Your Information. Your Rights. Our Responsibilities.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Your Rights
You have the right to:
• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
Your Choices
You have some choices in the way that we use and share information as we:
• Tell family and friends about your condition
• Provide disaster relief
• Include you in a hospital directory
• Provide mental health care
• Market our services and sell your information
• Raise funds
Our Uses and Disclosures
We may use and share your information as we:
• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions
To the extent that we have your substance use disorder patient records, subject to 42 CFR Part 2, we will not share that information for investigations or legal proceedings against you without:
(1) your written consent or
(2) a court order and a subpoena.
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
• You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations.
• We are not required to agree to your request, and we may say “no,” for example, if it could affect your care.
• If we agree to your request, we may still share this information in the event that you need emergency treatment.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for payment or operations with your health insurer.
• We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all disclosures except those about treatment, payment, and health care operations and certain other disclosures.
• We will provide one accounting per year for free, but may charge a reasonable cost-based fee if you ask for another within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you agreed to receive the notice electronically. We will provide a paper copy promptly.
Choose someone to act for you
• If someone has authority to act as your personal representative, such as through medical power of attorney or legal guardianship, that person can exercise your rights and make choices about your health information.
• We will confirm that the person has this authority before taking action.
File a complaint if you feel your rights are violated
• You can complain if you believe we violated your rights by contacting us using the information listed on page 1.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by:
- Sending a letter to:
200 Independence Avenue, S.W., Washington, D.C. 20201 - Calling: 1-877-696-6775
- Visiting: https://www.hhs.gov/hipaa/filing-a-complaint/index.html
• We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share.
If you have a clear preference about how we share your information in the situations described below, talk to us. Tell us what you want us to do and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
• Share information with your family, close friends, or others involved in your care or payment for your care
• Share information in a disaster relief situation
• Include your information in a hospital directory
If you are not able to tell us your preference (for example, if you are unconscious), we may share your information if we believe it is in your best interest. We may also share your information when needed to reduce a serious and imminent threat to health or safety.
In these cases we never share your information unless you give written permission:
• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes
Fundraising
• We may contact you for fundraising efforts, but you can tell us not to contact you again.
• If we have substance use disorder patient records subject to 42 CFR Part 2, we will give you clear advance notice and a choice about whether to receive fundraising communications using that information.
Our Uses and Disclosures
How do we typically use or share your health information?
Treat you
We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways that usually contribute to the public good, such as public health and research. We must meet legal conditions before sharing information for these purposes.
If we have substance use disorder patient records subject to 42 CFR Part 2, we cannot use or share them in civil, criminal, administrative, or legislative investigations or proceedings without:
(1) your consent
(2) a court order and a subpoena.
Help with public health and safety issues
We can share health information about you for situations such as:
• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to health or safety
Do research
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services to confirm compliance with federal privacy law.
Respond to organ and tissue donation requests
We can share health information with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and government requests
We can use or share health information:
• For workers’ compensation claims
• For law enforcement purposes
• With health oversight agencies for authorized activities
• For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
We can share health information in response to:
• A court or administrative order
• A subpoena
Our Responsibilities
• We are required by law to maintain the privacy and security of your protected health information.
• We will notify you promptly if a breach occurs that may compromise the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described in this notice unless you tell us we can in writing. You may change your mind at any time by notifying us in writing.
For more information:
https://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
B2B Billing Policy
Insurance
We participate with most commercial insurance plans, Medicare, and Medicaid/MassHealth. Patients are responsible for providing accurate insurance information and understanding their individual coverage, including copayments, deductibles, coinsurance, referral requirements, and non-covered services.
Patients must designate a B2B provider as their PCP if required by their insurance. Failure to do so may result in billing delays and patient payments.
B2B will bill your insurance company for services provided. Coverage and payment determinations are made by your insurance plan and do not guarantee payment for services rendered.
Patient Financial Responsibility
Copayments are due at the time of service.
After insurance processes your claim, any remaining balance becomes the patient’s responsibility and is payable upon receipt of a statement.
Patients may be responsible for:
● Copayments
● Deductibles
● Coinsurance
● Non-covered services
● Charges denied by insurance due to lack of required referrals, authorizations, inaccurate insurance information, or failure to designate B2B provider as PCP if required by insurance plan.
Medicare and MassHealth
We bill Medicare and MassHealth directly for covered services. Patients remain responsible for any cost-sharing required by Medicare and for services not covered by Medicare, MassHealth, or their insurance plan, as permitted by law.
Self-Pay and Out-of-Network Patients
Patients who do not have health insurance, choose not to use their insurance, or are covered by an insurance plan with which our practice is not contracted (out-of-network) are considered self-pay patients.
Self-pay patients are responsible for all charges associated with services provided by the practice.
Payment is expected at the time of service unless other arrangements have been made in advance. Patients may request an estimate of anticipated charges; however, actual charges may vary based on the services provided.
Electronic Statements
Our practice uses electronic statements (e-statements) as the primary method of patient billing.
Billing notifications and statements are delivered through our secure patient portal, email, and text message. Patients are responsible for maintaining current contact information and reviewing statements promptly.
Paper statements are readily available upon request at no additional charge. Patients may request paper statements at any time by contacting our office directly by phone, e-mail or text.
Payment Terms
Payment is due within 30 days of the statement date.
We accept:
● Credit and debit cards
● HSA/FSA cards
● Checks
● Cash
Payments may be made through the patient portal, by phone, by mail, or in person.
Past Due Accounts
Accounts with unpaid balances may receive additional billing notices. Patients experiencing financial hardship are encouraged to contact B2B directly to discuss payment arrangements.
Delinquent accounts may be referred to a collection agency in accordance with applicable laws and regulations. Medical care will not be withheld due to an outstanding balance.
Questions
If you have questions about your bill, you may call our billing department directly:
➔ Patient Services: 877-785-3477
➔ Hours: 8:00 AM – 5:00 PM Central Time
If an agent is not available at the time of your call, you can expect a callback within 24 hours.
You may call, text or e-mail B2B at any time to inquire about your bill:
➔ 617-545-5459
➔ office@b2bprimarycare.com