Please read the following information regarding our
practice's financial policy. Our main concern is in
providing excellent medical care to our patients.
Clear communication and understanding of the
expectations regarding the payment of our fees helps
us focus on the reason you came to our practice-your
At the time of service, all co-pays, deductibles and
past-due balances are due. We accept all major
credit cards and personal checks as methods of
payment. A $25.00 fee will be charged for any
As courtesy to our patients, Atlanta Center for
Gastroenterology, P.C. and Atlanta Endoscopy Cetner,
Ltd. will gladly file an insurance claim on your
behalf for payment of our charges. However, you are
still the person responsible for your account; not
your insurance company. We will file a claim for our
charges within 48 hours of providing services. In
most cases, if your insurance carrier has not paid
the claim within a reasonable length of time,
(usually 60 days) we will bill you directly for the
charges. We will continue to assist you in getting
your claim paid in any way possible.
Appointments cancelled without a 24-hour prior
notice will result in a $50.00 fee; due and payable
prior to your next visit.
If your insurance company requires you to get a
referral prior to seeing our physicians, you are
responisble for obtaining that referral- not our
office. At the time of service, if no referal has
been issued, you may still be seen but you will be
responsible for payment of the charges, at the end
of that visit.
If any account requires professional collections
activity, the patient will be billed for all accrued
interest, collection costs, court and attorney fees
incurred. In the course of our collection activity,
we will use information from credit bureaus to
collect a debt, as well as reporting delinquent
payment activity to these creit bureaus.
Statement of Privacy Practices (HIPAA)
Examples Of Disclosures For Treatment, Payment And
We will use your health information for treatment.
Information obtained by a nurse, physician or other
member of your healthcare team will be recorded in
your 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 healthcare team.
We will also provide your physician or a subsequent
healthcare provider with copies of various reports
that should assist him or her in treating you once
you are discharged from the hospital.
We will use your health information for payment
A bill may be sent to you or a third-party payer.
The information on or accompanying the bill may
include information that identifies you, as well as
your diagnosis, procedures, and supplies used.
We will use your health information for regular
-Quality Improvement: Members of the medical staff,
the risk of quality improvement manager, or members
of the quality improvement team may use information
in your health record 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 service we provide.
-Business Associates: There are some services
provided in our organization through contacts with
business associates. When these services are
contracted, we may disclose your health information
to our business associate so that they can perform
the job we have asked them to do and bill your
third-party payer for services rendered. To protect
your health information, however, we require the
business associate to appropriately safeguard your
-Notification: We may use or disclose information to
notify or assist in notifying a family member,
personal representative, or another person
responsible for your care, your location and general
Communication with family: Health professionals,
using their best judgment, may disclose to a family
member, other relative, close personal friend or any
other person you identify, health information
relevant to that person's involvement in your care
or payment related to your care.
Funeral Directors: We may disclose health
information to funeral directors consistent with
applicable law to carry out their duties.
Marketing: We may contact you to provide appointment
reminders of information about treatment
alternatives or other health related benefits and
services that may be of interest to you.
Food And Drug Administration (FDA): We may disclose
to the FDA health information relative to adverse
events with respect to food, supplements, product
and product defects, or post marketing surveillance
information to enable product recalls, repairs, or
Workers Compensation: We may disclose health
information to the extent authorized by and to the
extent necessary to comply with laws relating to
workers compensation or other similar programs
established by law.
Public Health: As required by law, we may disclose
your health information to public health or legal
authorities charged with preventing or controlling
disease, injury, or disability.
Law Enforcement: We may disclose health information
for law enforcement purposes by law or in response
to a valid subpoena.
Federal Oversight Agency: Federal law makes
provisions for your health information to be
released to an appropriate health oversight agency,
public health authority or attorney, provided that a
work force member or business associate believes in
good faith that we have engaged in unlawful conduct
or have otherwise violated professional or clinical
standards and are potentially endangering one or
more patients, workers, or the public.
Understanding Your Health Record/Information
Each time you visit a hospital, physician, or other
healthcare provider, 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 of treatment. This
information, often referred to you as your health or
medical 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 document describing the care you received.
-Means by which you or a third-party payer can
verify that services billed were actually provided.
-A tool in educating health professionals
-A source of data for medical research
-A source of information for public health officials
charged with improving the health of the nation
-A source of data for facility planning or marketing
-A tool with which we can access and continually
work to improve the care we rendered, and the
outcomes we achieve
Understanding what is in your record and how your
health information is used helps you to:
-Ensure its accuracy
-Better understand who, what, when, where, and why
others may access your health information.
-Make more informed decisions when authorizing
disclosure to others.
Your Health Information Rights
Although your health record is the physical property
of the healthcare practitioner or facility that
compiled it, the information belongs to you. You
have the right to:
-Request a restriction on certain uses and
disclosures of your information.
-Obtain a paper copy of the notice of information
practices, upon request
-Inspect and/or receive a copy of your health record
(a fee may be applied)
-Request an amendment or correction to your health
-Obtain an accounting of disclosures of your health
-Request communications of your health information
by alternative means or at alternative locations
-Revoke your authorization to use or disclose health
information except to the extent that action has
already been taken.
The organization is required to:
-Maintain the privacy of your health information
-Provide you with a notice as to our legal duties
and privacy practices with respect to information we
collect and maintain about you.
-Abide by the terms of this notice
-Notify you if we are unable to agree to a requested
-Accommodate reasonable requests you may have to
communicate health information by alternative means
or alternative locations
**We reserve the right to change our
practices and make new provisions effective for all
protected health information we maintain. We will
not use or disclose your health information without
your authorization, except as described in this