Digestive Care of Evansville and the Gastrointestinal Endoscopy Center
This notice describes how medical information about you may be used and disclosed and how you get access to this information. Please review it carefully.
Protected health information about you is maintained as a record of your contacts or visits for healthcare services with our clinic. Specifically, “protected health information” is information about you, including demographic information (i.e. name, address, phone number, etc.) that may identify you and relates to your past, present, or future physical or mental health condition and related health care services.
We are required to follow specific rules on maintaining the confidentiality of your protected health information, using your information, and disclosing or sharing this information with other healthcare professionals involved in your care and treatment. This Notice describes your rights to access and control your protected health information. It also describes how we follow applicable rules and use and disclose your protected health information to provide your treatment, obtain payment for services you receive, manage our health care operations and for other purposes that are permitted or required by law. If you have any questions about this Notice, please contact our Privacy Manager.
Your Rights Under the Privacy Rule
Following is a statement of your rights, under the Privacy Rule, in reference to your protected health information. Please feel free to discuss any questions with our staff.
You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices. We are required to follow the terms of this Notice. We reserve the right to change the terms of our Notice at any time. If needed, new versions of this Notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with a revised Notice of Privacy Practices if you call our office and request that a revised copy be sent to you in the mail or ask for one at the time of your next appointment.
You have the right to authorize other use and disclosure. This means you have the right to authorize or deny, in writing, any other use or disclosure of protected health information that is not specified within this Notice. You may revoke an authorization at any time in writing, except to the extent that your healthcare provider or our office has taken an action in reliance on the use or disclosure indicated in the authorization.
You have the right to designate a personal representative. This means you may designate a person with the delegated authority to authorize or consent to the use or disclosure of protected health information.
You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in your patient record. You may request these records as a hard copy or have them sent to you electronically.
You have the right to request a restriction of your protected health information. This means you may ask us, in writing, 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. In certain cases, we may deny your request for a restriction.
You have the right to request an amendment to your protected health information. This means, if you believe your protected health information is incomplete or incorrect, you may request an amendment of your protected health information for as long as we maintain this information. In certain cases, we may deny your request for an amendment.
You have the right to request disclosure accountability. This means that you may request a listing of disclosures that we have made of your protected health information to entities or persons outside of our office other than for the purposes of treatment, payment, healthcare operations, or a purpose authorized by you. Certain uses and disclosures of protected health information, including psychotherapy notes, protected health information for marketing purposes, and the sale of protected health information, cannot be released without your authorization.
You have the right to receive notification of a breach of your protected health information. This means that you will be notified, in writing, of any breach of unsecured protected health information. This includes any acquisition, access, use, or disclosure of protected health information which compromises the security or privacy of the protected health information and could cause significant risk of financial, reputational, or other harm to you.
You have the right to opt out of any fundraising communications from this center. This means that you may request, in writing, to opt out of any fundraising communications sent out from our center, and this center cannot condition treatment or payment based on your choice to not receive these communications.
How We May Use or Disclose Protected Health Information
Following are examples of uses and disclosures of your protected health information that we are permitted to make:
Treatment – We may 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 that is involved in your care and treatment. For example, we would disclose your protected health information, as necessary, to a pharmacy that would fill your prescriptions. We will also disclose protected health information to other healthcare providers who may be involved in your care and treatment. We may also call you by name in the waiting room when your healthcare provider is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment. We may contact you by phone or other means to provide results from exams or tests and to provide information that describes or recommends treatment alternatives regarding your care. Also, we may contact you to provide information about health related benefits and services offered by our office.
Payment – Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you, such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. However, if you choose to pay for a service in full, you may request that service not be reported to your health insurance company. This request must be submitted in writing.
Healthcare Operations – We may use or disclose, as needed, your protected health information in order to support the business activities of our practice. This includes, but is not limited to, business planning and development, quality assessment and improvement, medical review, legal services, and auditing functions. It also includes education, provider credentialing, certification, underwriting, rating or other insurance-related activities. Additionally it includes administrative activities such as customer service, compliance with privacy requirements, internal grievance procedures, due diligence in connection with the sale or transfer of assets, and creating de-identified information.
To Others Involved in Your Healthcare – Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care, general condition or death. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your physician may, using professional judgment, determine whether the disclosure is in your best interest. In the case, only the protected health information that relevant to your healthcare will be disclosed.
To Business Associates – There are some business associates or third parties with whom we contract to perform services on our behalf. Examples include physician services, pathology, and certain radiology and laboratory tests. We have an agreement that all of our business associates will safeguard your information in the same way that we do.
As Required by Law – We may use or disclose your protected health information to the extent that the use or disclosure is required by law.
For Public Health – We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information.
For Communicable Diseases – We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
For Health Oversight – We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations and inspections.
In Cases of Abuse or Neglect – We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect, or domestic violence to the governmental entity or agency authorized to receive such information. In the case, the disclosure will be made in a manner that is consistent with the requirements of applicable federal and state laws.
To the Food and Drug Administration – We may disclose your protected health information, if authorized by law, to enable product recalls, make repairs or replacements, or to conduct post-marketing surveillance, as required.
For Legal Proceedings – We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court of administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process
To Law Enforcement – We may also disclose protected health information, as long as applicable legal requirements are met, for law enforcement purposes.
To Coroners, Funeral Directors, and Organ Donation – We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out his/her duties. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.
In Cases of Criminal Activity – Consistent with applicable federal and state laws, we may disclose your protected health information if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
For Military Activity and National Security – When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military service.
For Workers’ Compensation – Your protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally-established programs.
When an Inmate – We may use of disclose your protected health information if you are an inmate of a correctional facility and your physician created or received your protected health information in the course of providing care to you.
Required Uses or and Disclosures – Under the law, we must make disclosures about you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of the Privacy Rule.
You may address complaints to us or to 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 Privacy Manager of your complaint. You will not be penalized for filing a complaint.
For questions or complaints, please contact:
Digestive Care Center
Gastrointestinal Endoscopy Center
801 St. Mary’s Drive, Suite 110 West
Evansville, Indiana 47714
Good Faith Estimate Policy
You have the right to receive a “good-faith estimate” explaining how much your medical care will cost
If you don’t have insurance or don’t intend to use insurance to pay for scheduled non-emergency health care services, federal law requires that health care providers and facilities provide you with an estimate of the expected charges for medical items and services at least one business day before the scheduled services are to be performed.
- If you are uninsured or not using insurance to pay for your health care services and receive a bill that is at least $400 more than your good-faith estimate, you can dispute the bill.
Any patient may request an estimate of the expected charges for non emergency health care services that have been ordered, scheduled or referred, and state law requires that health care providers and facilities provide you with an estimate of the expected bill for medical items and services within five business days of the request.
- You have the right to receive a good-faith estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment and hospital fees.
- If you request an estimate and the actual charge for the health care services exceeds your good-faith estimate by the greater of: (i) $100; or (ii) 5%, we will provide a written explanation as to why the charges exceed the estimate.
- Make sure to save a copy or picture of your good-faith estimate.
If you have questions or need more information about your right to a good-faith estimate, visit www.cms.gov/nosurprises/consumers or call 1-800-985-3059.
THANK YOU FOR CHOOSING DIGESTIVE CARE CENTER!
IN HEA 1004-2020; I.C.§25-22.5-5.5