Notice of Privacy Practices (HIPAA)

THE SECOND 9 MONTHS NOTICE OF PRIVACY PRACTICES
EFFECTIVE DATE: APRIL 14, 2003/update JANUARY 1, 2014

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.

UNDERSTANDING YOUR HEALTH RECORD/INFORMATION
Each time you visit a hospital, physician, dentist, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information often referred to as your health or medical record, serves as a basis for planning your care and treatment and serves as a means of communication among the many health professionals who contribute to your care. Understanding what is in your record and how your health information is used helps you to ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and helps you make more informed decisions when authorizing disclosure to others.

YOUR HEALTH INFORMATION RIGHTS
Unless otherwise required by law, your health record is the physical property of the healthcare practitioner or facility that compiled it. However, you have certain rights with respect to the information. You have the right to:
1. Receive a copy of this Notice of Privacy Practices from us upon enrollment or upon request.
2. Request restrictions on our uses and disclosures of your protected health information for treatment, payment and health care operations. However, we reserve the right not to agree to the requested restriction.
3. Request to receive communications of protected health information in confidence.
4. Inspect and obtain a copy of the protected health information contained in your medical and billing records and in any other Practice records used by us to make decisions about you.  A reasonable copying charge may apply.
5. Request an amendment to your protected health information. However, we may deny your request for an amendment, if we determine that the protected health information or record that is the subject of the request:
• was not created by us, unless you provide a reasonable basis to believe that the originator of the protected health
information is no longer available to act on the requested amendment;
• is not part of your medical or billing records;
• is not available for inspection as set forth above; or
• is accurate and complete.
In any event, any agreed upon amendment will be included as an addition to, and not a replacement of, already existing records.
6. Receive an accounting of disclosures of protected health information made by us to individuals or entities other than to you, except for disclosures:
• to carry out treatment, payment and health care operations as provided above;
• to persons involved in your care or for other notification purposes as provided by law;
• to correctional institutions or law enforcement officials as provided by law;
• for national security or intelligence purposes;
• that occurred prior to the date of compliance with privacy standards (April 14, 2003);
• incidental to other permissible uses or disclosures;
• that are part of a limited data set (does not contain protected health information that directly identifies individuals);
• made to patient or their personal representatives;
•for which a written authorization form from the patient has been received
7. Revoke your authorization to use or disclose health information except to the extent that we have already been taken action in reliance on your authorization, or if the authorization was obtained as a condition of obtaining insurance coverage and other applicable law provides the insurer that obtained the authorization with the right to contest a claim under the policy.
8. Breach Notification. In the case of a breach of unsecured protected health information, we will notify you as required by law. If you have provided us with a current e-mail address, we may use e-mail to communicate information related to the breach.

OUR RESPONSIBILITIES
We are required to maintain the privacy of your health information. In addition, we are required to provide you with a notice of our legal duties and privacy practices with respect to information we collect and maintain about you. We must abide by the terms of this notice. We reserve the right to change our practices and to make the new provisions effective for all the protected health information we maintain. If our information practices change, a revised notice will be mailed to the address you have supplied upon request. If we maintain a Web site that provides information about our patient/customer services or benefits, the new notice will be posted on that Web site. Your health information will not be used or disclosed without your written authorization, except as described in this notice. Except as noted above, you may revoke your authorization in writing at any time.

FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions about this notice or would like additional information, you may contact our Privacy Officer at the telephone or address below. If you believe that your privacy rights have been violated, you have the right to file a complaint with the practice’s Privacy Officer or with the Secretary of the Department of Health and Human Services. The DHHS complaint form may be found at www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaint.pdf. You will not be penalized in any way for filing a complaint.The contact information for both is included below.

THE SECOND 9 MONTHS
RENEE BEEBE, Privacy Officer
7325 12TH AVE NE
SEATTLE, WA 98115

(206)356-7252

Filing a Claim with your Insurance

INSTRUCTIONS for PATIENTS FILING FOR REIMBURSEMENT

You are encouraged to file a claim for third party reimbursement. By filing a claim, you may receive partial or full reimbursement and you help to establish the need for reimbursement of lactation services. You may find it helpful to contact your insurance company first. Some companies have specific forms that they require you to fill out when filing a claim on your own and most companies have a filing time limit.

1. Make at least one copy of the blank form (the superbill you were given at your consultation) —before you fill out the patient information on the top. This will ensure that you have another copy in case you have to appeal, or the insurance company loses the form or if you want to re-send with different patient information. (parent vs baby) It is your responsibility to keep track of this form. Duplicates will incur a charge of $10.00.

2. Complete the upper part (Patient Information portion) of the lactation visit receipt and sign the release of information on the right side directly under the Patient Information section. Be sure that the patient matches the diagnosis code. For example, if the diagnosis is “newborn sucking problem,” the patient is the baby. Some companies will reject claims for babies and some for parents. If you’ve made another copy you can file the claim a different way.

3. Parents should mail a copy of the lactation visit receipt with any other forms their insurance company may require to their insurance company. Include a note that you don’t expect to be reimbursed for mileage or other expenses on the super bill (such as nipples shields, etc). Insurance companies often “kick out” a claim because of other fees.

4. Please be sure to keep a copy of your lactation visit receipt, claim forms, referral scripts, etc. for your records and mark on your calendar when the claim was mailed in.

5. If, after 60 days, you have not heard from your insurance company, call them to check on the status of the claim. If you have not heard anything for 60-90 days, you may want to write a letter to your insurance commissioner in your state and send a copy to the insurance company.

6. The top reasons that claims are denied are because it’s not a covered service or the lactation consultant is not a provider on your plan. If it is because the lactation consultant is not a provider on your plan, ask who the lactation consultant provider is. Most likely they will say that they do not have a lactation consultant provider on their plan. Then, you reply that you had a referral to be seen by this lactation consultant by your physician because you were experiencing such and such a problem. Tell them that the American Academy of Pediatrics recommends that all babies be breastfed for one year and that the AAP recommends mothers and babies be seen by a board certified lactation consultant when breastfeeding difficulties occur. The AAP also recommends that third party insurance reimbursement be made for lactation help.

7. The Affordable Care Act mandates insurance coverage for lactation services. This is the law. It also mandates no co-pays or deductible for lactation services. Know your rights! This post will give you more information about how to talk to your insurance company about this.

8. Don’t stop with NO from the first person you speak to. Request to speak to their supervisor. The squeaky wheel is the wheel that gets oiled. If you want reimbursement, you may have to fight for it. This is how many things that are now covered by third party insurance companies have come to be standard reimbursement.

A formal appeal may be necessary for you to get reimbursed. You will find a sample letter of appeal on my website.  There is also a link there for the Washington State Insurance Commissioner. If you have been denied reimbursement for lactation services, he wants to know about it!

Virtual Consults: How do They Work?

Baby in Central America with restricted tongue.

I can do a video consultation with you no matter where you are on the planet! We are not limited by long-distance fees—only by time zones.

Ideally every breastfeeding parent and infant would have access to high-quality in-person lactation care. The reality is that many people to not have this available in their communities. Virtual consultations are just like in-person consultations except we’re not actually in the same room. They are appropriate for any type of breastfeeding challenges you may have including, latching difficulties, questions about tongue mobility, frenotomy aftercare, sore nipples and milk supply or pumping difficulties. These consultations are not recorded. Continue reading

Frenotomy–Parent Perseverance Pays Off

20140828_095301Breastfeeding always hurt for first- time breastfeeder, Tina. She was given a nipple shield to help with the pain. And it did help. Even so, she knew a nipple shield was not a long-term solution. She kept trying to get rid of the shield. She hated the thing! But every time baby latched without it it, it resulted in intense nipple pain and wounds—her nipple was painfully creased after feedings as well. So, understandably,  she continued to nurse with the shield.

Meanwhile, baby Carolyn wasn’t gaining weight well. At every appointment she was gaining about ½ of expected weight gain. Baby was breastfeeding frequently—over 10x/day and still not gaining appropriately. She was having infrequent bowel movements, was gassy, and uncomfortable. Tina felt that something was very wrong. Continue reading

Guest Post: Two Big Reasons to Skip Rice Cereal

The following is a guest post from Beth Martin. Beth is a certified Nutritional Therapy Practitioner (NTP) and the owner of Small Bites Wellness in Seattle, Washington. She is passionate about whole food nutrition for the whole family and believes that ANY change you make in the pursuit of your health, or your child’s health, is worthy. Health is a journey, not a destination. Thank you Beth, for this great information!

I recently shared the most common reasons pediatricians recommend rice cereal as a first food for infants.

IMG_1091I advocate feeding children nutrient dense whole foods that naturally contain the macronutrients, vitamins, and minerals they need to grow and develop. Rice cereal does not fit into this paradigm as a first food, and here’s why. Continue reading