Billing, Insurance, and Policies

Financial Policy

Thank you for choosing our medical office as your child’s medical home. We are committed to providing and maintaining the best possible care for our patients and your family.

The affiliated offices of Medical Health Associates provide equal access to all its patients regardless of source of payment. Your review of our office financial policy in advance allows for effective communication and enables us to provide the highest quality service to your family. Each time you arrive at one of our offices, we will ask to confirm your current insurance, address and contact information. Keeping your file updated keeps the lines of communication open in case we need to reach you regarding your child’s health or your account.

At the time of each appointment, please provide your insurance card, current residential address and copayment/coinsurance. If you have any questions or concerns, please contact our billing office at 716-639-0155 Monday through Friday 8:00 am through 4:30 pm.

Your Insurance/Health Plan

We participate with numerous insurance companies and health plans including most local insurance plans and many national plans. You are responsible for providing current or updated insurance information at each appointment.

If your insurance carrier requires a designated primary care physician (PCP), you are responsible for contacting your insurance or health plan prior to your visit.

Please be aware that some insurance companies do not pay the entire doctor’s bill, therefore you may be responsible to pay for some of or all the balance.

You should be aware of your insurance coverage policy provisions, authorization requirements and network providers. You are responsible for providing our offices with prior authorization if your insurance company requires it. Most insurance plans have a website or call-center that can provide this information.
Copayments

At the check in, we will collect your office co-payment and open balances. We accept cash, checks, debit cards, MasterCard, Visa, Discover, and American Express. During a visit to our office, patients may receive various kinds of services; each service may have a separate charge.

MHA reserves the right to reschedule your appointment if you arrive unprepared to settle your outstanding financial obligation.

If your scheduled visit is for a “well” service and additional time is spent by your provider to address acute care or “sick” issues, there may be additional charges for those services.
High Deductible Plans
Health and Developmental Screening

The providers of MHA use and bill for standardized screening forms to gather valuable behavioral health, mental health, and social status data to strengthen their assessment of a patient’s social and emotional development. You will be responsible for the balance not paid by your insurance.
After Hour Services
Urgent, Non-Scheduled Visits
Non-Participating Insurance Companies
Non-Covered Services

If your health insurance company determines a service is “not covered”, you will be responsible for the complete charge. You may be asked to sign a form outlining the charges that could be incurred at that day’s visit. Should your insurance not cover the charges, we will personally bill you for the services. Payment is due upon receipt of that statement.

Please determine in advance if your insurance plan completely covers immunizations. All our affiliate offices participate in the Vaccines for Children (VFC) program. If your insurance plan does not cover immunizations or you have no insurance coverage, VFC provides immunizations for children under 19 years old at no cost to you. While the cost of the vaccine will be covered by the VFC program, you will be responsible for an administration fee.
Medicaid and Medicaid Managed Care

We participate with some NYS Medicaid and Medicaid Managed Care insurance plans. If you are required by Medicaid to select a managed care plan, please make sure you inform our office of your selection. You are responsible for selecting your primary care physician either through the plan’s website or by phone call. Failure to select a PCP may prevent you from being able to schedule an appointment.
NYS Child Health Plus and NYS Essential Plan
No Fault and Workers Compensation

If you have sustained injuries in a motor vehicle accident, please notify us at the time of your appointment. We do not submit claims to No Fault; however, we will provide you with the information and paid receipt needed to bill your insurance. We will collect payment at the time of service.
Minor Patients

Patients under the age of 18 require parental consent for any treatment or immunization except as permitted by New York State law. The parent/guardian accompanying the minor patient will be responsible for payment of all services rendered, whether the account is considered self-pay, participating insurance, or non-participating insurance.
Statement Fee
Past Due Accounts

An account is considered past due if no payment is received within 30 days of the first account statement. Patients with past due accounts must make a payment before the next appointment with their health care provider. Accounts beyond 60 days past due are considered delinquent and may be forwarded to a collection agency. A 25% surcharge will be assessed on accounts that are sent to a collection agency plus legal fees, if any.
Payment Arrangements

If you are unable to make full payment of the account balance when due, arrangements for a budget payment plan can be made with our billing office. Please call 716-639-0155 Monday through Friday 8:00 am through 4:30 pm. Note: There is a $5.00 per statement fee on budget payment accounts.
Telemedicine Services
Insufficient Funds Checks
Billing Company

Our insurance and patient billing services are handled by HealthTec Solutions. The staff at HealthTec Solutions works very closely with the affiliated practices of Medical Health Associates to ensure that your insurance is billed properly, and that full reimbursement is received from your insurance company.

For any questions regarding your account, please call HealthTec Solutions at 716-639-0155 Monday through Friday 8:00 am through 4:30 pm.
Missed Appointments

A missed appointment prevents our practice from providing care to other patients. Patients who miss or cancel their scheduled appointment without notifying our office more than 24 hours in advance will have a $50 fee applied to their account, depending on the health plan. MHA reserves the right to discharge you from the practice due to frequent missed appointments. In this event, you will be unable receive services from other MHA member practices.
Refunds
Financial Non-Compliance

Medical Health Associates of Western New York, PLLC

Vaccine Policy

One of the most important services we can provide to our patients is to give vaccinations against life threatening diseases. We strongly agree with the American Academy of Pediatrics (AAP) and Centers for Disease Control (CDC) that childhood vaccines are critical to maintaining healthy children and communities. As medical professionals, we feel that vaccinating children following the recommended schedule with currently available vaccines is absolutely the right thing to do for all children and young adults.

We firmly believe in the effectiveness of vaccines to prevent serious illness and save lives.
We firmly believe in the safety of our vaccines.
We firmly believe that all children and young adults should receive all of the recommended vaccines according to the AAP and the CDC.
We firmly believe, based on all available literature, evidence, and current studies, that vaccines do not cause autism or other developmental disabilities.
We firmly believe that vaccinating children and young adults may be the single most important health-promoting intervention we perform as healthcare providers, and that you can perform as parents/caregivers.

Our policy is that:

We adhere to the American Academy of Pediatrics (AAP) Immunization Guidelines.
Because we are committed to protecting the health of your children, we require all of our patients to be vaccinated.
Any parent who refuses to adhere to the AAP recommended vaccine schedule may be discharged from our practice following a 30-day written notice.
If you refuse to vaccinate your child despite all our efforts, we will ask you to find another healthcare provider who shares your views. Please recognize that by not vaccinating you are putting your child and others around you at unnecessary risk for life threatening illness and disability and even death.
We understand that the choice to vaccinate may be a very emotional decision for some parents. We will do everything we can to educate you that vaccinating according to the recommend schedule is the best thing you can do for your child. If you have doubts, please talk with your child’s pediatrician.

Have Any Vaccine Related Questions?

Medical Health Associates of Western New York, PLLC (MHA)

Privacy Notice

IMPORTANT: Please review the Privacy Notice. The notice describes how your medical information may be used and disclosed. The notice also provides information on how you can access your information.

Medical Health Associates of Western New York (MHA) has made a commitment to maintain the privacy of certain confidential health care information about you, known as Protected Health Information or PHI. We are required by law to protect your health care information and to provide you with this Notice of Privacy Practices.

The Notice outlines our legal duties and privacy practices with respect to your PHI. It not only describes our privacy practices and your legal rights, but lets you know, among other things, how MHA is permitted to use and disclose PHI about you, how you can access and copy that information, how you may request amendment of that information, and how you may request restrictions on our use and disclosure of your PHI.

MHA is also required to abide by the terms of the version of this Notice currently in effect. In most situations we may use this information as described in this Notice without your permission, but there are some situations where we may use it only after we obtain your written authorization, if we are required by law to do so.

We respect your privacy and treat all health care information about our patients with care under strict policies of confidentiality. The staff of MHA are committed to following at all times.

PLEASE READ THE BELOW DETAILED NOTICE. IF YOU HAVE ANY QUESTIONS ABOUT IT, PLEASE CONTACT OUR OFFICE.

Expand Detailed Notice
Purpose of This Notice: MHA is required by law to maintain the privacy of certain confidential health care information, known as Protected Health Information or PHI, and to provide you with a notice of our legal duties and privacy practices with respect to your PHI. This Notice describes your legal rights, advises you of our privacy practices, and lets you know how MHA is permitted to use and disclose PHI about you.

MHA is also required to abide by the terms of the version of this Notice currently in effect. In most situations we may use this information as described in this Notice without your permission, but there are some situations where we may use it only after we obtain your written authorization, if we are required by law to do so.

Uses and Disclosures of PHI: MHA may use PHI for the purposes of treatment, payment, and health care operations, in most cases without your written permission. Examples of our use of your PHI:

For treatment. This includes such things as verbal and written information that we obtain about you and use pertaining to your medical condition and treatment provided to you by us and other medical personnel. It also includes information we give to other health care personnel who participate in your care and treatment, and includes transfer of PHI via fax, electronic means or telephone to other providers as well as providing other medical professionals with a copy of the written record we create in the course of providing you with treatment.

For payment. This includes any activities we must undertake in order to get reimbursed for the services we provide to you, including such things as organizing your PHI and submitting bills to insurance companies (either directly or through a third party billing company), management of billed claims for services rendered, medical necessity determinations and reviews, utilization review, and collection of outstanding accounts.

For health care operations. This includes quality assurance activities, licensing, and training programs to ensure that our personnel meet our standards of care and follow established policies and procedures, obtaining legal and financial services, conducting business planning, processing grievances and complaints, creating reports that do not individually identify you for data collection purposes and certain marketing activities.

Reminders. We may also contact you to provide you with a reminder of any scheduled appointments or for other information about alternative services we provide or other health-related benefits and services that may be of interest to you.

Use and Disclosure of PHI Without Your Authorization. MHA is permitted to use PHI without your written authorization, or opportunity to object in certain situations, including:

For use in treating you or in obtaining payment for services provided to you or in other health care operations;

For the treatment activities of another health care provider;

To another health care provider or entity for the payment activities of the provider or entity that receives the information (such as a hospital or insurance company);

To another health care provider for the health care operations activities of the entity that receives the information as long as the entity receiving the information has or has had a relationship with you and the PHI pertains to that relationship;

For health care fraud and abuse detection or for activities related to compliance with the law;

To a family member, other relative, or close personal friend or other individual involved in your care if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection. We may also disclose health information to your family, relatives, or friends if we infer from the circumstances that you would not ob For example, we may assume you agree to our disclosure of your personal health information to your spouse. In situations where you are not capable of objecting (because you are not present or due to your incapacity or medical emergency), we may, in our professional judgment, determine that a disclosure to your family member, relative, or friend is in your best interest. In that situation, we will disclose only health information relevant to that person’s involvement in your care;

To a public health authority in certain situations (such as reporting a birth, death or disease as required by law, as part of a public health investigation;

To report child or adult abuse or neglect or domestic violence;

To report adverse events such as product defects, or to notify a person about exposure to a possible communicable disease as required by law;

For health oversight activities including audits or government investigations, inspections, disciplinary proceedings, and other administrative or judicial actions undertaken by the government (or their contractors) by law to oversee the health care system;

For judicial and administrative proceedings as required by a court or administrative order, or in some cases in response to a subpoena or other legal process;

For law enforcement activities in limited situations, such as when there is a warrant for the request, or when the information is needed to locate a suspect or stop a crime;

For military, national defense and security and other special government functions;

To avert a serious threat to the health and safety of a person or the public at large;

For workers’ compensation purposes, and in compliance with workers’ compensation laws;

To coroners, medical examiners, and funeral directors for identifying a deceased person, determining cause of death, or carrying on their duties as authorized by law;

If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ donation and transplantation;

For research projects, but this will be subject to strict oversight and approvals and health information will be released only when there is a minimal risk to your privacy and adequate safeguards are in place in accordance with the law;

We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.

Any other use or disclosure of PHI, other than those listed above, will only be made with your written authorization, (the authorization must specifically identify the information we seek to use or disclose, as well as when and how we seek to use or disclose it). You may revoke your authorization at any time, in writing, except to the extent that we have already used or disclosed medical information in reliance on that authorization.

Patient Rights: As a patient, you have a number of rights with respect to the protection of your PHI, including:

The right to access, copy or inspect your PHI. This means you may come to our offices and inspect and request a copy of most of the medical information about you that we maintain. We will normally provide you with access to this information within 30 days of your request. We may also charge you a reasonable fee for copies of any medical information that you have the right to access. In limited circumstances, we may deny you access to your medical information, and you may appeal certain types of denials.

We have available forms to request access to your PHI, and we will provide a written response if we deny you access and let you know your appeal rights. If you wish to inspect and obtain copies of your medical information, you should contact the Privacy Officer listed at the end of this Notice.

You should take note that, if you are a parent or legal guardian of a patient that is a minor, certain portions of the minor’s medical record will not be accessible to you (e.g., records relating to venereal disease, abortion, or care and treatment to which the minor is permitted to consent himself/herself (without your consent) such as HIV testing, sexually transmitted disease diagnosis and treatment, chemical dependence treatment, prenatal care, care received by a married minor, and contraception and/or family planning services).

The right to amend your PHI. You have the right to ask us to amend written medical information that we may have about you. We will generally amend your information within 60 days of your request and will notify you when we have amended the information. We are permitted by law to deny your request to amend your medical information only in certain circumstances, such as when we believe the information you have asked us to amend is correct. If you wish to request that we amend the medical information that we have about you, you should contact the Privacy Officer listed at the end of this Notice.

The right to request an accounting of our use and disclosure of your PHI. You may request an accounting from us of certain disclosures of your medical information that we have made in the last six years prior to the date of your request. We are not required to give you an accounting of information we have used or disclosed for purposes of treatment, payment or health care operations, or when we share your health information with our business associates, like our billing company or a medical facility.

We are also not required to give you an accounting of our uses of protected health information for which you have already given us written authorization. If you wish to request an accounting of the medical information about you that we have used or disclosed that is not exempted from the accounting requirement, you should contact the Privacy Officer listed at the end of this Notice.

The right to request that we restrict the uses and disclosures of your PHI. You have the right to request that we restrict how we use and disclose your medical information that we have about you for treatment, payment or health care operations, or to restrict the information that is provided to family, friends and other individuals involved in your health care. But if you request a restriction and the information you asked us to restrict is needed to provide you with emergency treatment, then we may use the PHI or disclose the PHI to a health care provider to provide you with emergency treatment. MHA is not required to agree to any restrictions you request, but any restrictions agreed to are binding by MHA.

Internet, Electronic Mail, and the Right to Obtain Copy of Paper Notice on Request. If you allow us, we will forward you this Notice by electronic mail instead of on paper and you may always request a paper copy of the Notice.

Revisions to the Notice: MHA reserves the right to change the terms of this Notice at any time, and the changes will be effective immediately and will apply to all protected health information that we maintain. Any material changes to the Notice will be promptly posted in our office and posted to our website if we maintain one. You can get a copy of the latest version of this Notice by contacting the Privacy Officer identified below.

Your Legal Rights and Complaints: You also have the right to complain to us, or to the Secretary of the United States Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against in any way for filing a complaint with us or to the government. Should you have any questions, comments or complaints, you may direct all inquiries to the Privacy Officer listed at the end of this Notice. Individuals will not be retaliated against for filing a complaint.

If you have any questions or if you wish to file a complaint or exercise any rights listed in this Notice, please contact our office.

Effective Date of the Notice: January 1, 2019 CPT

Billing, Insurance, and Policies

Medical Health Associates of Western New York, PLLC

Financial Policy

Medical Health Associates of Western New York, PLLC

Vaccine Policy

Have Any Vaccine Related Questions?

Medical Health Associates of Western New York, PLLC (MHA)

Privacy Notice

Medical Health Associates of Western New York

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