Policies & Fee Schedule
We are committed to providing quality healthcare. Fees include the time necessary to carefully and thoroughly review each patient’s history, questionnaire(s), medical records, and lab data. Appointment durations are approximate and take into account additional practitioner time outside of the actual appointment required to review medical records, lab documents, and consultation notes, make referrals to outside practitioners, complete required documentation, and perform any post-appointment follow-up. The fee schedule varies depending on the fee schedule negotiated with your health insurance. As a result, the time estimates of billed fees may not exactly match the time spent in the practitioner’s office. Fees may change without notice.
Payment & Insurance
ALL PAYMENT IS EXPECTED AT THE TIME OF SERVICE
Payment is required at the time services are rendered unless other arrangements have been made in advance. This includes applicable coinsurance and copayments for participating insurance companies. MOLINARES MEDICAL & HOLISTIC CENTRE, INC. accepts cash, VISA, MasterCard, and Care Credit. Sorry, we do not accept checks.
Patients with an outstanding balance of 60 days or more overdue must make arrangements for payment prior to scheduling appointments. We realize that financial difficulty is a reality.
We participate in most insurance plans, including Medicare. If you are not insured by a plan we do business with, payment in full is expected at each visit. If you are insured by a plan we do business with but don’t have an up-to-date insurance card, payment in full for each visit is required until we can verify your coverage. Knowing your insurance benefits is your responsibility. Please contact your insurance company with any questions you may have regarding your coverage.
Co-payments and deductibles. All co-payments and deductibles must be paid at the time of service. This arrangement is part of your contract with your insurance company. Failure on our part to collect co-payments and deductibles from patients can be considered fraud. Please help us in upholding the law by paying your co-payment at each visit.
Non-covered services. Please be aware that some – and perhaps all – of the services you receive may be non-covered or not considered reasonable or necessary by Medicare or other insurers. You must pay for these services in full at the time of visit.
Proof of insurance. All patients must complete our patient information form before seeing the doctor. We must obtain a copy of your driver’s license and current valid insurance to provide proof of insurance. If you fail to provide us with the correct insurance information in a timely manner, you will be responsible for the balance of a claim.
Claims submission. We will submit your claims and assist you in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim. Your insurance benefit is a contract between you and your insurance company; we are not party to that contract.
Coverage changes. If your insurance changes, please notify us before your next visit so we can make the appropriate changes to help you receive your maximum benefits. If your insurance company does not pay your claim in 45 days, the balance will automatically be billed to you.
If your account is over 90 days past due, you will receive a letter stating that you have 15 days to pay your account in full. Partial payments will not be accepted unless otherwise negotiated. Please be aware that if a balance remains unpaid, we may refer your account to a collection agency and you and your immediate family members may be discharged from this practice. If this is to occur, you will be notified by regular and certified mail that you have 30 days to find alternative medical care. During that 30-day period, our physician will only be able to treat you on an emergency basis.
Missed appointments. Our policy is to charge for missed appointments not canceled within a reasonable amount of time. These charges will be your responsibility and billed directly to you. Please help us to serve you better by keeping your regularly scheduled appointment. Broken appointments represent a cost to us, to you and to other patients who could have been seen in the time set aside for you. Cancellations are requested 24 hours prior to the appointment. We will charge you a no call/no show fee of $40.
Telephone and Patient Portal
Our office uses an electronic medical record system along with a Patient Portal. The Patient Portal enables our patients to send messages and questions to our staff and practitioners easily and securely via the internet. Through the Patient Portal, our patients are able to schedule appointments, view scheduled and past appointments, request appointments be re-scheduled or cancelled, request medication (with the exception of controlled substances), update demographic information, and send and receive non-urgent messages. These messages seamlessly become a part of each patient record.
We kindly request that all non-urgent telephone calls and Patient Portal messages be limited to brief matters that cannot wait until your next appointment or telephone consultation. If you notice that it is taking a couple of minutes to write your message or question, most likely, it will be better if you schedule an appointment to discuss these matters with your doctor.
We understand that sometimes it is difficult to assist to a doctor’s office. Because of that, we have “Virtual Visits” available by appointment only.
All urgent and non-urgent phone calls or video conference that cannot wait until your next visit will be considered “Virtual Visit” and charged to your credit card and must be paid in advanced. Your insurance will not be billed for a Virtual Visit. Please note that appointment times for phone consultations or video conference will be Monday through Friday from 4:00 pm to 6:00 pm depending on the practitioner’s availability.
Phone call or Video Conference will be billed $60 for the first 15 minutes (minimum) and after the first 15 minutes, the call will be billed in increments of 15 minutes and the cost will be $60. WE ARE NOT GOING TO BILL YOUR INSURANCE. The cost of the Virtual Visit will be paid in advance and no exceptions or payment arrangements will be allowed.
Example 1: If a phone call or video conference last 14 minutes, the patient will be charged $60
Example 2: If a phone call or video conference last 16 minutes, the patient will be charged $120.
The cost of the call will not be prorated regardless of the amount of time spent on the phone call or video conference.
Phone call or video conference topics that may become a Virtual Visit include:
Treatment plan updates, laboratory orders, prescriptions, or referrals.
Non-urgent consultation requests for existing or new symptoms that do not require a face-to-face evaluation.
Any symptom or topic that requires further evaluation, additional lab testing, changes to treatment plans, or new prescriptions.
Frequent or lengthy emails with multiple questions.
Topics that require back and forth discussion.
Request for new lab orders prior to the next visit.
Review of labs.
The phone calls or video conference service will not be available for new patients, patients that have an outstanding balance, patient requesting refill for controlled prescriptions and/or to discuss billing issues with the physician.
The physician may call from a blocked , unknown or undisclosed number, and will attempt to call the patient 3 times. It will be the patient responsibility to answer
The practitioners at Molinares Medical & Holistic Centre, Inc. may order lab tests as deemed appropriate in the management of your care. Your practitioner will review each of the lab tests ordered and notify you if any result requires immediate attention. Otherwise, all test results will be reviewed at a scheduled lab review appointment. It is the patient’s responsibility to schedule a follow-up appointment or keep the scheduled follow up appointment to discuss test results. Copies of lab results will be provided to patients at the time of the lab review appointment with your practitioner.
At Molinares Medical & Holistic Centre, Inc., we will collect lab test necessary to treat your health issue. It is the patient’s responsibility to know his or hers insurance benefits regarding laboratory testing. Neither the office staff nor the practitioners know the cost of the labs being ordered. Billing questions regarding test ordered must be addressed to the laboratory where the specimens where sent to. Neither the office staff nor the practitioners are responsible for charges incurred in your lab testing.
Medication Refills and Referrals
The practitioners at Molinares Medical & Holistic Centre, Inc. will refill the patient’s routine medications by sending us a request through your patient portal, pharmacy or by just calling our office with the exception of controlled prescriptions (prescriptions that you need to take physically to the pharmacy), and if the patient has not been seen in the office for the last 6 months.
It is the patient’s responsibility to plan ahead and request refills with at least a minimum of 5 days in advance before your prescriptions are done so your prescription refill can be completed in a timely manner.
If you (the patient) have an HMO insurance, you will be required to schedule an appointment to request a referral for any specialist (per your insurance policy requirement), even if you already visited the office before.
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
I. WHO WE ARE
This Notice of Privacy Practices (“Notice”) describes the privacy practices of Molinares Medical & Holistic Centre, Inc., their physicians, nurses and other personnel (“we” or “us”). It applies to services furnished to you at all of the offices where we provide services.
II. OUR PRIVACY OBLIGATIONS
We are required by law to maintain the privacy of your health information (“Protected Health Information” or “PHI”) and to provide you with this Notice of our legal duties and privacy practices with respect to your PHI. We are also obligated to notify you following a breach of unsecured PHI. When we use or disclose your PHI, we are required to abide by the terms of this Notice (or other notice in effect at the time of the use or disclosure).
III. PERMISSIBLE USES AND DISCLOSURES WITHOUT YOUR WRITTEN AUTHORIZATION
In certain situations, which we describe in Section IV, we must obtain your written authorization in order to use and/or disclose your PHI. However, we do not need any type of authorization from you for the following uses and/or disclosures:
Uses and Disclosures for Treatment, Payment and Health Care Operations. We may use and disclose PHI, but not your “Highly Confidential Information” (defined in Section IV.B), in order to treat you, obtain payment for services provided to you and conduct our “health care operations” as detailed:
• Treatment. We may use and disclose your PHI to provide treatment, for example, to diagnose and treat your injury or illness. We may also disclose PHI to other health care providers involved in your treatment.
• Payment. In most cases, we may use and disclose your PHI to obtain payment for services that we provide to you, for example, disclosures to claim and obtain payment from your health insurer, HMO, or other company that arranges or pays the cost of some or all of your health care (“Your Payor”) to verify that Your Payor will pay for health care.
• Health Care Operations. We may use and disclose your PHI for our health care operations, which include internal administration and planning and various activities that improve the quality and cost effectiveness of the care that we deliver to you. For example, we may use PHI to evaluate the quality and competence of our physicians, nurses and other health care workers. We may disclose PHI internally in order to resolve any complaints you may have and ensure that you have a comfortable visit with us. We may also disclose PHI to your other health care providers when such PHI is required for them to treat you, receive payment for services they render to you, or conduct certain health care operations, such as quality assessment and improvement activities, reviewing the quality and competence of health care professionals, or for health care fraud and abuse detection or compliance.
Use or Disclosure for Facility Directories. If we maintain a facility, we may include your name, location in the facility, general health condition and religious affiliation in a patient directory without obtaining your authorization unless you object to inclusion in the directory. Information in the directory may be disclosed to anyone who asks for you by name or members of the clergy; provided, however, that religious affiliation will only be disclosed to members of the clergy.
Disclosure to Patient, Relatives, Close Friends and Other Caregivers. We may use or disclose your PHI to the patient, a family member, other relative, a close personal friend, or any other person identified by you when you are present for, or otherwise available prior to, the disclosure, if we (1) obtain your agreement; (2) provide you with the opportunity to object to the disclosure and you do not object; or (3) reasonably infer that you do not object to the disclosure. If you are not present, or the opportunity to agree or object to a use or disclosure cannot practicably be provided because of your incapacity or an emergency circumstance, we may exercise our professional judgment to determine whether a disclosure is in your best interests. If we disclose information to a family member, other relative or a close personal friend, we would disclose only information that we believe is directly relevant to the person’s involvement with your health care or payment related to your health care. We may also disclose your PHI in order to notify (or assist in notifying) such persons of your location, general condition or death. We will not discuss and/or provide any laboratory results, imaging results or any diagnostic test results over the phone or by any electronic means (such as email, text message or publish on the patient portal) regardless if we can positively identify the patient or designated family member over the phone or electronic means. Once we discuss and/or provide the patient at their follow up appointment any laboratory results, imaging results or any diagnostic test, we will make them available at the patient’s portal or the patient, designated friend, relative or caregiver can request a copy.
Public Health Activities. We may use or disclose your PHI for the following public health activities: (1) to report health information to public health authorities for the purpose of preventing or controlling disease, injury or disability; (2) to report child abuse and neglect to public health authorities or other government authorities authorized by law to receive such reports; (3) to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration; (4) to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition; and (5) to report information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance.
Victims of Abuse, Neglect or Domestic Violence. If we reasonably believe you are a victim of abuse, neglect or domestic violence, we may disclose your PHI to a governmental authority, including a social service or protective services agency, authorized by law to receive reports of such abuse, neglect, or domestic violence.
Health Oversight Activities. We may disclose your PHI to a health oversight agency that oversees the health care system and is charged with responsibility for ensuring compliance with the rules of government health programs such as Medicare or Medicaid.
Judicial and Administrative Proceedings. We may disclose your PHI in the course of a judicial or administrative proceeding in response to a legal order or other lawful process.
Law Enforcement Officials. We may disclose your PHI to the police or other law enforcement officials as required or permitted by law or in compliance with a court order or a grand jury or administrative subpoena.
< > We may disclose your PHI to a coroner or medical examiner as authorized by law.
Organ and Tissue Procurement. We may use or disclose your PHI to organizations that facilitate organ, eye or tissue procurement, banking or transplantation.
< > We may use or disclose your PHI without your consent or authorization if an Institutional Review Board or Privacy Board approves a waiver of authorization for disclosure.
Health or Safety. We may use or disclose your PHI to prevent or lessen a serious and imminent threat to a person’s or the public’s health or safety.
Specialized Government Functions. We may use and disclose your PHI to units of the government with special functions, such as the U.S. military or the U.S. Department of State under certain circumstances.
Workers’ Compensation. We may disclose your PHI as authorized by and to the extent necessary to comply with state law relating to workers’ compensation or other similar programs.
As Required By Law. We may use and disclose your PHI when required to do so by any other law not already referred to in the preceding categories.
IV. USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
Use or Disclosure with Your Authorization. We must obtain your written authorization for most uses and disclosures of psychotherapy notes, uses and disclosures of PHI for marketing purposes and disclosures that constitute the sale of PHI. Additionally, other uses and disclosures of PHI not described in this Notice will be made only when you give us your written permission on an authorization form (“Your Authorization”). For instance, you will need to complete and sign an authorization form before we can send your PHI to your life insurance company or to the attorney representing the other party in a lawsuit in which you are involved.
Uses and Disclosures of Your Highly Confidential Information. Federal and state law requires special privacy protections for certain highly confidential information about you (“Highly Confidential Information”). This Highly Confidential Information may include the subset of your PHI that: (1) is maintained in psychotherapy notes; (2) is about mental health and developmental disabilities services; (3) is about alcohol and drug abuse prevention, treatment and referral; (4) is about HIV/AIDS testing, diagnosis or treatment; (5) is about sexually-transmitted disease(s); (6) is about genetic testing; (7) is about child abuse and neglect; (8) is about domestic abuse of an adult with a disability; or (9) is about sexual assault. In order for us to disclose your Highly Confidential Information for a purpose other than those permitted by law, we must have Your Authorization.
Revocation of Your Authorization. You may withdraw (revoke) Your Authorization, or any written authorization regarding your Highly Confidential Information (except to the extent that we have taken action in reliance upon it) by delivering a written statement to your physician. A form of Written Revocation is available upon request from the Privacy Officer.
V. YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
For Further Information; Complaints. If you would like more information about your privacy rights, if you are concerned that we have violated your privacy rights, or if you disagree with a decision that we made about access to your PHI, you may contact our Privacy Officer. Also, you may make a complaint by calling our Privacy Officer at (813) 994-8538. You may also file written complaints with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. Upon request, our Privacy Officer will provide you with the correct address for the Director. We will not retaliate against you if you file a complaint with us or the Director.
Right to Request Additional Restrictions. You have the right to request a restriction on the uses and disclosures of your PHI (1) for treatment, payment and health care operations purposes; and (2) to individuals (such as a family member, other relative, close personal friend or any other person identified by you) involved in your care or with payment related to your care. For example, you have the right to request that we not disclose your PHI to a health plan for payment or health care operations purposes, if that PHI pertains solely to a health care item or service for which we have been involved and which has been paid out of pocket in full. Unless otherwise required by law, we are required to comply with your request for this type of restriction. For all other requests for restrictions on use and disclosures of your PHI, we are not required to agree to your request. If you wish to request additional restrictions, please obtain a request form from your physician. We will send you a written response.
Right to Receive Confidential Communications. You may request, and we will accommodate, any reasonable written request for you to receive your PHI by alternative means of communication or at alternative locations.
Right to Inspect and Copy Your Health Information. You may request access to your medical record file and billing records maintained by us in order to inspect and request copies of the records. Under limited circumstances, we may deny you access to a portion of your records. If you would like to access your records, please obtain a record request form from your physician’s office. If you request copies, we will charge you a cost-based fee, consistent with State law, that includes (1) labor for copying the PHI; (2) supplies for creating the paper copy or electronic media if you request an electronic copy on portable media; (3) our postage costs, if you request that we mail the copies to you; and (4) if you agree in advance, the cost of preparing an explanation or summary of the PHI.
Right to Amend Your Records. You have the right to request that we amend PHI maintained in your medical record file or billing records. If you desire to amend your records, please obtain an amendment request form from you physician. We will comply with your request unless we believe that the information that would be amended is accurate and complete or other special circumstances apply.
Right to Receive an Accounting of Disclosures. Upon request, you may obtain an accounting of certain disclosures of your PHI made by us during any period of time prior to the date of your request provided such period does not exceed six years. If you request an accounting more than once during a twelve (12) month period, we may charge you for the cost of the additional accounting statement(s). We will inform you in advance of any fee and provide you with an opportunity to withdraw or modify the request.
Right to Receive a Copy of this Notice. Upon request, you may obtain a copy of this Notice, either by email or in paper format. Please submit your request to:
Molinares Medical & Holistic Centre, Inc.
2312 Crestover Lane Suite 101
Wesley Chapel, FL 33544
VI. EFFECTIVE DATE AND DURATION OF THIS NOTICE
Effective Date. This Notice is effective on May 18, 2015.
Right to Change Terms of this Notice. We may change the terms of this Notice at any time. If we change this Notice, we may make the new notice terms effective for all PHI that we maintain, including any information created or received prior to issuing the new notice. If we change this Notice, we will post the new notice in waiting areas around our offices. You also may obtain any new notice by contacting the Privacy Officer.
VII. PRIVACY OFFICER
You may contact the Privacy Officer at:
Molinares Medical & Holistic Centre, Inc.
2312 Crestover Lane Suite 101
Wesley Chapel, FL 33544