Cancellation/No Show Fee
Please call us at least 24 hours prior to your appointment if you need to cancel or reschedule. This will allow time for the slot to be filled by another patient. If you do not come to your appointment without canceling ("no show"), or cancel with less than 24 hours notice, you will be required to pay a fee of $50. We will keep a credit card on file for all patients and it will be charged within 48 hours of the missed appointment.
We strive to be on time out of respect for both your and our time. Therefore, we request patients arrive early and let us know when they are running late. Appointment times may be cut short or rescheduled in order to keep on schedule. If an appointment must be rescheduled due to tardiness, a fee may be charged.
For non-urgent questions please call us at the clinic at 541-636-3079. For non-urgent medically related questions you can also contact us through the patient portal messaging system. If you have an urgent health concern after hours and require immediate assistance please seek urgent care. For a life-threatening emergency, always call 911 immediately.
We provide patients with access to a patient portal where you can message the clinic, schedule appointments, and view your treatment plans, lab results, and other handouts.
Email is a convenient way to communicate brief questions or concerns regarding recent appointments with practitioners, please use the patient portal messaging system as email is not secure. However, in order to provide the best patient care, we will request you to schedule an appointment for more detailed questions or concerns.
When practitioners take vacations they may or may not be able to be reached by phone. In these situations associate practitioners will provide coverage for established patients. Please call our office with any additional questions or concerns.
Please call your pharmacy and ask them to send us a refill request. Many medications require monitoring by exam and/or labs and therefore will not be refilled without proper follow-up. Please plan ahead, some refills may take 3 to 5 days to review and authorize for renewal.
We rarely believe it is in the best interest of our patients to rely on chronic narcotics or sedatives, and thus infrequently prescribe them. If you come to us on chronic narcotics or sedatives we will work to decrease your dose to the lowest tolerable level. Additionally, for both your safety and ours, we require a signed contract and random drug testing for continued prescribing. By law, these medications cannot be refilled over the phone and any refills will require an office visit.
With regards to follow-up, we will attempt to contact you at your preferred phone number three times and then we will send a letter to your address on file as a final attempt to contact you.
Termination of Practitioner-Patient Relationship
You may terminate your relationship with us at any time for any reason. We would appreciate communication from you expressing your desire for termination, but it is not required. Likewise, we may terminate your relationship at any time. Generally, we will reserve this measure for patients who are not abiding by the stated policies, are delinquent in paying bills, or are disrespectful to practitioners, the clinic or staff members. If we choose to terminate you as a patient, you will be notified in writing. You will then have 30 days to find a new practitioner, during which time we will be available to you for urgent health issues only. You may request a transfer of medical records to your new practitioner.
- The patient (or patient’s guardian, if a minor) is ultimately responsible for the payment for treatment and care.
- We will bill your insurance for you. However, the patient is required to provide the most correct and updated information regarding insurance.
- Patients are responsible for payment of co-pays, coinsurance, deductibles and all other procedures or treatment not covered by their insurance plan.
- We are IN-NETWORK with the following insurance companies, but please note individual plans may vary.
- Pacific Source
- Blue Cross/Blue Shield of Oregon
- Oregon Health Plan (Pacific Source Community Solutions and Trillium)
- We will bill as an OUT-OF-NETWORK provider for all other insurance plans, please note that this may effect your coverage. We do not bill Medicare.
- If a practitioner that provided services is NOT in-network/contracted with your insurance carrier you will be responsible for full payment at the time of service. Once your patient responsibility has been determined a co-pay may be collected for ongoing visits.
- Your insurance policy is a contract between you and your insurance carrier and we cannot guarantee payment of your claims.
- Co-pays are due at the time of service. Co-insurance, deductibles and non-covered items are due 30 days from receipt of billing. Patients may incur, and are responsible for payment of additional charges, if applicable.
- The following items are not covered by most insurance plans and therefore you will be directly responsible. These charges may include:
- Charge for returned checks ($25)
- Late cancellation/missed appointments without 24 hours notice ($50)
- Telephone consultations ($70 per 15 minutes)
If you fail to make a payment when due (30 days from date invoiced), you will be sent a second bill as well as given the option for a payment plan. If you do not respond to the second bill within 30 days, your account will be referred to a collection agency for collections. In that event, any fees assessed by the collection agency will be assessed in the amount of 40% of the outstanding balance as permitted by ORS 697.115.
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 AS THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
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, or to family and friends you approve.
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. You also have the right to request restrictions on disclosure of PHI (Personal Health Information),or alternative means of communication to ensure privacy.
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 or national security activities.
Abuse or Neglect: We may disclose your health information to appropriate authorities when we suspect abuse or neglect.
Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders
(Such as voicemail messages, texts, postcards, or letters).
Access: You have the right to look at or get copies of your health information with limited exceptions. If you request copies, we will charge you a reasonable fee to locate and copy your information, and postage if you want the copies mailed to you.
Amendment: You have the right to request that we amend your health information.
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 by mail addressed to:
Alive Integrative Medicine
1902 Jefferson St. Suite 1
Eugene, OR 97405
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 with the U.S. Department of Health and Human Services. A Privacy/Contact Officer has been designated for this office. The Privacy Officer can be contacted by simply contacting the office and asking to speak to the Office Manager who serves as the Privacy Officer.