Consents and Policies

If you have a billing question, please call: (302) 212-9096

We understand how complicated insurance plans can be and will do our best to assist you in understanding your benefits and financial responsibility. Our team strives to ensure you understand your treatment and applicable charges. We value you as a patient and recognize that you need clear, concise answers when it comes to your financial responsibility. Our financial policy is simple and easy to understand.

NOTICE OF PRIVACY PRACTICES 

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US. 

OUR LEGAL DUTY 

We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect. This Notice takes effect 10/12/2020, and will remain in effect until we replace it. 

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request. 

You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice. 

USES AND DISCLOSURES OF HEALTH INFORMATION

We use and disclose health information about you for treatment, payment, and healthcare operations. For example: 

Treatment: We may use or disclose your health information to a physician or other healthcare provider providing treatment to you. 

Payment: We may use and disclose your health information to obtain payment for services we provide to you.

Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities. 

Your Authorization: In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this Notice. 

To Your Family and Friends: We must disclose your health information to you, as described in the Patient Rights section of this Notice. We may disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may do so.

Persons Involved In Care: We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information. 

Marketing Health-Related Services: We will not use your health information for marketing communications without your written authorization. 

Required by Law: We may use or disclose your health information when we are required to do so by law. 

Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others. 

National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institutions or law enforcement officials having lawful custody of protected health information of inmates or patients under certain circumstances.

Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters). 

PATIENT RIGHTS

Access: You have the right to look at or get copies of your health information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. (You must make a request in writing to obtain access to your health information. You may obtain a form to request access by using the contact information listed at the end of this Notice. 

Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment, healthcare operations and certain other activities. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. 

Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency). 

Alternative Communication: You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. (You must make your request in writing.) Your request must specify the alternative means or location, and provide satisfactory explanation how payments will be handled under the alternative means or location you request. 

Amendment: You have the right to request that we amend your health information. (Your request must be in writing, and it must explain why the information should be amended.)We may deny your request under certain circumstances. 

Electronic Notice: If you receive this Notice on our Web site or by electronic mail (e-mail), you are entitled to receive this Notice in written form. 

QUESTIONS AND COMPLAINTS 

If you want more information about our privacy practices or have questions or concerns, please contact us. 

If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of this Notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request. We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services. 

Contact Officer: William Albanese III
Telephone : 302.567.1500
Email Address info@atracare.com
Mailing Address: 10860 Coastal HWY, Lewes DE, 19958

NO SHOW AND LATE POLICY

Atracare policy for No Show and Late appointments are as follows.

As a New Patient of Atracare we have a 1 (one) visit policy for No shows. If you miss your 1st appointment and have provided 24 hours notice we will allow you to reschedule. If however you have not provided 24 hours notice or miss the second appointment we will not allow you to establish care with our Practice.  

As an Established Patients of Atracare we will allow up to 2 (two) No Shows visits, however after the 2nd missed visit, we will discharge you from the practice. You will be allowed up to 30 days of continued care after discharge notification as directed by the State of Delaware. 

Atracare requires 24 hours notice of cancellation. If you cancel the same day as your scheduled appointment date and time you will be charged a No Show Fee of $50.00. Medicare and Medicaid Patients are not subject to a No Show Fee, but are still subject to discharge from the practice. 

It is imperative to patient care that we stay on schedule, if you arrive at your appointment later than 10 minutes past your scheduled appointment time we will ask you to reschedule your appointment for a later date and time. A continued pattern of being late for your visits will result in being discharged from the practice. 

Atracare policy requires all primary care and pediatric patients planning on joining our practice to have their medical records on file BEFORE their visit to establish care. If we do not have your past records you will be required to reschedule your appointment. Please check with your former provider or practice prior to your scheduled appointment. 

I understand Atracare’s policies and agree to abide by the policies in place and understand I may be charged a fee and/or discharged from the practice. 

ACCOUNTABILITY ACT OF 1996 (HIPAA), PRIVACY PRACTICES  AND RECORDS AND RELEASE OF INFORMATION POLICY 

Our Notice of Privacy Practices provides information about how we may use and disclose  protected health information about you. It also provides information about your rights as a patient of our practice and whom you may contact at our office to ask questions about our privacy practices.  By signing this form, I hereby acknowledge that I have had the opportunity to read the Notice of Privacy Practices of Atracare and understand that in compliance with that notice, Atracare is allowed to use or disclose my individually identifiable health information for purposes of treatment, payment, and other health care operations. I further understand that the Notice of Privacy Practices provides a more complete explanation of the use or disclosure of my individually identifiable health information.   

HIPAA RELEASE OF INFORMATION AND  DISCLOSURE OF PROTECTED HEALTH INFORMATION (PHI) 

This is to certify that I, the undersigned, authorize Atracare to disclose Protected Health Information (PHI) to family members /individuals or entities. Please note that the below list will replace any previous authorization on file.

List all parties you wish to grant access.

Name: 

Relationship:  

I do understand that my medical or billing record may contain information regarding drug and/or alcohol abuse, sexually transmitted diseases, lab testing and/or any other sensitive information that will be available to all individuals listed on this form. The entities or persons listed on this form are allowed access to the following records.

FINANCIAL POLICY

Please read the following information below. Your signature acknowledges that you have had the opportunity to ask questions related to Atracare’s financial policy and agree to the terms outlined in this policy.

As the patient, you are responsible for providing our team with (1) an up-to-date insurance card and (1) government issued photo identification card. A photo identification card must be presented on the date of service or a valid photo identification card must be present on the patient’s file. It is also your responsibility to understand your individual benefits offered under your plan. If you have any questions about your plan please call your insurance company plan administrator.

If you are unable to provide our team with an insurance card, you will be required to pay for your visit at the time of service per the terms of our self-pay rate. If we are unable to validate and verify your insurance on the date of service, you may be required to pay for your visit at the time of service per the terms of our self-pay rate, and/or a Deductible Deposit until that claim has been paid by the insurance carrier.

Our team collects a patient’s financial responsibility at the time of their visit, including copayments, coinsurance percentage, and deductibles. Our team will determine your financial responsibility based on your insurance card and benefits profile from your insurance carrier. Please understand that under the rules of our insurance contracts we are required to collect copayments, coinsurance percentage and any non met deductibles at time of service.

Personal Checks and Traveler’s checks are NOT accepted. Atracare is always seeking ways to improve our efficiency and service. We have instituted a “credit card on file” system to allow smoother transactions and billing for your visits. At your visit we will take your credit card info, and save the card on file. Your credit card information will be safely held on a secure, encrypted gateway site. No financial information will be available to our staff, held in our system, or at our office. Co-payments will still be collected at each visit and can be paid in any manner you choose at that time. If your insurance is accepted by Atracare, we will submit your claim as usual. When your claim is processed you should receive an explanation of benefits (EOB) from your insurer that outlines what part of your service has been covered by your insurance and indicates exactly how much remains your responsibility to pay for services rendered. A statement of the charge will be mailed to the address provided and a paid receipt for the balance.

If Atracare is not contracted with your insurance company or you have an out-of-state plan, our team is still happy to serve you, but will require payment in full at the time of service. Referrals and authorizations are patient responsibility. Please call your insurance carrier to verify if you need a referral and/or authorization for your visit.

Many insurance carriers, including Medicare, will no longer pay for durable medical equipment (DME), such as crutches, braces,and boots etc., obtained at a physician’s office or clinic. Therefore, if you wish to obtain DME at the time of your visit, you may be required to pay in-full at the time of service. Medicare patients are required to complete an Advanced Beneficiary Notice (ABN). Atracare contracts with an outside vendor for DME in the office. The DME vendors do not have access to your insurance coverage at the time of service, patients may be subject to a co-pay or deductibles based on the individual’s insurance plan benefits. You also have the option to not choose Atracare’s vendor prior to dispensation of DME. Atracare will provide the patient with a DME prescription which you can take to your preferred DME supplier or pharmacy. 

Diagnostic testing, such as laboratory testing and imaging, may need to be performed at an outside facility, such as the hospital, or independent lab like Quest Diagnostics or LabCorp. These facilities have their own physicians/independent practitioners, (i.e.radiologists, pathologists, etc) who provide the clinical interpretation of your tests. Likewise, these facilities and their physicians or independent practitioners operate and bill independently from Atracare. It is your responsibility to know if your insurance company is contracted with a preferred lab.

If the patient is a minor (under18 years of age), the parent or legal guardian of a minor is financially responsible for payment at the time of service, as well as obtaining any required referrals and providing insurance and picture ID cards. Minors must be accompanied by a parent/legal guardian or by a designated adult who has been given written permission to make medical decisions, on behalf of the parent/guardian, for the minor child.

In the event your account is turned over to an outside collection agency, you will be responsible for an additional associated costs incurred to collect unpaid debt. If your account is turned over for collections to a third party collection agency, or if a past due amount is reported to credit bureaus for late payment, non-payment, or charge-off, the record of the patient visit may become public record. Failure to maintain financial responsibility may cause you to forfeit your right to confidentiality subject to state and federal law. Atracare reserves the right to refuse treatment to anyone who fails to comply with these policies, or for non-payment of past services subject to state and federal law.

These policies are subject to change without notice.

AUTHORIZATION TO RELEASE BILLING INFORMATION:  

I hereby authorize the treating provider to release any information required in the course  of my examination or treatment to my insurance company, providers, individuals and entites authorized by Atracare or their contracted entities for the purpose of billing claims and insurance verification.

ASSIGNMENT OF BENEFITS: 

I do hereby assign all medical and/or surgical benefits ( payments) to which I am entitled, including all government and private insurance plans or other payers, for service rendered by Atracare, and the medical professionals caring for me during my treatment in this office to be paid directly to Atracare, or other associated providers as appropriate. I  understand that I am responsible for all charges not paid by insurance.  This  assignment will remain in effect until revoked in writing by me.

ATTENTION WORKERS COMPENSATION CLAIMANTS:

As the employee, you must report any work related injuries to your employer. You must provide Atracare with the appropriate claim number, insurance company name and address, claims adjuster name and any relevant phone numbers. If your employer fails to report your injury and/or the insurance carrier denies your claim for any reason, you will be financially responsible for services rendered. 

ATTENTION AUTOMOBILE ACCIDENT CLAIMANTS:

Atracare will bill your personal auto insurance carrier should you incur injuries as a result of a motor vehicle accident. A third party insurance carrier cannot be billed for services.

You must provide us with the correct claims information including insurance company name, claim number, claims adjuster name, relevant phone numbers, etc. If for any reason this claim is denied, you will be financially responsible for services rendered

ATTENTION UNINSURED PATIENTS:

Payments for services rendered to self pay patients are due on the date of service (DOS). The charge for an office visit may not include any additional procedures including, but not limited to, blood draws, in-house lab testing, x-rays, medications, injections, sutures, suture removal, crutches, slings, casting materials, and other durable medical equipment. Any additional charges incurred from X-rays or lab work that is performed at an outside facility is the sole responsibility of the patient or guarantor. In the event your financial responsibility is not collected in full at the time of service, you will receive a statement. Prompt payment is required

We reserve the right to vary our charging rates from time to time. We will use reasonable commercial efforts to notify you of any such changes that will fall immediately due on notice for all services.

CONSENT TO TREATMENT

Please read the following information below. Your signature below applies to the services rendered in conjunction with all of your in person visits at Atracare. The “Consent To Treatment” can be rescinded at any time should you wish to do so. 

You have the right, as a patient, to be informed about your condition and the recommended surgical, medical or diagnostic procedure to be used so that you may make the decision whether or not to undergo any suggested treatment or procedure after knowing the risks and hazards involved.This consent provides us with your permission to perform reasonable and necessary medical examinations, testing and treatment. By signing below, you are indicating that (1) you intend that this consent is continuing in nature even after a specific diagnosis has been made and treatment recommended; and (2) you consent to treatment at this office or any other satellite office under common ownership. The consent will remain fully effective until it is revoked in writing. You have the right at any time to discontinue services. You have the right to discuss the treatment plan with your clinician about the purpose, potential risks and benefits of any test ordered for you. If you have any concerns regarding any test or treatment

recommended by your healthcare provider, we encourage you to ask questions. I voluntarily request a physician, and/or mid-level provider (Nurse Practitioner, Physician Assistant, or Clinical Nurse Specialist), and other health care providers or the designees as deemed necessary, to perform reasonable and necessary medical examination, testing and treatment for the condition which has brought me to seek care at this practice. I understand that if additional testing, invasive or interventional procedures are recommended, I will be asked to read and sign additional consent forms prior to the test(s) or procedure(s). I hereby authorize Atracare to take a picture for my electronic medical records if I do not produce a current Photo ID.

TREATMENT OF A MINOR:   

All children under the age of 18, unless mandated by the State of Delaware or under any provision defined by Federal law, should complete a “Consent to Treatment of a Minor Form”. This form gives Atracare permission to treat your child in your absence, if the need arises.  

PATIENT RIGHTS & RESPONSIBILITIES: 

I, the undersigned, have received the Patient Rights and Responsibilities Form. I understand and agree to abide by the conditions for treatment at Atracare. 

CONSENT TO PARTICIPATE IN TELEMEDICINE CONSULTATION 

Please read the following information below. Your signature acknowledges consent to participate in a telemedicine visit at Atracare.

​This form is to obtain your consent for a visit through video with our providers. Staff, including receptionist, medical assistants, and others involved in your care may at times participate in the telemedicine visit.  

Telemedicine uses video, audio, and other electronic communications to connect you with your healthcare provider. Details of your medical history and personal health information may be discussed throughout this face-to-face video visit. During this visit a provider may record specific portions of the visit, which may include video, audio, and photos that will be placed in your medical record. 

The risks associated with telemedicine visits include, but are not limited to, technical problems with the information transmission, and equipment failures that could result in lost information or delays in treatment. There is the rare possibility that security protocols could fail, causing a breach in patient privacy. You are welcome to take advantage of scheduling an in person visit with your provider. 

Your medical records are protected in telemedicine the same as they are protected with face-to-face in person visits. The same laws are in place that give you privacy whether you see a provider face-to-face or through telemedicine.   

You may withhold or withdraw your consent to telemedicine visits at any time before or during the visit without affecting your right to medical care and treatment in the future, or jeopardizing your access to benefits which you would be otherwise eligible for.