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If you have not already done so, please schedule an appointment with our office before filling out the New Patient Forms. This can be done by calling 207-854-2001 or email us at email@example.com
We take many insurance plans for chiropractic care, and the coverage varies with each company and with each plan. As a service to our patients, we will call on your chiropractic coverage so that your insurance company will provide you with maximum benefits. Listed below are some of the insurance companies we work with. Please call us if you don’t see your company on this list; we will be happy to call and verify your benefits for you.
- Anthem Blue Cross and Blue Shield
- Harvard Pilgrim Health Care
- Medicaid/Maine Care
- United Health Care
- CCN/First Health
Download HIPPA and Consent Forms:
- HIPPA Privacy Notice (pdf)
- Informed Consent for Chiropractic Care (pdf)
- Informed Consent To Chiropractic Adjustments And Care (pdf)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
OUR LEGAL DUTY
We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this NOTICE about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this NOTICE while it is in effect. This NOTICE takes effect April 14, 2003, and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this NOTICE at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our NOTICE effective for all health information that we maintain, including health information we created or received before we made changes. Before we make a significant change in our privacy practices, we will change this NOTICE and make the new NOTICE available upon request.
You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this NOTICE, please contact us using the information listed at the end of this NOTICE.
USES AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose health information about you for treatment, payment, and healthcare operations. For example:
TREATMENT: We may use or disclose your health information to any other physician or healthcare provider providing treatment to you.
PAYMENT: We may use and disclose your health information to obtain payment for services we provide to you.
HEALTHCARE OPERATIONS: We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.
YOUR AUTHORIZATION: In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you five us a written authorization, we cannot use or disclose your health information for any reason except those described in the NOTICE.
TO YOUR FAMILY AND FRIENDS: We must disclose your health information to you. as described in the Patient Rights section of the NOTICE. We may disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may do so.
PERSONS INVOLVED IN CARE: We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, or your location, your general condition, or death. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up medical supplies, x-rays, or other similar forms of health information.
MARKETING HEALTH-RELATED SERVICES: We will not use your health information for marketing communications without your written authorization.
REQUIRED BY LAW: We may use or disclose your health information when we are required to do so by law.
ABUSE OR NEGLECT: We may disclose your protected health information to public authorities as allowed by law to report abuse or neglect.
NATIONAL SECURITY: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal official health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institution or law enforcement official having lawful custody of protected health information of inmate or patient under certain circumstances.
APPOINTMENT REMINDERS: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, e-mail or letters).
ACCESS: You have the right to look at or get copies of your health information. (You must make a request in writing to obtain access to your health information. You may obtain a form to request access by using the contact information listed at the end of this NOTICE. We may charge you a reasonable cost-based fee for expenses such as copies and staff time.)
DISCLOSURE ACCOUNTING: You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment, healthcare operations and certain other activities, for the last 6 years, but not before April 14, 2003. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.
RESTRICTION: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree, but if we do, we will abide by our agreement (except in an emergency).
AMENDMENT: You have the right to request that we amend your health information. (Your request must be in writing, and it must explain why the information should be amended.) We may deny your request under certain circumstances.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have questions or concerns, please contact us. If you are concerned that we may have violated your privacy right, or you disagree with a decision we made about access to your health information you may complain to us using the contact information listed at the end of this NOTICE. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint upon request.
We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services. Mailing address: Department of Human Resources, Region 1, JFK Federal Building, Boston MA 02203.
MEDICAL INFORMATION HANDLING
THIS NOTICE DESCRIBES HOW CHIROPRACTIC AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
In the course of your care as a patient at New England Chiropractic we may use or disclose personal and health related information about you in the following ways:
- Your personal health information, including your clinical record, may be disclosed to another health care provider or hospital if it is necessary to refer you for further diagnosis, assessment or treatment.
- Your health care records as well as your billing records may be disclosed to another party, such as an insurance carrier, an HMO, a PPO, or your employer, if they are or may be responsible for the payment of your services.
- Your name, address, e-mail, phone number, and your health care records may be used to contact you regarding appointment reminders, special events and information about other health related information that may be of interest to you.
If you are not at home to receive an appointment reminder, a message may be left on your answering machine.
Your first name and last initial will be used on our welcome and refer all board.
Further, you have the right to inspect or obtain a copy of the information we will use for these purposes. You also have the right to refuse to provide authorization for this office to contact you regarding these matters. If you do not provide us with that authorization for this office to contact you regarding these matters. If you do not provide us with that authorization it will not affect the care provided to you or the reimbursement avenues associated with your care.
Under federal law we are also permitted or required to use or disclose your health information without your consent or authorization in these following circumstances:
- If we are providing health care services to you based on the order of another health care provider.
- If we provide health care services to you in an emergency.
- If we are required by law to provide care to you and we are unable to obtain your consent after attempting to do so.
- If these are substantial barriers to communicating with you, but in our professional judgment we believe that you intend for us to provide care.
- If we are ordered by the courts or another appropriate agency.
Any use or disclosure of your protected health information, other than as outlined above, will only be made upon your written authorization.
We normally provide information about your health to you in person at the time you receive chiropractic care from us. We may also mail information to you regarding your health or about the status of your account. If you would like to receive this information in a different form please advise us in writing as to your preferences.