NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices covers Sound Access, LLC and all healthcare providers and staff therein.
OUR PLEDGE REGARDING HEALTH INFORMATION:
Sound Access, LLC understands that health information about you is personal and we are committed to protecting your health information. Protected Health Information (PHI) is defined as your past, present, or future physical or mental health or condition; the provision of your healthcare, including medical procedures, testing, and treatment; medications; symptoms; test results; diagnoses; and past, present, and future payment for the provision of your healthcare. PHI further includes, individually identifiable health information which includes your street number and name; city, state, and zip code of residence; your date of birth; your phone number; your fax number (if obtained); your e-mail address; your social security number (if obtained); your medical records numbers (if applicable); your health insurance member number (if obtained); and internal account numbers. We create a record of the care and services you receive with Sound Access, LLC. The record is needed in order to provide you with quality care and to comply with certain legal requirements. This notice applies to all medical records pertaining to your health care in possession by Sound Access, LLC.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
The following categories describe different ways that we may use and disclose your health information. Not every use or disclosure in a category will be listed.
1. General Uses and Disclosures. Under the Privacy Rules, we are permitted to use and disclose your health information for the following purposes, without obtaining your permission or authorization:
2. Uses and Disclosures, Which Require You the Opportunity to Verbally Agree or Object. Under the Privacy Rules, we are permitted to use and disclose your health information: (i) for the creation of facility directories, (ii) to disaster relief agencies, and (iii) to family members, close personal friends or any other person identified by you, if the information is directly relevant to that person’s involvement in your care or treatment.
3. Use and Disclosures Which Require Your Authorization. Except as provided above, we will obtain your written authorization prior to disclosure of your information for any other purpose. Specifically, written authorization is required prior to the disclosure of your information.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
CHANGES TO THIS NOTICE
We may change the terms of this Notice. The revised Notice will apply to all health information in our possession as well as any information we receive in the future. If we make changes to the Notice, we will have copies of the new Notice in patient care areas for review and have copies of the new Notice available upon request from our Privacy Officer at 314-313-2289.
BY SIGNING THE SEPARATE POLICY NOTICE YOU ACKNOWLEDGE YOU HAVE BEEN GIVEN OPPORTUNITY TO READ/HAVE READ TO YOU, REVIEW, AND CONSIDER THIS NOTICE OF PRIVACY PRACTICES.
If, at any time, you have questions about information in this Notice or about Sound Access’s privacy policies, procedures, or practices, you can contact our Privacy Officer at 314-313-2289.
REPORT A PRIVACY RIGHTS VIOLATION
If you believe your privacy rights have been violated or that we have violated our own privacy practice, you may file a complaint with us, Sound Access, LLC. You may also file a complaint with the Secretary of the U. S. Department of Health and Human Services. There will be no retaliation for filing a complaint.
If you want to exercise any of these rights, please contact: Sound Access, LLC, 10097 Manchester Road, Suite 105, St. Louis, MO 63122. All requests must be submitted to us in writing.
You may file a written complaint with the federal government: Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Ave, S.W., Room 509F, HHH Building, Washington, D.C., 20201
The effective date of this notice is December 7, 2023.
RETURN AND CANCELLATION POLICY
NO SURPRISE ACT - GOOD FAITH ESTIMATE
NOTICE: AVAILABILITY OF GOOD FAITH ESTIMATE
You may have the right to receive a “Good Faith Estimate” explaining how much your health care will cost
If you are uninsured, or you do not wish to submit a bill for your care to your insurance plan for your care, then you have a right to receive an estimate of your bill before receiving any health care items or services.
When scheduling your appointment, we will ask you if you have insurance or how you wish to pay. If you do not have insurance, or if you wish to pay on your own without insurance, then you will be given a good faith estimate for the costs of the services we anticipate providing to you.
The estimate will include the total expected cost for all items or services that we reasonably expect to provide to you at the time of scheduling.
If you schedule at least 10 days in advance, we will deliver a good faith estimate to you within 3 days of scheduling. If you schedule at least 3 days in advance, we will deliver a good faith estimate to you within 1 day of scheduling. If you schedule less than 3 days in advance, you may not receive a good faith estimate prior to your appointment.
You may also request an estimate at any time. We will return a good faith estimate within 3 days of your request.
Make sure to save a copy or picture of your estimate and the bill.
If you receive a bill that is at least $400 more than your estimate, you can dispute the bill by visiting www.cms.gov/nosurprises/consumers.
For questions or more information about your right to a good faith estimate, please visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1- 800-985-3059.
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We appreciate your business!
Return Policy: Product(s), excluding hearing aids, may not be returned after the receipt of the product(s) by the buyer. Repair, adjustment, remake, replacement, or exchange of product(s) will be completed if the product(s) are defective and the requirements of the product(s)'s warranty are met. For hearing aids, please refer to your Hearing Instrument Purchase Agreement for details regarding our return policy.
Cancellation Policy: Product orders may not be cancelled after the order for the product(s) is received by Sound Access unless Sound Access consents in writing to such cancellation. Cancellation will be granted only on terms indemnifying Sound Access against any loss resulting from such action and on such terms determined by Sound Access. At minimum, the buyer will be liable for all costs incurred on the order of the product(s) through the cancellation date.
Fees are payable at time of service and/or product purchase. Payment is required at the time a product order is placed and/or at the time any services are rendered unless exclusion, at the sole discretion of an official representative of Sound Access, is otherwise expressed by the representative in advance. For products delivered by certified mail, title and risk of loss in all goods sold shall pass to buyer upon Sound Access's delivery to the carrier at shipping point. The order is not final until approved and accepted by the home office of Sound Access. All prices are subject to change without notice.
Other than traditional Medicare, we do not participate with any insurance companies and will be considered out-of-network. You will be responsible for filing claims to any insurance other than Medicare, if desired. Because we are out-of-network, your insurance may pay less or not cover the services provided in our clinic. You should contact your insurance company with any questions regarding claims or coverage.
Sound Access accepts the following types of payment:
Visa, Master, Discover, American Express, check, or cash.
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