Clinic Policy

Privacy Policy with HIPAA Compliance

NOTICE OF PRIVACY PRACTICES

Privacy Officer: Alfredo Massa MD

(612) 442-3749

INTEGRO CLINIC

6545 France Avenue Suite 501

Edina MN 55435

Effective Date: 06/01/2023

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. We reserve the right to change this Notice. The changes will apply for PHI we already have about you
and PHI we receive about you in the future. We will provide an updated Notice to you when you request one. Please review it carefully along with the info provided in the link!

We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. We make a record of the medical care we provide and may receive such records from others. We use these
records to provide or enable other health care providers to provide quality medical care, to obtain payment for services provided to you as allowed by your health plan and to enable us to meet our professional and legal obligations
to operate this medical practice properly. We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health
information, and to notify affected individuals following a breach of unsecured protected health information. This notice describes how we may use and disclose your medical information. It also describes your rights and our
legal obligations with respect to your medical information. Whenever possible, we will de-identify or encrypt your personal information so that you cannot be personally identified. We have put physical, electronic, and procedural
safeguards in place to protect your PHI and comply with federal and state laws. If you have any questions about this Notice, please contact our Privacy Officer listed above.

All treatment provided and services rendered by Integro Clinic are strictly voluntary. You may choose to stop treatment at any time you wish. If you experience any problem(s) with medication and/or psychotherapy, it is your responsibility
to inform your provider of the problem(s). 

By consenting to treatment, you are also indicating your agreement with the policies and procedures of this clinic, including your consent of the use of telehealth for your appointments and the right to refuse the use of telehealth.

The preferred method of communication is through your patient portal. You will get the fastest and most complete response if you state your concern by sending a message through the portal. Please note that all communications will
be added to your medical records. Messages received through the portal are checked daily, Monday through Friday, from 8:30am-5pm. Messages received after hours, on weekends, or holidays are reviewed the next business day. Please
allow at least 1-2 business days for a response for portal messages.

Portal communication is not for emergency or urgent issues. Please do not send us a message through the portal that is of an urgent or emergent nature. Please note if you need immediate assistance, are having suicidal or homicidal
thoughts, a serious medication reaction, or any emergency, please call 911 or go to the emergency room. 

Please note: A fee may be charged for clinical phone calls/portal messages between appointments. This fee is not covered by insurance. This fee does not apply to phone calls or messages strictly related to scheduling, billing, or other
non-clinical questions.

Phone Calls:

Phone hours are Monday to Friday 8am – 4:00pm. Brief phone calls of 5 minutes or less are not charged. Longer, more involved calls may be charged as outlined in Professional Fees. Please note that all communications will be added to
your medical records.

Most routine calls are returned within 48 hours during the above stated business hours. If you have an after hours concern that cannot wait for the next business day please call and leave a voicemail. Your call will be returned as
soon as possible. For any emergencies, please do not wait for a call back. Instead, please go immediately to the emergency room or call 911. 

Please note a fee may be applied for after hours phone calls. Portal messages are not checked after hours, on holidays, or on the weekends. Please check our website for the holiday schedule. 

Please note that we do not schedule/cancel appointments or refill medications after hours, on holidays, or over the weekend.

Integro Clinic is not currently in-network for any insurance. Service is provided on a flat fee basis:

• Initial or intake appointments will be charged $400
• Follow up appointments will be charged $200

Fees are collected on the same day of the appointment, including copays. Prior to the start of an appointment, credit card information or another eligible form of payment must be on file. Payments will be collected through our
portal where your credit card/debit card information will be safely stored. If you are not able to pay for your appointment in full prior to the start time, you will need to reschedule. The expectations in this policy also reflect
any future insurance companies with which EBH may become in-network. If someone else (parent, spouse, domestic partner, etc.) is financially responsible for your expenses or carries your insurance, please share this policy with them,
as it explains our practices regarding insurance billing, copayments, and patient billing.

Patients may request an invoice to submit to their insurance company for possible reimbursement upon request. You may request a superbill be provided to you reflecting your charges with our clinic. Insurance reimbursement depends on
an individual patient’s policy terms. We are not responsible for filing or ensuring insurance reimbursements. Your insurance plan is a contract between you and the insurance company and does not directly involve the provider. Even
if your insurance company reimburses you for your treatment, they may limit the amount of treatments for which you may receive reimbursement. Some services may not be reimbursable by insurance at all, such as fees for filling out
forms, writing letters, writing reports, etc. Please be aware insurance companies generally require some basic information about your care if you choose to seek reimbursement. Once this information is provided, it will be subject
to the privacy policies of the insurance provider. Please check with your insurance company before making an appointment to determine what out-of-network benefits are available to you.

We do not overbook appointments. Your appointment time is a reservation just for you. If you are not able to come to your appointment, please reschedule through your patient portal. If you contact your provider within 48 business hours
(excluding weekends and holidays) of your appointment you may reschedule with no additional cost, and the appointment will be offered to someone else.

If an appointment is not canceled or rescheduled more than 48 business hours ahead, the standard appointment fee will be applied to your account. Stating that you did not receive a reminder does not exempt you from a no-show/late cancellation
fee.

Should you arrive more than 10 minutes late for any appointment, you will be asked to reschedule so that an appropriate amount of time and attention may be devoted to your care. You will still be responsible for payment of the missed
session. This fee will not be covered by insurance and cannot be submitted for insurance reimbursement.

For initial evaluations, Integro Clinic (Integro Recovery) may require full prepayment in order to schedule the appointment. This will be charged to the credit card on file. If you miss that appointment and do not give appropriate
notice, that fee is nonrefundable. If you wish to book the initial appointment again, another full prepayment may be required to schedule the second appointment. Please ensure that you give us 48 hours’ notice to reschedule your
appointment. An appointment canceled without at least a 48 hour notice is considered a No Show/late cancellation and may not be rescheduled. 

Failure to show for your follow up appointments (or violation of this cancellation policy) on two or more occasions may be grounds for discharge from the clinic. Note that the cancellation fee may be waived in special circumstances,
determined on an individual basis.

For our part, we will make every effort to provide you with adequate notice if the provider will be unavailable for a scheduled appointment and will work to reschedule your appointment in a timely fashion.

Integro Clinic has a zero-tolerance policy toward abusive behavior toward others, including staff or other patients, and visitors. This can also include disrupting the practice facilities that interferes with the ability to deliver
services to other patients. In the event of such behavior, we will provide proper warning and termination as related to abusive and/or noncompliant patients. You may also be referred elsewhere for ongoing care at your request. Care
may also be terminated due to recurrent treatment noncompliance. 

Abusive behavior is defined as any physical or verbal action that intentionally harms or injures another person or any physical or verbal action with the intent to do such harm. This also includes harassment, manipulative behavior,
and other behaviors that can be construed as abusive.

Noncompliance is defined as failure or refusal to conform to or follow rules, regulations, or the advice of another. A patient may be considered noncompliant, for example, if he/she does not adhere to the “Practice Rules” or does not
follow his/her prescribed plan of care.

Should a patient be considered noncompliant, the staff and/or provider will follow the approved procedures for issuing letters of warning and termination. Letters to the patient regarding non- compliance must be delivered directly
to the patient or via certified mail to the address provided by the patient, and with return receipt requested. Communications are not to be delivered through family members or other parties.

Should a patient engage in behavior that is considered to be abusive in nature (verbal or physical), the staff and/or provider may institute approved procedures for immediate termination or defer to approved procedures for issuing
letters of warning and termination.

Reasons for which termination may be initiated:

• A patient’s repeated failure to comply with the practice rules including personal conduct
• A patient’s repeated failure to make or keep scheduled appointments
• A patient’s failure to provide accurate, complete, and current information on health status to the physician or clinical staff
• A patient’s repeated failure to comply with their plan of care. Violations may include failure to take medications as prescribed, prescription drug abuse, failure to follow personal health practices (such as diet), and other aspects
  of the treatment which have been explained to the patient and which are reasonable within the patient’s ability to comply

IntegroRecovery Clinic is a Mental Health and Addiction Care Outpatient Clinic, providing in-person and virtual services to the community. Specifically, we provide:

• Level 0.5, which is called Early Intervention. Early intervention can consist of assessment and education for people at risk of developing a substance use disorder, or programs like DUI classes for people arrested
  for driving under the influence. The goal of .5 services is to intervene before a person develops a substance use disorder.
• Level 1 
  outpatient treatment consists of treatment for substance use that is less than 9 hours a week. Level 1 is appropriate for people with less severe disorders, or as a step-down from more
  intensive services.