Zero Tolerance Policy
We have a zero tolerance policy for discrimination, bullying and/or threatening of any kind towards any employee, independent contractor, or other staff member at any of the NFM Health Inc. clinics (Naturopathic Family Medicine, Natural Healthcare NW, and West Seattle Natural Medicine).
- Bullying: seeking to harm, intimidate, or coerce
- Threatening: having a hostile or deliberately frightening quality or manner.
- Discrimination: the unjust or prejudicial treatment of different categories of people or things, especially on the grounds of race, age, sex, or gender.
This policy is in effect during business hours and outside of business hours. It includes (but is not limited to) in person communications, phone conversations, written communications (text, email, letters, messages), and all other forms of communication.
We understand the burden that healthcare costs can add to a person or family’s financial situation and ask that you speak to us courteously and respectfully to see if there is any way we can help. If you have a question about a bill, please call and talk to us. We are very willing to work with patients to help resolve any concerns or problems.
If you have any other concerns regarding your care or experience working with us please reach out and let us know. We work very hard to help our patients feel comfortable and heard. We ask that you do this in a respectful and courteous manner free from bullying and/or threatening.
CLINIC POLICIES: I understand that this clinic is by appointment only and office hours vary by location and by day. Drop ins cannot be accommodated. I have the right to be informed about my health condition(s) and recommended treatment. This disclosure is to help me to become better informed by discussing potential benefits, risks and hazards involved. Botanical/herbal medicines, prescribing of various therapeutic substances may be given. I understand that the US Food and Drug Administration have not approved nutritional, herbal and homeopathic substances. I understand there is an after hours pager for emergency calls that will be answered by rotating physicians of the clinic and may not be the physician that I am familiar with. After hours calls are subject to a fee.
FINANCIAL RESPONSIBILITY: I understand that payment of all services, copays, balances and outside lab fees, as well as, dispensary items are due on the day of the visit and payable to the clinic that I am being seen at. I agree to be responsible for charges not covered by insurance. I understand that I am responsible for determining my insurance plan’s eligibility and benefits for all charges. I understand that my health insurance coverage may have certain restrictions and limitations, such as authorization requirements, non-covered services, co-insurance, co-pays and deductibles. I understand that I will be charged a fee for a missed appointment with less that 24-hour notice. I understand that if I call/message my physician about a new health concern, I may be asked to schedule an appointment or the call/message may be billed.
Due to insurance and coding laws for billing, I understand that all well-child or well-adult annual exams will be billed as preventative care. If during my visit I have additional concerns or problems I want to discuss, that will require a diagnosis or treatment, it will incur additional charges. You and your physician may want to keep your preventative exam SEPARATE from a problem-oriented exam, due to insurance coverage.
I give my permission to the clinic, along with any billing service, collection agency or attorney who may work on collecting monies on the clinic’s behalf, to contact me on my cell phone, home and/or work phone using pre-recorded messages, artificial voice messages, automatic telephone dialing devices or other computer assisted technology, or by e-mail, text messaging, or by any other form of electronic communication.
INSURANCE: I request that payment of authorized insurance benefits be made to clinic for any services provided to me by the clinic. I give permission to the clinic to release any medical information about me to Medicare or other insurers and its agents for the purpose of deciding benefits and processing claims. I authorize the clinic to act on my behalf as my authorized representative regarding all claims and appeals for the purpose of reimbursement. This may include but is not limited to: requesting prior authorization or appealing denied claims. The clinic may request and receive any and all information that would be provided to me. The clinic may act for me in providing information to the insurance plan that relates to claims or appeals for coverage or benefits under the plan. The insurance plan will direct all information and/or notification regarding my claim or appeal to the clinic unless I otherwise provide specific written directions. A financial advisor is available to help you find the best payment plan.
HIPAA Notice Of Privacy Practices and Protected Health Information (PHI):
The Health Insurance Portability and Accountability Act (HIPAA) requires all health care providers to provide a Notice of Privacy Practices. The notice describes the ways we may use your information, when we may disclose this information to others and your HIPAA rights regarding your health information.
These include the right to:
- Receive Written Notice of Privacy Practices, which details individual rights and provides examples about how health information is used for treatment, payment, and health care operations.
- Request a restriction on specific uses and disclosures of protected health information. o Receive confidential communications of health information.
- Access, inspect and copy protected health information.
- Request amendment and/or correction of protected health information.
- Receive an accounting of disclosures of protected health information.
- File a complaint with the clinic as well as with the Department of Health and Human Services.
We have prepared a Notice of Privacy Practices for you. This document tells you what we do with your health information and what your rights are. This document is available upon request.
RELEASE OF MEDICAL RECORDS: I understand that my records may contain confidential information and that my records may be released or obtained for the clinic or providers of the clinic on an as needed basis, per HIPAA laws. I authorize that my information may be released to or from any of the providers of the clinics; Naturopathic Family Medicine located at 4411 Fremont Ave N, Seattle, WA 98103, or/and Natural Healthcare Northwest 509 Olive Way, Suite 1645 Seattle, WA 98101 and/or West Seattle Natural Medicine 3256 California Ave SW, Seattle, WA 98116.
CREDIT CARD POLICY: At this clinic, we require keeping your credit, debit card, or HSA on file as a convenient method of payment for the portion of services that your insurance doesn’t cover for which you are liable. We keep your credit card on file for the following instances: 1. Your credit card will be charged for any outstanding balance owed after three billing cycles (90 days). 2. You have charges for a cancellation and/or no show fees not paid within 7 days. Please speak to us if there are extenuating circumstances that prevented you from attending your visit. 3 Proof of insurance is required at each visit. If you do not provide insurance information in a timely manner, the cost of the visit will be charged to the credit card on file. Your credit card information is kept confidential and HIPAA secure. Payments to your card are processed only after the claim has been filed and processed by your insurer, the insurance portion of the claim has paid and posted to the account and 90 days has passed since your initial bill.
HIPAA Notice Of Privacy Practices
Please review this notice carefully. It describes how medical information about you may be used and disclosed and how to get access to this information.
Uses And Disclosures Of Protected Health Information
The providers of this clinic keep a record of the healthcare services we provide. You may ask to see and copy that record (copy charges may apply, per Washington law).
Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your healthcare bills, to support the operation of the physician’s practice, and other uses required by law.
TREATMENT: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you, As another example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
PAYMENT: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.
HEALTHCARE OPERATIONS: We may use or disclose, as needed, your protected health information in order to support the business activities of your physician’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities. For example, we may disclose your protected health information to medical school students that see patients at our office. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as needed, to contact you to remind you of your appointment.
USE REQUIRED BY LAW: We may use or disclose your protected health information in the following situations without your authorization. These situations include: as Required By Law, Public Health Issues as required by law, Communicable Diseases: Health Oversight; Abuse or Neglect; Food and Drug Administration requirements; Legal Proceedings; Law Enforcement; Coroners; Funeral Directors; and Organ Donation; Research; Criminal Activity; Military Activity and National Security; Worker’s Compensation; Inmates. Under the law, we must make disclosures to you and when, required by the Secretary of the Department of Health and Human Services.
The following is a statement of your rights with respect to your protected health information.
- You have the right to inspect and copy your protected health information: Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.
- You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. Your physician is not required to agree to a restriction that you may request. If the physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to use another Healthcare Professional.
- You have the right to request to receive confidential communications from us by alternative means or at an alternative location.
- You have a right to receive an accounting of certain disclosures we have made, if any, of your protected health information. We reserve the right to change the terms of this notice and will inform you by mail of any changes. You then have the right to object or withdraw as provided in this notice.
- You may have the right to have your physician amend your protected health information.
- You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
- If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
- You may complain to us or the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our office of your complaint. We will not retaliate against you for filing a complaint.
- We are required by law to maintain the privacy of and provide individuals with this notice of our legal duties and privacy practices with respect to protected health information. If you have any objections to this form, please ask to speak with out HIPAA Compliance Officer in person or by phone at our main phone number.
NFM Health Incorporated
“I have never been as happy and comfortable with any doctors as I am with West Seattle Natural Medicine and am so grateful to everyone in this office.”
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