Patient Policies

All patients will be asked to initial a set of the following policies to confirm that they have received and understand the following Patient's Rights.

• To be afforded considerate and respectful care
• Upon request, to be furnished with the name of the provider responsible for coordinating care
• Upon request, to be furnished with the name of the provider or other person responsible for conducting any specific test or other medical procedure performed by the healthcare facility in connection with treatment
• To refuse any treatment by the healthcare facility to the extent permitted by law
• To privacy to the extent consistent with the provision of adequate medical care and with the efficient administration of the healthcare facility. Nothing in this section shall be construed to preclude discreet discussion or examination by appropriate medical personnel
• To privacy and confidentiality of all records pertaining to treatment except as otherwise provided by law
• To a response in a reasonable manner to a request for healthcare services
• To be informed of the need for a transfer to another facility, and alternatives to a transfer before a transfer occurs
• Upon request, to be furnished with the identities of all other healthcare and educational institutions that the healthcare facility has authorized to participate in treatment and the nature of the relationship between the institutions and the healthcare facility
• To be thoroughly informed of and given the right to refuse to participate in any project involving human experimentation before any such project commences
• Upon request, to be allowed to examine and to be given an explanation of a bill rendered by the healthcare facility irrespective of the source payment of the bill
• Upon request, to be allowed to examine any pertinent healthcare facility rules and regulations that specifically govern treatment
• To be offered treatment without discrimination as to race, color, religion, national origin, sexual orientation, or source of payment
• Upon request, to be provided with a summarized bill within thirty (30) days of termination of services

All patients will be asked to initial a set of the following policies to confirm that they have received and understand the following Patient's Responsibilities.

• To be respectful and considerate of other staff, patients, families, and health center facilities
• To participate to the fullest in my care and treatment
• To provide complete information about my healthcare condition and medical history.

When an appointment cannot be kept, patients are expected to contact us at least 24 hours before the appointment time.

Please be sure to Contact Us if you are unable to make your scheduled appointment. If Wood River Health does not receive notice prior to the appointment, this is considered a no-show.

If a patient does not show for appointments, their appointment history will be reviewed by Wood River Health. Future services may be limited to emergencies and patients may not be scheduled for future routine appointments.

Patients have a responsibility to pay for the services provided to them or their family member based on their insurance benefits, deductibles, co-pays or sliding fee scale as explained to them by Wood River Health.

We work closely with our patients to determine the appropriate level of financial responsibility they must assume while maximizing the financial support available to them through health insurance and other benefit programs. Our policies define our application of these principles.

If a patient in unable to make the required payment, they may request a budget plan. Payments not made as agreed will be submitted to a collection agency for processing. Continued failure to make expected payments may result in termination from all treatment at Wood River Health or limitation of services to emergencies only and future routine appointments will not be scheduled.

Below is information on how to read your billing statement.

The DATE column is the day the service was performed.

The PATIENT column is the patient who received the service. In families, several patients may be listed on one statement.

The PROVIDER column is the person who performed the service.

The DESCRIPTION column is the service received and billed for.

The CHARGE is the universal charge to all patients receiving that service.

The RECEIPT FROM INS. (insurance) column is any payments received from the insurance company for that associated date of service and charge.

The RECEIPT FROM PAT. (patient) column is any payments received from the patient including copays or coinsurance.

The ADJUST. (adjustment) column is the amount not allowed by the insurance company. Our contracts with the insurance company determine what we can charge for a procedure. As part of our contract, we must adjust off any amount between the insurance allowed amount and our universal charge.

The INS. BAL (insurance balance) column is the amount we are still expecting from the insurance company.

The PAT. BAL (patient balance) column is what is now due from the patient or guarantor. The total of this column is in a double box in the bottom right corner of the statement and says “Due From Patient” see below

The boxes at the bottom of the statement are the current balance, and all aged balances for any services we have not yet been paid for.

Example

Please call the number on your statement if you have any questions regarding your bill or if you have any information which might affect the amounts in each column on the statement. Please remember that amounts in the “Over 120 Days” column may be subject to collection.

Wood River Health is an equal opportunity provider.

In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, age, disability, religion, family status, sex, gender identity, or sexual orientation. (Not all prohibited bases apply to all programs.)

To file a complaint of discrimination write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410. You can also call 800.795-3272 (voice) or 202.720.6382 (TDD).

Patients have the right to receive a “Good Faith Estimate” explaining how much their medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

Patients have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services that are reasonably expected at the time of scheduling. This includes related costs like medical tests, prescription drugs, and equipment.

For patients who don’t have insurance or who are not using insurance, Wood River Health will provide a Good Faith Estimate of scheduled services in writing at least 1-3 business days before the medical service or item.

You can also ask Wood River Health (and any other provider you choose) for a Good Faith Estimate before you schedule an item or service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit the Centers for Medicare & Medicaid Services or call the federal surprise billing hotline at 800.985.3059.

This notice is not intended to be a full summary of the No Surprises Act. It is intended only to be a general information summary of technical legal standards. Complete and current information is available at the Centers for Medicare & Medicaid Services.

Wood River Health cares about our patients' privacy and strives to protect the confidentiality of every patient's medical information. Please see Patient Privacy on how we ensure our patients' privacy is protected.