You have the right to ask to view and receive a copy of your health records, have corrections added to your health information, receive a notice that tells you how your health information may be used and shared, decide if you want to give your permission before your health information can be used or shared for certain purposes, such as marketing, and receive a report on when and why your health information was shared for certain purposes. If you believe your rights are being denied or your health information isn’t being protected, you can ask your provider or health insurer questions about your rights and/or file a complaint. You also can learn more about your rights, including how to file a complaint from the Web site at www.hhs.gov/ocr/hipaa/ or by calling 1-866-627-7748.
A patient’s Statement of Rights has been established at the Center, with the expectation that observance of these rights will contribute to more effective patient care and greater satisfaction for the patient, their family, physician, and the facility caring for the patient. The following rights are available without regard to age, race, sex, national origin, religion, or physical handicap, are posted at the Center, and made available to the patient, their family, and/or the public upon request:
That the patient will receive the care necessary to help regain or maintain his maximum state of health. That the facility personnel who care for the patient are qualified through education and experience to perform the services for which they are responsible. That the patient will be treated with consideration, respect, and full recognition of individuality, including privacy in treatment and in care. That the patient is provided to the extent known by the physician, complete information regarding diagnosis, treatment and the prognosis. If medically inadvisable to disclose to the patient such information, the information is given to a person designated by the patient or to a legally authorized individual. Within the limits of the facility, the patient and family will be instructed in appropriate care techniques. That the patient or responsible person will be fully informed of services available in the facility, provisions for after-hours and emergency care, and related fees for services rendered. Information will be given to the patient on a timely basis. Financial incentives will be made available to patients, upon request. That the patient will be a participant in decisions regarding their care plan and will have the right to refuse treatment to the extent permitted by law and to be informed of the medical consequences of such a refusal. The patient will be requested to sign a release of responsibility form and, if refused, a registered letter will be sent. When the patient is not legally responsible, the surrogate decision maker, as allowed by law, has the right to refuse care, treatment, and services on the patient’s behalf. That plans will be made with the patient and family so that continuing services will be available to the patient throughout the period of need. The plans should be timely and involve the use of all appropriate personnel and community resources. Those facility personnel will keep adequate records and will treat with confidence, all personnel matters that relate to the patient. That the patient has the right to be notified, approve and/or refuse the release of protected health information (PHI) to any individual outside the facility, except when this information is used to facilitate health care procedures for their treatment, as required by law or a third party payment contract. That the patient has the right to be informed of any human experimentation or other research/educational projects affecting their care or treatment, and to refuse participation in such experimentation or research. That ethical principles will guide the business practices of the Center at all times. That the Center will provide for and welcome the expression of grievances/complaints and suggestions by the patient and/or the patient’s family, and these expressions can be submitted to the Center’s personnel authorized to handle grievances/complaints. That the patient has the right to change primary or specialty physicians, if other qualified physicians are available. That the patient has a right to have an advance directive, such as a living will or healthcare proxy. That the patient and/or patient’s family has a right to be fully informed before any transfer to another facility or organization. That the patient has a responsibility to observe prescribed rules of the Center for their stay and treatment and that the patient forfeits the right to care, at the Center, if printed instructions are not followed. That the patient is responsible for promptly fulfilling his or her financial obligations to the Center, and the right to request information on billing practices. Every attempt will be made to contact the patient prior to their scheduled procedure to advise them of financial responsibility. That the patient has a responsibility for being considerate of other patients and personnel, and for assisting in the control of noise and the number of visitors. That the patient has the right to accept medical care or to refuse treatment, to the extent permitted by law, and to be informed of the medical consequences of such refusal. The patient also has the responsibility for their action should they refuses treatment or do not follow the physician and/or Center instructions. That the patient is responsible for reporting whether they clearly understand the planned course of treatment and what is expected of them. Impairments may include but are not limited to vision, speech, hearing, or cognitive impairments. If interpretive services are required, those necessary will be provided by the Center to assure an understanding of the planned course of treatment. That the patient is responsible for keeping appointments and, when unable to do so for any reason, for notifying the Center and physician. That the patient care rendered reflects consideration of the patient as an individual with personal value and belief systems, which affect their attitude toward and response for the care provided by the Center. Patients are allowed to express those spiritual beliefs and cultural practices that do not harm others or interfere with the planned course of medical therapy for the patient. That the patient has the right to be free from mental, physical, sexual and verbal abuse, neglect and exploitation. That the patient has the right to pain management. That the patient will be provided the name of the physician or other practitioner primarily responsible for their care, treatment, and services and the name of the physician or other practitioner who will provide their care, treatment and services. Decisions regarding the provision of ongoing care, treatment, or services, discharge or transfer are based on the assessed needs of the patient, regardless or the recommendations of any internal or external review. That the organization will inform the patient or surrogate decision maker about unanticipated outcomes of care, treatment, or services that relate to sentinel events considered reviewable to accrediting organizations. The patient has a right to report complaints to the Arkansas Department of Health, http://www.healthyarkansas.com, 501-661-2201, 5800 West 10th, Suite 400, Little Rock, AR 72204 and/or to Medicare, www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html, 1-800-MEDICARE, Office of Inspector General, P. O. Box 23489, Washington, DC 20026, without regard to retaliatory retribution.
Arkansas Advance Directive
Because of the elective nature of the procedures performed at the Center, every effort will be made to sustain life during your stay at our facility. However, if you already have an Advanced Directive and/or Durable Power of Attorney for Healthcare, or Living Will, please bring a copy of this document with you, to be filed in your medical record. In the event of transfer to another healthcare facility, a copy of this document will be provide the receiving facility. If you do not have the above mentioned document, an Arkansas Declaration will be made available to you, if requested, as required by law. The Arkansas Declaration is your state’s living will, which allows you to state your wishes about medical care in the event that you either: (1) develop a terminal condition and are unable to make your own medical decisions; or (2) you are in a permanently unconscious state. The Declaration becomes effective when you are in either of these states, your physician and one other physician has determined you are in such a state, and the Declaration has been communicated to your doctor. The Declaration lets you name a Health Care Proxy to make decisions about your medical care—including decisions about life support — if you can no longer make your own decisions about healthcare. Your proxy can only make decisions for you if you become terminally ill or permanently unconscious.
You have the right to know that your physician may have a financial interest in the Center. Further information can be provided, at your request.
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or are treated by an out-of-network provider at an
in-network hospital or ambulatory surgical center, you are protected from
balance billing. In these cases, you shouldn’t be charged more than your plan’s
copayments, coinsurance and/or deductible.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-
pocket costs, like a copayment, coinsurance, or deductible. You may have
additional costs or have to pay the entire bill if you see a provider or visit a health
care facility that isn’t in your health plan’s network.
“Out-of-network” means providers and facilities that haven’t signed a contract with
your health plan to provide services. Out-of-network providers may be allowed to
bill you for the difference between what your plan pays and the full amount
charged for a service. This is called “balance billing.” This amount is likely more
than in-network costs for the same service and might not count toward your plan’s
deductible or annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t
control who is involved in your care—like when you have an emergency or when
you schedule a visit at an in- network facility but are unexpectedly treated by an
out-of-network provider. Surprise medical bills could cost thousands of dollars
depending on the procedure or service.
You’re protected from balance billing for:
If you have an emergency medical condition and get emergency services from an
out-of- network provider or facility, the most they can bill you is your plan’s in network
cost-sharing amount (such as copayments, coinsurance, and
deductibles). You can’t be balance billed for these emergency services. This
includes services you may get after you’re in stable condition, unless you give
written consent and give up your protections not to be balanced billed for these
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical
center, certain providers there may be out-of-network. In these cases, the most
those providers can bill you is your plan’s in-network cost-sharing amount. This
applies to emergency medicine, anesthesia, pathology, radiology, laboratory,
neonatology, assistant surgeon, hospitalist, or intensivist services. These
providers can’t balance bill you and may not ask you to give up your protections
not to be balance billed.
If you get other types of services at these in-network facilities, out-of-network
providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also
aren’t required to get out-of-network care. You can choose a provider or facility in
your plan’s network.
When balance billing isn’t allowed, you also have these protections:
• You’re only responsible for paying your share of the cost (like the copayments,
coinsurance, and deductible that you would pay if the provider or facility was
in-network). Your health plan will pay any additional costs to out-of-network
providers and facilities directly.
• Generally, your health plan must:
* Cover emergency services without requiring you to get approval
for services in advance (also known as “prior authorization”).
* Cover emergency services by out-of-network providers.
* Base what you owe the provider or facility (cost-sharing) on what it
would pay an in-network provider or facility and show that amount in
your explanation of benefits.
* Count any amount you pay for emergency services or out-of-network
services toward your in-network deductible and out-of-pocket
If you think you’ve been wrongly billed, contact: 1-800-985-3059.
Visit www.cms.gov/nosurprises/consumers for more information about your rights
under federal law.
Visit our insurance page to learn about our insurance and billing procedures.Learn More
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