Thank you for choosing our practice!
We are committed to the success of your medical treatment and care. The following is a statement of our Clinic Financial Policy. The policy applies to all services provided by VentilateOK, regardless of the location.
We will bill your health insurance carrier for services rendered by our providers, but it is your responsibility to make sure that we have your most current insurance information. If you change or add an insurance policy, you must make our staff aware and present a new insurance card prior to your appointment. Any balances not paid by your insurance carrier are your responsibility, and payment is due upon receipt of your billing statement or your next office visit, whichever occurs first.
Your insurance plan requires a prescription. It is your responsibility to obtain one from either your primary care physician or your specialist. Please fax your prescription (405) 604-8999.
We have a contractual obligation (with your insurance company) to collect your deductible & co-insurance. We will collect it at the time of service. Our office does not bill co-insurance. Copays are the patient’s responsibility and are due at the time of service. We are considered specialty care by insurance carriers. If your insurance carrier has a specific copay amount for specialty care, you will be expected to pay this amount at the time of service. We cannot waive copays, deductibles, or coinsurance for non-covered services defined as patient responsibility under the terms of our contract with various health plans.
VentilateOK requires a minimum payment for all self-pay patients prior to being seen in the practice. This is only a minimum payment and the patient will be required to pay the remaining balance in a timely fashion. Payment arrangements can be made thru the billing department if the remaining balance cannot be paid in full within 30 days of receiving the patient statement.
Please let us know if you are having difficulty paying our account in a timely fashion. VentilateOK may be able to help by setting up a payment plan based on your financial needs. Our billing office is available Monday – Friday from 9:00 am to 4:30 pm to assist you in satisfying your financial obligation. Please contract our office at (405) 604-6999 and ask to speak to a billing specialist.
We accept payment by cash, check, Visa, MasterCard, Discover, and American Express.
In the event you do not satisfy your account balance on a timely basis (defined as making regular payments each month), we may elect to send your account to an outside collection agency.
It is the policy of VentilateOK to charge $20 to patients whose checks are returned by our bank for non-sufficient funds.
It is our policy to verify demographics information once every year. As such, you may be asked to complete a Patient Registration Form during the check-in process of your appointment. If you have had any recent demographic changes such as address, phone number, insurance provider, etc. you will be required to update your information.
Equipment & Supplies Policies
VentilateOK LLC. has a 30-day return policy option on all purchased items. VentilateOK LLC agrees to contact and schedule delivery of all equipment and/or products that it provides to its patients in a timely manner. VentilateOK LLC does its best to have a stock of all equipment that we provide. Once we have an order and all required documents have been received, we will call to schedule the patient for set-up. Instruction and education on how to use and maintain the products shall be given to the customer and his or her family/caregivers.
The limitation of liability provision (section 1879) of the Social Security Act is applied where a Supplier (whether participating or nonparticipating) bills for items or services on an assigned basis which are determined by a carrier or a peer review organization to be "not reasonable and necessary." A limitation of liability determination will be made with regard to all assigned claims at the time of the initial determination. For purposes of making the limitation of liability finding at the initial determination, the supplier will be treated as if he/she had knowledge that Medicare would not pay for the denied items or services. This initial determination is subject to modification, if appropriate, upon the supplier's appeal. Moreover, a supplier will not be held liable under section 1879 where the assigned claim Following are examples of notices for suppliers and beneficiaries which will satisfy the advance notice requirements and which will protect you from liability for denied items or services:
Beneficiary Agreement: I have been notified by my supplier that he or she believes that, in my case, Medicare is likely to deny payment for the items or services identified above, for the reason stated. If Medicare denies payment, I agree to be personally and fully responsible for the payment.
Dear customer you have the right to freely voice your grievances and recommend changes in the care or services without fear of reprisal or unreasonable interruption of services. Service, equipment, and billing complaints will be communicated to management and upper management. These complaints will be documented in the VentilateOK, LLC. Medicare Jurisdiction C beneficiary’s complaint log, and completed forms will include the patients name, address, telephone number, and health insurance claim number, a summary of the complaint, the date it was received, the name of the person receiving the complaint, and a summary of actions taken to resolve the complaint. All complaints will be handled in a professional manner. All logged complaints will be investigated, acted upon and responded to in writing or by telephone by a manager within five (5) business days of receiving a beneficiary’s complaint, VentilateOK, LLC shall notify the beneficiary, using either oral, telephone, email, fax, or letter format, that it has received the complaint and that it is investigating. Within 14 business days VentilateOK, LLC shall provide written notification to the beneficiary of the results of its investigation and response. The suppliers shall maintain documentation of all complaints that it receives copies of the investigation, and responses to the beneficiary. If there is no satisfactory resolution of the complaint, the next level of management will be notified progressively and up to the president or owner of the company.
VentilateOK, LLC is committed to resolving the customer's complaint to his/her satisfaction.
VentilateOK, LLC will replace the equipment within 24 hours, provided it is still under manufacturer's warranty. VentilateOK, LLC will work with the patient, the insurance company, and the manufacturer to resolve any issue that occurs after the warranty has expired. In most cases, we will provide a loaner piece of equipment, until a resolution has been obtained through the manufacture and the insurance company.
You have the following patient rights:
- The right to be fully informed in advance about the care, treatments, and/or services to be provided, including the disciplines that furnish care and the frequency of visits as well as any modifications to the plan of care.
- The right to choose a health care provider and to be able to identify visiting staff members through proper identification.
- The right to be cared for and choose an organization that adheres to ethical care and business practices.
- The right to be informed of care, treatment, and/or service limitations.
- The right to be involved in his or her care including the development of the plan of care.
- The right to have the plan of care adapted to his or her specific needs and limitations.
- The right to make informed decisions regarding care.
- The right to have their values and preferences, including decisions to refuse care, discontinue care treatments, and services respected.
- The right to confidentiality of the information collected about them and to control access to this information.
- The right to privacy and security and to have their property respected.
- The right to have care, treatments, and services provided in a manner that safeguards each patent’s dignity and cultural, psychosocial, and spiritual values.
- The right to be free from mental, physical, sexual, verbal abuse, neglect, and exploitation.
- The right to have a complaint heard, reviewed, and, if possible, resolved.
- The right to be involved in resolving conflicts, dilemmas or ethical issues about care or service decisions.
- The right to formulate advance directives.
- The right to be involved in decisions to withhold resuscitation and decisions to forgo or withdraw life-sustaining care.
- The right to be involved in decisions when the organization’s review results in a denial of care, treatment, services, or payment.
- The right to choose whether or not to participate in research, investigational or experimental studies, or clinical trials.
- The right to be communicated with, both directly and indirectly through other providers, in an ethical and efficient manner.
- The right to help patients, family members, and other care providers understand and exercise their rights.
- The right to be informed of his or her responsibilities in the provision of care, treatments, and services.
- The right to be informed of any obligation the organization has under applicable laws and/or regulations.
- The right to have consequences of any requested modifications and actions that are not recommended explained and to have alternative care, treatments, and services explained.
- The right to be provided with information about the charges for which the patient is responsible.
- The right to access, request amendments to, and receive an accounting of disclosures regarding their own health information as permitted under applicable law.
- The right to be informed of any existing or potential conflict of interest, including financial benefits that can affect provision of care when referred to an organization.
- Responsibility to provide accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to your health.
- Responsibility to report perceived risks in your care and unexpected changes in your condition.
- Responsibility to help our organization understand your environment by providing feedback about service needs and expectations.
- Responsibility to ask questions when you do not understand any aspect of care or expectations.
- Responsibility to follow the care, treatments, and services as planned.
- Responsibility for the outcomes if you do not follow the care, treatments, and services we provide.
- Responsibility to follow our organization’s rules and regulations.
- Responsibility for you and your family to be considerate of our staff and property.
- Responsibility to meet any financial obligation agreed to with our organization.
Most items may be returned within 30 days of receipt for a full refund. They must be returned at the customer’s expense in their original packaging and meet the following conditions:
- Product must be in new condition - no cracks, scratches or dirt.
- Product must be returned in its original packaging.
Once your return is received, VentilateOK LLC will issue a credit to the credit card used for the purchase. Please allow up to 2 weeks after receipt of your returned items for your credit to be issued. If you paid by check or money order, we will issue a check within 30 days.
If your item is defective or was damaged in shipping, please call us at 405-604-6999, or email us at firstname.lastname@example.org. We will arrange for the item to be repaired or replaced promptly.
Every product sold or rented by VentilateOK LLC carries a 2-year manufacturer’s warranty. VentilateOK LLC will notify all customers of the warranty coverage, and will honor all warranties under applicable law. VentilateOK LLC will repair or replace, free of charge, Medicare or all other insurance-covered equipment that is under warranty. In addition, an owner’s manual with warranty information will be provided to beneficiaries for durable medical equipment where this manual is available. However, if the item is not working or functioning as it should upon the receipt of the equipment, please notify us immediately. This warranty shall be voided and not apply if the equipment, including any of its parts, is modified without VentilateOK LLC’s authorization. The warranty stated above (including its limitations), is the only warranty made by VentilateOK LLC and is in lieu of other warranties, whether expressed or implied. VentilateOK LLC shall not be liable for consequential or incidental damages of any kind.
This notice describes how medical information about you may be used and disclosed by VentilateOK LLC and how you can access this information.
As required by privacy standards of health insurance portability and accountability act of 1996 (HIPAA) VentilateOK LLC is required to maintain the privacy of your protected health information (PHI) and to provide you with a notice of our legal duties and privacy practices with respect to PHI. PHI is information about you, including basic demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health services. This notice of privacy practices (Notice) describes how we may use and disclose your PHI to carry out treatment, payment, or health care operations and for other specific purposes that are permitted or required by law. The notice also describes your rights with respect to your PHI. We will not disclose or use your PHI for any other purpose without your written authorization, except as described in this notice. We reserve the right to change our practices and/or this notice to make the new notice effective for all PHI we maintain.
You have the following rights with regards to PHI about you:
- Obtain a detailed /revised copy of the notice upon request.
- Request an amendment of PHI.
- Request a restriction on certain uses and disclosure of PHI.
- Request communication of PHI by alternate means or at alternate locations.
- Receive an accounting of disclosure of PHI/inspect and obtain a copy of PHI about you contained in a designated record set forth as long as VentilateOK LLC maintains the PHI. The designated record set usually will include prescriptions, physician orders, and billing records. To inspect or receive a copy of your PHI for your inspection, you must send a written request to: Privacy Officer, VentilateOK LLC, 4401 NW 4th ST. Suite 133, Oklahoma City, OK 73107, under federal law however, you may not inspect or copy the following records: information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. We may charge you a fee for the costs of copying, mailing, or other supplies that are necessary to grant your request. We may deny your request to inspect/copy/receive an accounting in certain limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed.
You may complain to VentilateOK LLC and to the Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint. If you wish to file a complaint, please contact our chief privacy officer at VentilateOK LLC, 4401 NW 4th ST. Suite 133, Oklahoma City, OK 73107.