• Clinic Policy (Read only)

  • CLINIC POLICIES:

    I understand that this clinic is by appointment only and office hours vary by location and by day. Drop ins cannot be accommodated. I have the right to be informed about my health condition(s) and recommended treatment. This disclosure is to help me to become better informed by discussing potential benefits, risks and hazards involved. Botanical/herbal medicines, prescribing of various therapeutic substances may be given. I understand that the US Food and Drug Administration have not approved nutritional, herbal and homeopathic substances. I understand there is an after hours pager for emergency calls that will be answered by rotating physicians of the clinic and may not be the physician that I am familiar with. After hours calls are subject to a fee.

  • FINANCIAL RESPONSIBILITY:

    I understand that payment of all services, copays, balances and outside lab fees, as well as, dispensary items are due on the day of the visit and payable to the clinic that I am being seen at. I agree to be responsible for charges not covered by insurance. I understand that I am responsible for determining my insurance plan’s eligibility and benefits for all charges. I understand that my health insurance coverage may have certain restrictions and limitations, such as authorization requirements, non-covered services, co-insurance, co-pays and deductibles. I understand that I will be charged a fee for a missed appointment with less that 24-hour notice. I understand that if I call/message my physician about a new health concern, I may be asked to schedule an appointment or the call/message may be billed.Due to insurance and coding laws for billing, I understand that all well-child or well-adult annual exams will be billed as preventative care. If during my visit I have additional concerns or problems I want to discuss, that will require a diagnosis or treatment, it will incur additional charges. You and your physician may want to keep your preventative exam SEPARATE from a problem-oriented exam, due to insurance coverage. I give my permission to the clinic, along with any billing service, collection agency or attorney who may work on collecting monies on the clinic’s behalf, to contact me on my cell phone, home and/or work phone using prerecorded messages, artificial voice messages, automatic telephone dialing devices or other computer assisted technology, or by e-mail, text messaging, or by any other form of electronic communication. 

  • INSURANCE:

    I request that payment of authorized insurance benefits be made to clinic for any services provided to me by the clinic. I give permission to the clinic to release any medical information about me to Medicare or other insurers and its agents for the purpose of deciding benefits and processing claims. I authorize the clinic to act on my behalf as my authorized representative regarding all claims and appeals for the purpose of reimbursement.  This may include but is not limited to: requesting prior authorization or appealing denied claims. The clinic may request and receive any and all information that would be provided to me.  The clinic may act for me in providing information to the insurance plan that relates to claims or appeals for coverage or benefits under the plan.  The insurance plan will direct all information and/or notification regarding my claim or appeal to the clinic unless I otherwise provide specific written directions.  A financial advisor is available to help you find the best payment plan.

  • HIPAA NOTICE OF PRIVACY PRACTICES AND PROTECTED HEALTH INFORMATION (PHI):

    The Health Insurance Portability and Accountability Act (HIPAA) requires all health care providers to provide a Notice of Privacy Practices. The notice describes the ways we may use your information, when we may disclose this information to others and your HIPAA rights regarding your health information. 

  • These include the right to:

    • Receive Written Notice of Privacy Practices, which details individual rights and provides examples about how health information is used for treatment, payment, and health care operations.
    • Request a restriction on specific uses and disclosures of protected health information.
    • Receive confidential communications of health information.
    • Access, inspect and copy protected health information.
    • Request amendment and/or correction of protected health information.
    • Receive an accounting of disclosures of protected health information.
    • File a complaint with the clinic as well as with the Department of Health and Human Services.

    We have prepared a Notice of Privacy Practices for you. This document tells you what we do with your health information and what your rights are. This document is available upon request.

  • RELEASE OF MEDICAL RECORDS:

    I understand that my records may contain confidential information and that my records may be released or obtained for the clinic or providers of the clinic on an as needed basis, per HIPAA laws. I authorize that my information may be released to or from any of the providers of the clinics; Naturopathic Family Medicine located at 4411 Fremont Ave N, Seattle, WA 98103, or/and Natural Healthcare Northwest 509 Olive Way, Suite 1645 Seattle, WA 98101 and/or West Seattle Natural Medicine 3256 California Ave SW, Seattle, WA 98116. 

  • CREDIT CARD POLICY

    At this clinic, we require keeping your credit, debit card, or HSA on file as a convenient method of payment for the portion of services that your insurance doesn’t cover for which you are liable. We keep your credit card on file for the following instances: 1. Your credit card will be charged for any outstanding balance owed after three billing cycles (90 days). 2. You have charges for a cancellation and/or no show fees not paid within 7 days. Please speak to us if there are extenuating circumstances that prevented you from attending your visit. 3 Proof of insurance is required at each visit. If you do not provide insurance information in a timely manner, the cost of the visit will be charged to the credit card on file. Your credit card information is kept confidential and HIPAA secure. Payments to your card are processed only after the claim has been filed and processed by your insurer, the insurance portion of the claim has paid and posted to the account and 90 days has passed since your initial bill.
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