arrangements must be made! Please contact our office immediately. If prior payment arrangements are not made, your procedure will be CANCELLED. We will make every attempt to work with you, but we do expect timely payment.