Updated Payment Policies and Procedures (January 2022) Amanda J Gretsch, Inc. (AJG) is considered an out-of-network provider for all insurance companies and therefore, does not bill insurance companies. Payment is due at the time of treatment.
As an out-of-network provider, some insurance companies will reimburse you for a portion of the fees paid for occupational therapy services. It is highly recommended that if you are seeking reimbursement from your insurance company that you call to verify your benefits. Please be aware that policies change from time to time, so it is strongly advised that you call them every month while receiving treatment.
Patients will be provided a “Superbill” (invoice that contains all necessary insurance codes) after payment is received. These invoices can then be submitted to your insurance company, if you choose. Please be aware that to avoid a fee when requesting that AJG rebill invoices due to insurance company requirements, AJG must be made aware within two months of the date of the invoice.
Recommended Questions to Ask Your Insurance Provider:
What is my out-of-network deductible? How much has been met this year?
What portion of my services will be reimbursed?
Does my plan allow reimbursement for each of the following therapy codes?
Evaluations: 97165, 97166, 97167
Treatment: 97530, 97112, 97110, 97535
Do I need a referral from a physician to obtain reimbursement?
Do I need pre-authorization to obtain reimbursement?
What are the benefits of private pay? Insurance companies require a diagnosis and often have policies regarding reimbursement that restrict the type, length, frequency, and duration of services. We have found that without the limitations and restraints placed by insurance providers, patients are able to allay themselves of the most up-to-date, evidenced-based interventions for a duration that helps maximize outcomes. Finally, if confidentiality is a concern, the information will not become part of an individual’s permanent medical file.
While receiving treatment, patients may elect one of the following payment options: 1. Cash or Check We are happy to accept payment by cash or check at the time of the appointment. However, please be aware that if you wish to schedule ongoing therapy sessions through our online scheduling system, you will be required to keep a valid credit card on file. The credit card will not be charged unless there is a no show/ late cancellation or if the patient chooses to use it to pay for treatment. 2. Credit Cards For your convenience, we accept payment via Visa, MasterCard, and American Express. All information is maintained securely through our electronic medical records (EMR), scheduling, and billing system. 3. Health Savings Account (HSA) or Flexible Spending Account (FSA) Via issued HSA or FSA credit card (this allows for services to be paid using or Flexible Savings Account (FSA) pre-tax dollars.) Please be aware that patients will also need to keep a credit card of their choice on file in the event that there are insufficient funds in the HSA or FSA account.
Cancellation Policies AJG strives to provide you with the best, most consistent care possible. Scheduling is often consistent in nature with standing appointments on an ongoing basis. Attending these appointments is an essential part of treatment and patient management. With the exception of illness, for a more immediate cancellation or change, a minimum of 24 hours’ notice before the scheduled appointment is required (please note that if your appointment is on a Monday, the 24 hours EXCLUDES the weekends). If you do not cancel your appointment at (760) 525-3111 within 24 hours, you will be charged a “late cancellation/no show” fee of $225.00.
You have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost. Under the law, health care providers need to give patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services. You have a 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. Make sure your health care provider give you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
HIPAA NOTICE OF PRIVACY PRACTICES – Effective 4/28/12 Purpose of this Notice We are required by law to maintain the privacy of your protected health information (PHI). This notice applies to all records of the health care and services you received by Amanda J. Gretsch, Inc. (hereafter “AJG”). This notice will tell you about the ways in which we may use and disclose your PHI. This notice also describes your rights and certain obligations we have regarding the use and disclosure of your PHI.
Who Will Follow this Notice This notice describes AJG’s privacy practices, as well as the privacy practices of:
any health care professional authorized to enter information into your AJG medical record;
any member of a volunteer group that interacts with you while you are at AJG; and
all employees, staff, students and other AJG personnel.
AJG’s Commitment We are required by law to:
make sure that your PHI is kept private;
give you this notice of our legal duties and privacy practices with respect to your PHI;
follow the terms of this notice as long as it is currently in effect. If we revise this notice, we will follow the terms of the revised notice as long as it is currently in effect;
train our personnel concerning privacy and confidentiality; and
mitigate (lessen the harm of) any breach of privacy/confidentiality.
Understanding Your Health Record Each time you visit AJG, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for care or treatment. This information, often referred to as your health or medical record, serves as a:
basis for planning your care, treatment and any follow up care you may need;
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 (for example, insurance carriers, Medicare, Medicaid) can verify that services billed were actually provided;
tool in educating health professionals;
source of information for medical research; source of information for public health officials charged with improving the health of the nation;
source of information for facility planning and marketing; and
tool which can be used to assess and continually improve the care rendered and the results achieved.
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; and
make more informed decisions when authorizing disclosure to others.
How We May Use and Disclose Information about You The following categories (listed in bold-face print, below) describe different ways that we use and disclose your protected health information (PHI). For each category of uses or disclosures we will explain what we mean and give you some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information fall within the categories below.
For Treatment. We are permitted to use and disclose your PHI to personnel who are involved in taking care of you at AJG or provide you with medical treatment or services. We also may disclose your PHI to health care providers outside AJG who may be involved in your medical care, such as physicians, psychologists, speech and language pathologists, etc. For Payment. We are permitted to use and disclose your PHI so that the treatment and services you receive at AJG may be billed to (and payment may be collected from) your insurance company or a third party. For example, we may tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. For Health Care Operations. We are permitted to use and disclose your PHI for our business operations. These uses and disclosures are necessary to run AJG and to make sure that all of our patients receive quality care. For example, we may use PHI to review our treatment and services and to evaluate the performance of our staff in caring for you. We also may disclose information to other AJG personnel to conduct training programs. We also may combine certain PHI about several AJG patients as part of a study to determine what additional services AJG should offer, what services are not needed, and whether certain new treatments are effective. We also may remove all information that identifies you from a set of PHI so that others may use that information to study health care and health care delivery without learning who the specific patients are. To Business Associates for Treatment, Payment and Health Care Operations. We are permitted to disclose your PHI to our business associates in order to carry out treatment, payment or health care operations. For example, we may disclose your PHI to a company we hire to bill insurance companies on our behalf to help us obtain payment for the health care services we provide. Individuals Involved in Your Care or Payment for Your Care. We may release your PHI to a family member, other relative or close personal friend who is involved in your medical care if the PHI released is directly relevant to the person’s involvement with your care. We also may release information to someone who helps pay for your care. We also may tell your family or friends that you are at AJG and what your general condition is. In addition, we may disclose your PHI to a group assisting in a disaster relief effort so that your family can be notified about your location and general condition. Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at AJG. Treatment Alternatives. We may use and disclose medical information to give you information about treatment options or alternatives that may be of interest to you. Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you. Fund raising Activities. We may use certain allowable PHI to contact you in an effort to raise money for AJG and its operations. This limited PHI includes demographic information about you (for example, your name, address, phone number), and the dates you received treatment or services at AJG. If you do not want us to contact you for our fund raising efforts, please contact AJG at (760) 525-3111.
Special Situations As Required By Law. We will disclose your PHI when required to do so by federal, state, or local law. Health Oversight Activities. We may disclose PHI to a health oversight agency for practices authorized by law such as audits, investigations, inspections and licensure. These practices are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. Law Enforcement. We may release PHI if asked to do so by a law enforcement official:
in response to a court order, subpoena, warrant, summons or similar process;
about criminal conduct we believed occurred on AJG’s premises; and
in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
Research. Under certain circumstances, we may use and disclose your PHI for research purposes. Most research projects, however, are subject to a special approval process. This process requires an evaluation of the proposed research project and its use of PHI, and balances these research needs with our patients' need for privacy. Before we use or disclose PHI for research, the project will have been approved through this special approval process. However, this special approval process is not required when we allow researchers who are preparing a research project to look at information about patients with specific medical needs, so long as the PHI they review does not leave AJG. To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to law enforcement in order to help prevent the threat. Armed Forces and Foreign Military Personnel. If you are a member of the armed forces, we may release your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority. National Security and Intelligence Activities. We may release your PHI to authorized federal officials for intelligence, counterintelligence, and other national security practices authorized by law. Protective Services for the President and Others. We may disclose your PHI to authorized federal officials so they may provide protection to the President of the United States, other authorized persons or foreign heads of state, or to conduct special investigations. Workers' Compensation. We may release your PHI for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness. When Your Authorization is Required Uses or disclosures of your PHI for other purposes or practices not listed above will be made only with your written authorization (permission). If you provide us authorization to use or disclose your PHI, you may revoke your authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your PHI for the reasons covered by your written permission. However, we are unable to take back any disclosures we have already made with your permission.
You may obtain a paper authorization form by contacting: Amanda J. Gretsch, Inc., 543 Encinitas, CA, Ste.114, Encinitas, CA 92024 Your Rights: You have the following rights regarding the PHI we maintain about you. Right to Request Restrictions. You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. We are not required to agree with your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. AJG will notify you in writing whether we agree or do not agree with your request. In your request, you must tell us: (1) what information you want to limit; (2) whether you want to limit AJG’s use and/or disclosure of the information; (3) to whom you want the limits to apply (for example, disclosures to your spouse); and (4) your contact address. Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by telephone at work or that we only contact you by mail at home. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests. Right to Inspect and Receive a Copy. You have the right to inspect and receive a copy of PHI that may be used to make decisions about your care. Usually, this includes medical and billing records. If you request a copy of your PHI, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect or receive a copy in certain very limited circumstances. If you are denied access to PHI, we will notify you in writing, and you may request that the denial be reviewed. Another licensed health care professional chosen by AJG will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. Right to Amend. If you believe that PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for AJG. You must include a reason that supports your request. In order to ensure that we collect the information we need, please ask our office staff for a “Request For Correction/Amendment of Protected Health Information (PHI).” We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: (1) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; (2) is not part of the PHI kept by or for AJG; (3) is not part of the information that you would be permitted to inspect and copy; or (4) is accurate and complete. AJG will notify you in writing whether we agree or do not agree with your amendment request.
Additionally, if we grant the request, we will make the correction and distribute the correction to those who need it and those you identify that you want to receive the corrected information. If we deny your request for an amendment, we will notify you how you may file a complaint with AJG or the Department of Health and Human Services.
Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures” that have been made by AJG in the past six (6) years. The accounting (or list) of disclosures will include: (1) the date of the disclosure; (2) the name of the entity or person who received the PHI and, if known, the address; (3) a brief description of the PHI disclosed; and (4) a brief statement of the purpose of the disclosure.
Your request must state a time period not longer than six (6) years and may not include dates before October 24, 2011. The first list you request within a twelve (12) month period will be free of charge. For additional lists, we will charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Contact information for these rights. Any requests related to these rights should be directed to: Amanda J. Gretsch, Inc., 543 Encinitas, CA, Ste.114, Encinitas, CA 92024
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To obtain a paper copy of this notice, contact AGOTR at (760) 525-3111.
Changes to this Notice: We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. The notice will contain on the first page, the effective date.