Our Consents
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This notice describes how medical information about you may be used and disclosed and how you can get access to this information. It informs you regarding our financial policy and how we communicate with you. Please review it carefully. You have the right to obtain a paper copy of this notice upon request.
Protected Health Information
Comprehensive Dermatology of Rochester, PLLC (“the Practice”) is required to keep certain protected health information confidential. Protected health information includes information about symptoms, test results, diagnosis treatment, related medical information, payment, billing, and insurance information, regardless of the form in which it is received.
How We Use Your Patient Health Information
We use protected health information about you for treatment, to obtain payment and for health care operations, including administrative purposes and evaluation of the quality of care that you receive. Under some circumstances, described below, we may be required to use or disclose your protected health information even without your written consent.
Treatment:
We will use and disclose your protected health information to provide you with medical treatment or services, this includes photographs or recordings. Members of the treatment team will record information in your record and use it to determine the most appropriate course of care. We may also disclose the information to other healthcare providers who are participating in your treatment, providers you may be referred to for further needed care, pharmacists who are filling your prescriptions, family members who are helping with your care, home care agencies and their representatives and assisted living facilities and their representatives.
Payment:
We will use and disclose your protected health information for payment purposes. For example, we may need to obtain authorization from your insurance company before providing certain types of treatment. If we are a participating provider with your insurance, we will submit bills to and maintain records of payments from your health plan.
Healthcare Operations:
We will use and disclose your protected health information to conduct our standard internal operations, including proper administration of records, evaluation of the quality of treatment, and to assess the care and outcomes of your case and others like it. We may sometimes use an AI ambient assistant to reduce the clinical documentation burden. Your information is protected by law under HIPAA and secured using encryption technology.
Other Uses:
We may use your protected health information to contact you with appointment reminders. We may also contact you to provide information about treatment alternatives or other health related benefits and services that may be of interest to you.
If we have HIV or substance abuse information about you, we cannot release it without a special signed, written authorization from you that complies with the laws governing HIV or substance abuse records. Certain other laws that we must comply with may require us to follow the special requirements of those laws in addition to HIPAA.
Subject to applicable laws, we may use or disclose protected health information about you for other reasons, even without your authorization for the following purposes:
As Required by Law: We may be required by law to report gunshot wounds, suspected abuse or neglect, or similar injuries and events.
Research: We may use or disclose information for approved medical research.
Business Associates: We may disclose health information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or serviced, i.e. third party billing services, etc. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Public Health Activities: As required by law, we may disclose health information, vital statistics, diseases, information related to recalls of dangerous products, report births or deaths, reactions to medications and similar information to public health authorities to prevent or control disease or injury.
Health Oversight: We may be required to disclose information to help health oversight agencies monitor the health care system, government programs, and compliance with civil rights laws, including for audits, investigations, inspections, eligibility in government programs, licensing purposes and similar activities.
Law Enforcement Purposes: Subject to certain restrictions, we may disclose information required by law enforcement officials, if we receive a proper request and the request meets all other legal requirements.
Deaths: We may report information regarding deaths to coroners, medical examiners, funeral directors, and organ donation agencies, in order to help identify a deceased person, determine the cause of death, or perform other legally authorized duties.
Serious Threat to Health or Safety: To prevent serious threats to your health or safety or that of another person or the public.
Member of the armed services: We may release information as required by military command authorities.
National Security Purposes: We may also disclose information to correctional institutions or for national security purposes.
Workers Compensation: We may release information about you for workers compensation or similar programs providing benefits for work related injuries or illness.
To other government benefit programs in order to coordinate or improve administration and management of the programs.
To family or others involved in your treatment or financial affairs, if you have indicated that we can do so or if we can reasonably infer that you do not object.
As otherwise required by law.
For any other reason not described in this notice, we will ask for your written authorization before using or disclosing any protected health information. Specifically, we require authorization prior to the use or disclosure of protected health information for marketing purposes or sale of protected health information. You may revoke that authorization at any time to stop future uses and disclosures by writing to: Privacy Officer, 900 Winton Road South, Rochester, NY 14618.
Individual Rights: You have the following rights with regard to your protected health information.
Request Restrictions: You may request restrictions on certain uses and disclosures of your protected health information. We are not required to agree to such restrictions, but if we do agree, we must abide by these restrictions.
Confidential Communications: You may ask us to communicate with you confidentially, for example, sending notices to an alternate address or giving us an alternate number to call to remind you of appointments.
Inspect and Obtain Copies: In most cases, you have the right to look at or receive a paper copy of your protected health information. There may be a charge for copies. We may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state or federal needs-based benefit program.
Access to Electronic Medical Records: You have a right to request an electronic copy of your medical records. To obtain an electronic copy, you may make your request with a member of the front office staff.
Amend Information: If you believe that information in your record is incorrect, or if important information is missing, you have the right to request that we correct the existing information or add the missing information.
Right to Get Notice of a Breach: You have the right to be notified upon a breach of any of your unsecured protected health information.
Accounting of Disclosures: You may request an accounting of when and to whom we have disclosed protected health information about you for reasons other than treatment, payment, or healthcare operations.
Out-of-Pocket Payments: If you paid out-of-pocket in full for a specific item or service, you have the right to ask that your protected health information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.
Our Legal Duty:
We are required by law to protect and maintain the privacy of your health information, to provide this Notice about our legal duties and privacy practices regarding protected health information, and to abide by the terms of the Notice currently in effect.
Changes in Privacy Practices:
If you would like a paper copy of this Notice, we must give you one. We reserve the right to change this Notice at any time, and to apply the new practices to all of your health information, including information we received before the Notice was changed. If we change this Notice and you are still our patient, you will be informed at your next in office visit. You are entitled to the most current copy of the Notice. You can also find the most current notice at www.585derm.com
Complaints:
If you are concerned the we have violated your privacy rights, or if you disagree with a decision we made about your records, you may let us know in writing: Privacy Officer, Comprehensive Dermatology of Rochester, 900 Winton Road South, Rochester, NY 14618. You may also send a written complaint to the U.S. Department of Health and Human Services, U.S. Department of Health & Human Services, Office for Civil Rights, 150 S. Independence Mall West - Suite 372, Philadelphia, PA. 19106-3499. You will not be penalized in any way for filing a complaint.
This notice went into effect November 8, 2012.
Updated: October 1, 2024
Financial Policy:
Insurance Cards: Please provide us with your insurance card and complete insurance information at the time of each visit. If you are unable to provide your insurance card, we will gladly see you as a “Self Pay Patient.” You may submit your receipt for reimbursement to your insurance company. We do not guarantee reimbursement for any services rendered. Co-Pays, Co-insurance, Deductible and Self-Payments: Self-pay patients: Full payment is required at the time of service. Deductible plans: We require either an $80 minimum payment or credit-card-on-file unless we are able to verify you have met your deductible. We do have fee schedules for major insurers that we contract with, so the full amount can also be settled at the time of the visit. Copay plans: Payment of full copay is required at time of service. Our office accepts most major credit cards (MasterCard, Visa and Discover), cash and checks. There is a $20 fee for returned checks. A $10.00 billing fee will be added for any of the above not paid at time of service. Insurance Contracts Your insurance contract is between you, your employer and the insurance company. Not all services are covered by all contracts. We participate and accept assignment from most major payers, which means covered charges will be paid directly to us. As a courtesy, we will bill your primary and secondary insurance policies. However, you are ultimately responsible for payment of services not covered by your insurance plan(s). It is your responsibility to call and check with your insurance as to which services are covered and if we are a participating provider before your appointment. If we do not participate in your primary insurance plan, you may still choose to be seen in our practice as a “Self Pay Patient”. If you have a secondary insurance plan that usually covers any remaining payment that your primary insurance does not cover, and we do not participate with them or do not receive payment from them, you will be responsible for the remainder. Out-Of-Network: If you have out-of-network benefits, payment is still due, in full, on any rendered service. As a courtesy, we will bill your insurance; however, any uncovered portion or remaining portion is your responsibility. Cosmetic Services: Cosmetic services must be paid at the time of your visit. These services cannot be billed to your insurance. Cosmetic services include, but are not limited to: skin tag removal, benign growth removal, botulinum toxin, fillers, peels, and laser treatments, microblading, etc. Missed Appointments: Please call us at least 24 hours before your appointment time if you need to reschedule or cancel an appointment. A $50.00 charge may be applied for appointments that are not cancelled in this time frame. ASSIGNMENT OF BENEFITS By signing this financial policy agreement, you agree to assign all medical and surgical benefits provided by Medicare, private insurance and any other health/medical plan to Comprehensive Dermatology of Rochester, PLLC for payment of medical services rendered to you and/or your dependents. You agree to pay the difference, if any, for services not covered by your health plan(s). By signing below, you agree that you understand and will abide by the above described financial policy.
Consent to Calls:
You consent to representatives of Comprehensive Dermatology of Rochester, PLLC contacting you or your representative by phone to deliver detailed information regarding your protected health information on a voicemail or answering machine for a phone number that you designate to be your primary phone number upon registration. If your phone number changes or you no longer wish for us to leave a message, it is your responsibility to provide us with this updated information. Request to revoke this authorization can be made at any time.