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Billing and Insurance Information We are providers for: · Kaiser · Blue Shield/ Blue Cross · Cigna · Medicare · Pacificare . Riverside Physicians Network . PHN . Exclusive Care . Landmark · And many more Some insurance companies may require a referral from your primary care physician. Please call our office prior to your first visit, to verify that you have Chiropractic coverage on your health plan. We also handle workers compensation, personal injury, private pay, and Medicare cases. We do not accept 3rd party payments or Attorney Liens for personal injury or Worker’s Compensation cases. If you have any questions, please call our insurance and billing coordinator. Types of Payment Accepted: Master Card, Visa, Check, Cash, and Money Orders. Diagnostic Tests and X-Rays If necessary, imaging tests such as X-rays, MRI, CT, or other diagnostic tests such as EMG’s or nerve conduction studies may be recommended. This will involve referral to other facilities. We will assist you in obtaining an appointment. Your Doctor will go over the findings with you when you return. Conditions Commonly Treated Include: · Neck and back pain, and related pain going into the arms and legs · Neck and back disk problems · Chronic headaches · Tendonitis, Bursitis, Sprains and Strains of the arms and legs · Muscle Strains and Overuse Problems · Most types of injuries, including sports injuries, and those resulting from auto collisions. PRIVACY POLICY 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. Dr. David G. Madison, D.C., Inc. is required, by law, to maintain the privacy and confidentiality of your protected health information and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information. Disclosure of Your Health Care Information We may disclose your health care information to other healthcare professionals within our practice for the purpose of treatment, payment or healthcare operations. Treatment On occasion, it may be necessary to seek consultation regarding your condition from other health care providers associated with Dr. David G. Madison, D.C., Inc. It is our policy to provide a substitute health care provider, authorized by Dr. David G. Madison, D.C., Inc. to provide assessment and/or treatment to our patients, without advanced notice, in the event of your primary health care provider’s absence due to vacation, sickness, or other emergency situation. Payment As a courtesy to our patients, we will submit an itemized billing statement to your insurance carrier for the purpose of payment to Dr. David G. Madison, D.C., Inc. for health care services rendered. If you pay for your health care services personally, we will, as a courtesy, provide an itemized billing to your insurance carrier for the purpose of reimbursement to you. The billing statement contains your medical information, including diagnosis, date of injury or condition, and codes which describe the health care services received. At times, additional information may be requested by the Insurance Company and will be provided to them. The doctor may have to write a detailed report regarding your condition, the treatment provided, and an assessment of your future need for care and any permanent impairment or disability that you may have. Appointment Notifications We will allow family members to make, cancel and/or reschedule an appointment for you. We will allow them to know what time your scheduled appointment is for and if you are currently in the office for care. We will do this unless you specifically restrict us from doing so. We will not release any protected health information to them without your specific permission. As a courtesy to our patients, we may call your home prior to your scheduled appointment to remind you of your appointment time or to notify you of a missed appointment. If you are not at home, we leave a reminder message on your answering machine or with the person answering the phone. No personal health information will be disclosed during this recording or message other than the date and time of your scheduled appointment along with a request to call our office if you need to cancel or reschedule your appointment. We may also send you a card notifying you that you missed an appointment and requesting that you contact the office to reschedule. It is our policy to send a post-card letting you know that we have not seen you for a significant period of time. It is a wish that you are in good health, a reminder to do your recommended exercises and to call us if we can be of any further service to you. No personal health information is disclosed on the postcard. Workers’ Compensation We may disclose your health information as necessary to comply with California Workers’ Compensation Laws. Emergencies We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care about your medical condition or in the event of an emergency or of your death. Public Health As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications, and reporting disease or infection exposure. Judicial and Administrative Proceedings. We may disclose your health information in the course of any administrative or judicial proceeding. Law Enforcement. We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and for other law enforcement purposes. Deceased Persons. We may disclose your health information to coroners or medical examiners. Organ Donation. We may disclose your health information to organizations involved in procuring, banking, or transplanting organs and tissues. Research. We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board. Public Safety. It may be necessary to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or to the general public. Specialized Government Agencies. We may disclose your health information for military, national security, prisoner and government benefits purposes. Change of Ownership. In the event that Dr. David G. Madison, D.C., Inc. is sold or merged with another organization, your health information/record will become the property of the new owner. Your Health Information Rights You have the right to request restrictions on certain uses and disclosures of your health information. Please be advised, however, that Dr. David G. Madison, D.C., Inc. is not required to agree to the restriction that you requested. You have the right to have your health information received or communicated through an alternative method or sent to an alternative location other than the usual method of communication or delivery, upon your request. You have the right to submit a request to inspect and copy your health information. There will be reasonable charge for any copies of your information or a written report regarding the information. You have a right to request that Dr. David G. Madison, D.C., Inc. amend your protected health information. Please be advised, however, that Dr. David G. Madison, D.C., Inc. is not required to agree to amend your protected health information. If your request to amend your health information has been denied, you will be provided with an explanation of our denial reason(s)and information about how you can disagree with the denial. You have a right to receive an accounting of disclosures of your protected health information made by Dr. David G. Madison, D.C., Inc. You have a right to a paper copy of this Notice of Privacy Practices at any time upon request. Changes to this Notice of Privacy Practices Dr. David G. Madison, D.C., Inc. reserves the right to amend this Notice of Privacy Practices at any time in the future, and will make the new provisions effective for all information that it maintains. Until such amendment is made, Dr. David G. Madison, D.C., Inc. is required by law to comply with this Notice. Dr. David G. Madison, D.C., Inc. is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about your privacy rights, please contact: Ms. Lorri Coles by calling this office at (909) 784-7800. If Ms. Lorri Coles is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days. Complaints Complaints about your Privacy rights, or how Dr. David G. Madison, D.C., Inc. has handled your health information should be directed to Lorri Coles by calling this office at (909) 784-7800 If Ms. Lorri Coles is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days. If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to: DHHS, Office of Civil Rights 200 Independence Avenue, S.W. Room 509F HHH Building Washington, DC 20201 This notice is effective as of April 22, 2003.