The document encapsulates the collective understanding and commitments established between the involved parties, namely the individual or entity using our website(s) and our services, and 180 Health Clinic, PLLC (hereinafter referred to as 180 Health Clinic).
It serves as a comprehensive record detailing the terms, conditions, policies, operations and obligations mutually agreed upon by both parties. This agreement outlines the rights and responsibilities, defining the framework within which the relationship will operate.
By documenting these mutual agreements, it provides a clear reference point, fostering transparency, and mitigating potential misunderstandings, thereby promoting a harmonious and well-defined collaboration between the parties involved.
For our Correspondence and Legal Notice contact information, click on this link.
Data Collection for Medical Use
Our commitment to user safety is paramount in our policy for medical data collection via phone or website or during House-Calls. Prioritizing transparency and privacy, we ensure that users are fully informed and grant explicit consent before collecting any medical data.
Rigorous security measures, including encryption and access controls, are implemented to protect against unauthorized access or disclosure.
Compliant with relevant regulations, such as HIPAA, we collect the minimum necessary medical data solely for healthcare purposes, and under no circumstances is it used for unauthorized activities.
Users retain control over their data with access rights and the ability to request corrections or deletions. In the event of a data breach, prompt notifications and remedial actions are undertaken to safeguard user information.
Regular policy reviews ensure ongoing alignment with the highest standards of security, privacy, and ethical data handling practices.
Financial Policy
Payments are due at the time of service for office visits including any follow up office visit(s).
Payments made through your insurance, are a contract between you and your insurance company; therefore, 180 Health Clinic is unable to waive them. Based on standard insurance and clinic guidelines, all payments, co-pays, and outstanding balances are due at the time of service.
180 Health Clinic accepts insurance plans (see details of Insurance Accepted on our SERVICES page). Additional forms of payments include debit cards, MasterCard, Visa, Discover and American Express.
As described on our SERVICES page, here’s what we accept:
• Debit/Credit (Visa, MC, American Express), PayPal, Flexible Spending Accounts (FSA), and Health Savings Account (HSA)
Other Insurances Accepted:
• Medicare/Medicaid
• BCBS (HMO/PPO)
• Cigna (HMO/PPO)
• Aetna (HMO/PPO)
• TRICARE
• United Health (HMO/PPO)
• Workman’s Comp
As a service to you, 180 Health Clinic will process an insurance claim on your behalf. Not all insurance plans cover all services. In the event your insurance plan determines a service is not a covered benefit, you will be responsible for the entire charge.
Payment for past due patient balances will be collected prior to obtaining additional services. To ensure all billing and financial matters are handled appropriately, 180 Health Clinic engages a third-party agency to review and process all refund requests and therefore cannot issue refunds in the facility under any circumstance.
Self-Pay Patients
For all self-pay patients, payment is due in full at the time of service. This includes payment for any ancillary services including but not limited to labs, x-rays, immunizations, injections or procedures.
At any time if you choose to be seen as a self-pay patient, 180 Health Clinic will not be able to bill your insurance carrier for the cost of the office visit. The self-pay fees are only available for self-pay patients who pay in full at the time of service.
Worker’s Compensation Claims
If the injury is not approved, your insurance cannot be billed, and the services will be your responsibility.
Responsible Party: Patient
You agree that you have read and understand 180 Health Clinic’s Patient Policies (shown below), and you agree to be bound by its terms. You also understand and agree that such terms may be amended by the practice from time to time. You understand that you are responsible for all charges regardless of insurance coverage.
You agree to pay for your account with 180 Health Clinic in accordance with the standard rates and payment terms of this clinic. you agree that you have to provide all information including accurate provision and completion of insurance forms and information needed to process payment.
If you do not provide all necessary information, you understand you will be responsible for all charges incurred for any and all healthcare services provided by 180 Health Clinic.
You understand that a monthly late fee of $10 will be assessed for all patient balances over 30 days old. If it is deemed necessary, in the sole discretion of this clinic, to take collection action as a result of nonpayment, you understand that any collection expenses incurred, including late fees, attorney’s fees and contingency collection fees are ALL YOUR responsibility.
PRIMARY CARE PROVIDER (PCP)
You hereby authorize 180 Health Clinic to appoint a 180 Health Clinic provider as your Primary Care Provider (PCP). You hereby opt in to receive communications both related and unrelated to your healthcare in the form of SMS/Text and/or email from 180 Health Clinic. You agree and understand you may rescind this authorization, or Opt-Out, at any time by submitting written request to 180healthclinic@gmail.com.
NOTICE OF HEALTH INFORMATION PRACTICES
180 Health Clinic may participate (at any time of its choosing) in a non-profit, non-governmental health information exchange (HIE) called Health Current. This participation will not cost you anything and can help your doctor, healthcare providers, and health plans better coordinate your care by securely sharing your health information.
By agreeing to our TERMS, you acknowledge that you have received and read the Notice of Health Information Practices. You further understand that your healthcare provider participates in Texas Health Current, or similar health information exchange (HIE) and understand that your health information may be securely shared through the HIE unless you complete and return an Opt Out Form to your healthcare provider. The Opt Out Form is available upon request submitted to 180healthclinic@gmail.com.
PATIENT POLICIES
180 Health Clinic is your “House-Call Medical Home”, where you can be seen for all of your medical needs. Feel free to make an appointment in advance through our website. We are here whenever you need us. Providing you with superior healthcare is our number one priority.
Overview
We strive to provide you with all of your Internal Medicine needs. However, with certain HMO and Medicaid (AHCCCS) plans, we can only provide services if 180 Health Clinic and we will let you know in advance, where and when possible.
If you have an HMO or Medicaid (AHCCCS) plan, 180 Health Clinic needs to be designated as your primary care physician’s office in order for you to take advantage of all the services we provide.
These primary care services could include:
– Acute Illness, Headaches, Dizziness, Eye Conditions, Sore Throat, Ear Pain, Sinusitis, Flu
– Influenza, Serious Colds, Seasonal/Sinus Allergies, Infections, Fever, Strep Throat Analysis
– Ear, nose, and Throat Ailments, Earwax Removal, Bronchitis, Pneumonia, Asthma/COPD
– High Blood Pressure, Heart Disease, Congestive Heart Failure, Diabetes, Glucose Testing
– Sleeplessness, Anxiety/Stress, Depression, Weight Management
– Kidney Infections and Stones, Pregnancy Testing, Anemia, STD Evaluation and Treatment
– Skin Infections, Insect Bites, Rash, Hives, Allergic Reactions, Minor Burns, Acne, Cold Sores, Eczema
– Animal/Human Bites, Puncture Wounds, Lacerations, Suture Removal, Abscesses/Boils, Ingrown Toenails
– Abdominal Pain, Digestive Problems, Nausea/Vomiting, Heartburn/GERD, Gastritis, Diarrhea, Constipation, Food Poisoning, Stomach Flu
– Urinary Tract Infections (UTI), Urine Analysis, Urine Drug Screen Testing
– Sports Injuries, Sprains and Strains, Aches and Pains, Arthritis
– Back and Neck Pain (work injuries, muscle spasms, herniated discs)
– Shoulder, Elbow, and Hand Injuries
– Hip, Knee, Ankle, and Foot Injuries
– Alcohol and Drug withdrawal and detox
– Immunizations/Vaccines (including Flu Shot), Tuberculosis (TB) Skin Testing
– Sports Physicals, Employment Physicals, DMV Physicals
– Pre-op Clearance, Medical Clearance
– Travel Clinic Medicine and related Immunizations
– Injections (including Antibiotics, Pain Medicines, Anti-Nausea, Anti-Inflammatory, Anti-Allergy, Vitamin B12, Tetanus, Pertussis, and many more)
– Adult Medical Care, Geriatric Medical Care
– Laboratory Services (blood-work), and IV Fluids.
– X-rays, Ultrasound, EKG
– Telemedicine, Telehealth, and Telephone Consultation services (through interactive video, etc.).
Refills & Prescriptions
Medication errors involving prescription drugs account for 1.5 million injuries and deaths per year according to the esteemed Institute of Medicine. Of this number, 400,000 cases of medication errors are preventable.
In order to minimize preventable medication errors and provide the highest quality care, medication refills are best addressed at the time of your visit with your provider; please have all of your medications with you at the time of every visit.
Once an ailment or disease process is stable or controlled, you may receive a 3 to 6-month supply of medication at your provider’s discretion.
Prior to running out, we ask that you meet with your provider for re-evaluation to obtain refills, as they will not be refilled over the phone, by fax, or request from your pharmacy. Refills on antibiotics and narcotics are strictly prohibited.
Please note that lost prescriptions will not be refilled and will require a new visit with your provider (this includes self-pay patients).
Please also note that the providers at 180 Health Clinic are unable to see, evaluate, examine, or diagnose patients who are not officially being seen at a House Call visit, or through a Telemedicine visit.
Medical Visits
Based on a report from the National Academy of Sciences’ Institute of Medicine, preventable medical errors cause over 98,000 fatalities each year.
As we strive to provide the highest quality care to our patients, 180 Health Clinic has implemented policies to help ensure optimal care.
Therefore, the providers at 180 Health Clinic cannot treat, evaluate, or change the treatment modalities of anyone who is not officially being seen as a patient. This policy extends to giving medical advice or changing treatment modalities over the phone.
We are always happy to serve our patients, so if there are ever any questions or concerns regarding your healthcare, please don’t hesitate to come in for an office visit or schedule a House Call or Telemedicine visit for further evaluation.
Clinic policy states that all patients who visit 180 Health Clinic for any type of care or assistance are required to have a full set of vitals completed at the time of House Call visits.
Cancellation Policy
As a courtesy to other patients, we ask that you provide us with at least 24 hour notice if you need to cancel or reschedule your appointment. 180 Health Clinic reserves the right to charge a $25 fee to all patients who are in violation of this policy.
Co-Pays
All co-pays are due at the time of service; this includes follow-ups, nurse visits and blood draws (if it applies). All fees, co-pays, and outstanding balances are due at the time of service; failure to collect such balances as a result of oversight or misinformation provided by the payer does not void or negate balances due and may be subject to additional late and collection fees. A $10 convenience fee will be charged for all uncollected co-pays.
Preventative Medicine
Preventative medicine (such as physicals, well woman exams, and well child checks) is the part of medicine engaged with preventing disease rather than treating it.
For the sake of thoroughness, during a preventative office visit, the providers at 180 Health Clinic may defer treatment of other ailments or disease processes for a later visit.
If other non-preventative issues are addressed at the time of a preventative visit, the applicable co-pays will need to be collected prior to completing your visit.
Preventative visits are only exempt from co-pays when the focus of the encounter is strictly preventative and does not, in any manner, address non-preventative complaints, concerns, issues, or refills.
Medical House-Call Visit Basics
A medical visit is comprised of an evaluation by a trained medical professional. A medical visit in no way guarantees that any form of medication, treatment, referral, diagnostic study, doctor’s excuse, or any other request made by the patient will be granted. It is at the sole discretion of the provider to consider what is most prudent and requests for refunds will not be taken into consideration.
180 Health Clinic allows for a platform in which patient-provider interactions may occur; differing, conflicting, opposing, contradictory, inaccurate opinions, and/or diagnoses do not negate or void balances due.
Lab & Study Results
In order to minimize miscommunication of study results, details will be addressed with our patients during the time of a medical visit. Specific details of lab and study results will not be discussed over the phone or other electronic communications. In the event of an abnormal result, we ask our patients to complete a medical visit for interpretation of results, further evaluation, and to discuss the abnormal findings and treatment plan with a provider.
You will receive notification from our office to provide you with instructions on when you should set additional appointments. If you have questions or concerns about normal study results, we invite you to schedule a medical visit and have a provider interpret the results and discuss any remaining questions and/or concerns which you may have. There will be a charge for these visits.
Food & Eating
Your Nurse Practitioner will consult with you regarding food consumption in cases where blood test is performed, and other similar circumstances. Please follow the instructions to make sure that your results are as accurate as possible.
Referrals & Prior Authorizations
The healthcare industry standard for the processing of referrals and prior authorizations is 14 days. At 180 Health Clinic, we strive to beat industry standards in every aspect.
Please allow 7-14 days for the processing of referrals and prior authorizations. We are our patient’s biggest advocates, and we believe in attacking ailments and disease processes aggressively.
The providers and staff at 180 Health Clinic work diligently to get approval for the studies and referrals we believe our patients need. Sometimes this process may take longer than we like, but please be patient as we work with your insurance company to get you the superior healthcare you deserve.
Please also remember we are prohibited from completing referrals and prior authorizations on ailments for which you have never been seen and/or evaluated for here at 180 Health Clinic.
Phone Messages
A 180 Health Clinic patient representative may contact you by phone to ensure that all questions and concerns have been adequately addressed. We encourage and request that our patients ask questions and provide feedback; we also request that our patients contact us anytime they have questions or concerns about their care. Please allow 24-48 hours for a return call from one of our team members when leaving messages.
Please also remember that the providers at 180 Health Clinic are not able to refill medications, give any medical advice, or make changes to any treatment modalities outside of a medical house-call visit.
If your needs must be addressed sooner, please feel free to complete a medical visit any time during office hours.
Copies of Records
We are happy to provide you with copies of any and all of your medical records upon your request. We hope that you will be happy to know that we are a paperless office and eliminate waste whenever possible.
To aid in this effort, we provide our patients with a personal electronic copy within 3 business days (72 hours) for a fee of $25. A personal electronic copy may be expedited to within one business day (24 hours) for a $50 fee.
Forms & Letters
In order to provide patients with requested forms and letters in a timely manner, a charge to complete each individual and separately identifiable form will be assessed. If a provider must write a letter or fill out forms and documents on behalf of the patient, a flat fee will be required to complete the request. Please allow 3 business days (72 hours) for this process to be completed. All fees are due at the time of request.
Forms, Disability and FMLA paperwork $25
Narrative Report $100
Medical & Doctor’s Excuse of Absence
An excuse of absence will be granted by the provider based on medical necessity. If an extension is required for an excuse of absence, the patient will need to be re-evaluated with an additional medical visit. An excuse of absence or an extension for an excuse of absence cannot be granted without an evaluation by a provider during a medical visit.
Pain Management
Pain is costly for individuals and society; an adult experiencing pain loses an average of 23 days of productivity per year. Moreover, pain can significantly affect the quality of life of an individual and cause disruptions in sleep, eating, mobility, and overall functional status.
Furthermore, millions of Americans live with pain, and since pain management is an integral and important part of medicine, the providers at 180 Health Clinic believe acute pain should be managed appropriately.
However, in order for our patient population to receive the best care possible, we recommend a pain specialist be utilized for the evaluation, management and treatment of chronic pain. To reiterate, we do not treat chronic pain at 180 Health Clinic.
Acute pain is defined as pain that has a recent onset, has a duration of less than 3 months, and subsides as healing occurs. Chronic pain is defined as pain that persists or progresses over a 3-month period, is often resistant to medical treatments, and may require a consistent dose of medication in order for the patient to remain functional.
Please be aware that standard medical protocol states that pain management after surgery is best handled by the surgeon’s office and not a primary care doctor.
Disruptive Behavior & the 180 Health Clinic Code of Conduct
180 Health Clinic’s Code of Conduct defines disruptive behavior as anything that an individual might do which may:
(A) interfere with the orderly conduct of the practice
(B) interfere with the ability of others to effectively carry out their duties
(C) interfere with patient care
(D) undermine a patient’s confidence in the practice or any member of the healthcare team
(E) be interpreted as offensive, disrespectful, demeaning, abusive, combative, confrontational, including any behavior and/or language which may be deemed to be inappropriate in any manner.
180 Health Clinic is fully committed to protecting its staff, providers, and patients against any form of disruptive behavior, and once the cornerstone of the doctor patient relationship is eroded the practice reserves the right to discharge the patient permanently.
180 Health Clinic will aggressively pursue and litigate against any disparaging statements and/or behavior which may be deemed as defamatory, libelous, or slanderous.
Pregnancy Tests
Please note that when urine studies are ordered by a provider, a pregnancy test will automatically be performed on all female patients of childbearing age regardless of past Gynecological, Obstetric, or surgical history.
Additional Policies
Please review the following policy guidelines for 180 Health Clinic: