Home: FYI

Appointments
Appointments may be scheduled in person, by mail, or by contacting our appointment hotline, 800-362-7798. Our appointment staff can also make your reservations at The Greenbrier.

Please make arrangements well in advance of your planned visit. During certain times of the year, both the Clinic and The Greenbrier are often booked six months to one year in advance.

It is not necessary to be referred to the Greenbrier Clinic. If you are referred, please bring a referral letter from your physician. If you are coming to the Clinic for the evaluation of a specific health problem, copies of your medical records, including doctor’s notes regarding this problem, are very helpful to our physicians.

When You Arrive
When you arrive at the Greenbrier Clinic, be certain to have your insurance, Medicare, or Medicaid card with you. We cannot complete certain forms or accurately bill your insurance carrier without the information on these cards.

If you have changed your address, phone number, marital status or insurance coverage since your last visit, please make the necessary corrections on your registration form. If you were referred by your physician, or wish your physician to receive a copy of your report, please inform your doctor’s secretary.

Medical Records
We keep your records in strict confidence and will not disclose their contents without your expressed written permission. Before we will release information in your medical record to any third party, such as your insurance company, you must sign an authorization for such a release.

Insurance
A Review of Current Issues
The mission of The Greenbrier Clinic is to excel in the provision of comprehensive, adult diagnostic and preventive health care. An individualized approach, employing state-of-the-art equipment and testing procedures is coordinated over a two day period by medical staff and employees committed to making this process as comfortable, convenient, and informative as possible. In addition to evaluating any current problems or symptoms, your doctor will analyze your risk for other diseases and may recommend "screening tests" to detect problems such as cancer and heart disease in their early stages.

Many patients ask if their health insurance and/or Medicare will cover all or a portion of their Clinic examination. While most insurance plans and Medicare cover some portion of limited screening or preventive health services, many such tests are not covered. Tests such as chest x-rays, exercise stress tests, flexible sigmoidoscopy, cholesterol levels, blood tests for thyroid and liver function, and diabetes are examples. If such tests are performed for evaluation of specific symptoms or findings, they may be covered, but generally they will not be covered if performed for screening purposes. If you have questions regarding which screening services may be covered by your health plan, please contact your insurance carrier before your Clinic examination.

The Clinic is required by law to bill for all services using numerical "codes" that identify what tests were performed and why. The codes also identify the service as a diagnostic service or a screening service. An example of a screening test might be an exercise stress test in a patient with elevated cholesterol and a family history of heart attack, but no symptoms suggesting heart disease. Other examples might be tests performed to detect cancer in its early stages. Although doing such tests might be appropriate and desired by the patient, strictly speaking they are "screening" tests and must be coded as such by the Clinic. The use of these codes may reduce your reimbursement from an insurance carrier, and increase your out-of-pocket expense.

Medicare does not cover general preventive physicals. It does provide a very limited amount of preventive services. Medicare does cover annual (to the day) breast examinations and mammograms; periodic pap smears; and colorectal cancer screening (every four years). It also covers annual prostate cancer screening for men which includes a digital rectal exam and a PSA blood test.

If Medicare is your primary insurance, please note: As a courtesy to our Medicare patients prior to 2000, the Clinic included codes in its Medicare billing for services Medicare considered to be "non-covered services". Medicare denies these services but occasionally secondary insurance covers them. Medicare’s current policy is that they do not wish to have claims for "non-covered services" submitted. However, if you do have secondary insurance, we may, with your written authorization, bill for a denial. If you are a Medicare patient with no secondary insurance, these charges will be included on the bill you receive from the Clinic.

The Greenbrier Clinic is a participating provider with Medicare. The Clinic is not a participating provider with any managed care plan and most insurance plans. This means that if your insurance carrier covers a service but approves less than the Clinic’s fees, you will be responsible for reimbursing the Clinic for the remaining balance of the total billed.

The only exceptions to this are beneficiaries of the West Virginia Public Employees Insurance Agency (PEIA). We are required by law not to balance bill the non-allowed amounts determined by their fee schedule. The Clinic can bill its full charges to PEIA patients for services that are determined by PEIA to be non-covered services.

The Clinic cannot predict the total cost of your examination: The cost of our basic examination begins in the range of $1500-$1900. This can vary greatly depending upon your age, general health status, family history, ongoing symptoms, and any additional problems you wish to have addressed. The total bill may be as high as $3000-$4000 or more when symptoms requiring multiple sophisticated tests are evaluated. Insurance reimbursement often reduces out of pocket costs.

Patients who wish to receive the Clinic’s expertise in the evaluation of a condition or problem, but do not want the comprehensive Greenbrier Clinic examination, may schedule a problem-focused examination on a "space available" basis. If you choose this option, you will receive a high quality Greenbrier Clinic evaluation limited to your current symptoms or problems. This examination does not include screening tests or preventive health services and should not be considered a substitute for the traditional Greenbrier Clinic comprehensive evaluation.

As a courtesy, the Clinic business office will bill your primary insurance carrier for your reimbursement--provided we can verify your insurance information at the time of your visit. Please bring your insurance cards and present them to the business office representative at the time of check in. The Clinic respectfully requests all patients to make a $200.00 deposit (payable by check, cash or credit card) to cover expenses that are not paid by insurance. (Please note, expenses not covered by insurance may exceed this deposit)

The Greenbrier Clinic will be integrating new statement formats to better serve patients needs. We now have a new Collections Department to work with patients and assist in settling account balances.

Notice of Privacy Practices
The Greenbrier Clinic, Inc.

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. If you have any questions about this Notice please contact our Medical HIPAA Advisor, who can be reached at (304) 536-4870.

This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information (PHI) to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI. “PHI” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all PHI that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by accessing our website www.greenbrierclinic.com, or calling the clinic and requesting that a revised copy be sent to you in the mail or, asking for one at the time of your next appointment.


HIPAA Security Regulations
The Greenbrier Clinic is in compliance with HIPAA security regulations which specify a series of administrative, technical, and physical security procedures for covered entities to use to assure the confidentiality of electronic protected health information.


Uses and Disclosures of Protected Health Information
Uses and Disclosures of PHI Based upon Your Written Consent: You will be asked by your physician to sign a consent form. Once you have consented to use and disclosure of your PHI for treatment, payment and health care operations by signing the consent form, your physician will use or disclose your PHI as described in this Section 1. Your PHI may be used and disclosed by your physician, our clinic staff and others outside of our clinic that are involved in your care and treatment for the purpose of providing health care services to you. Your PHI may also be used and disclosed to pay your health care bills and to support the operation of the physician’s practice.

Following are examples of the types of uses and disclosures of your protected health care information that the physician’s office is permitted to make once you have signed our consent form. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our clinic once you have provided consent.
Treatment: We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your PHI. For example, we would disclose your PHI, as necessary, to a home health agency that provides care to you. We will also disclose PHI to other physicians who may be treating you when we have the necessary permission from you to disclose your PHI. For example, your PHI may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

In addition, we may disclose your PHI from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician.

Payment: Your PHI will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as; making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant PHI be disclosed to the health plan to obtain approval for the hospital admission.

Healthcare Operations: We may use or disclose, as needed, your PHI in order to support the business activities of your physician’s practice. These activities include, but are not limited to quality assessment activities, employee review activities, training of medical students and residents, licensing, marketing and conducting or arranging for other business activities. For example, we may disclose your PHI to medical school students that see patients at our clinic. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment.

We will share your PHI with third party “business associates” that perform various activities (e.g., billing, laboratory and transcription services) for the practice. Whenever an arrangement between our clinic and a business associate involves the use or disclosure of your PHI, we will have a written contract that contains terms that will protect the privacy or your PHI. We may use or disclose your PHI, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also use and disclose your PHI for other marketing activities. For example, your name and address may be used to send you a newsletter about our practice and the services we offer. We may also send you information about products or services we believe may be beneficial to you. You may contact our Medical HIPAA Advisor to request that these materials not be sent to you.

Uses and Disclosures of PHI Based upon Your Written Authorization
Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.

Other Permitted and Required Uses and Disclosures That May Be Made With your Consent, Authorization or Opportunity to Object
We may use and disclose your PHI in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your PHI. If you are not present or able to agree or object to the use of disclosure of the PHI, then your physician may, using professional judgement, determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your health care will be disclosed.

Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your PHI that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

Emergencies: We may use or disclose your PHI in an emergency treatment situation. If this happens, your physician shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If your physician or another physician in the practice is required by law to treat you and the physician has attempted to obtain your consent but is unable to obtain your consent, he or she may still use or disclose your PHI to treat you.

Communication Barriers: We may use and disclose your PHI if your physician or another physician in the practice attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the physician determines, using professional judgement, that you intend to consent to use or disclosure under the circumstances.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object
We may use or disclose your PHI in the following situations without your consent or authorization. These situations include:

Required By Law: We may use or disclose your PHI to the extent that law requires the use or disclosure. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.

Public Health: We may disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury, or disability. We may also disclose your PHI, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.

Communicable Diseases: We may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.

Abuse or Neglect: We may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your PHI if we believe that you have been a victim of abuse, neglect, or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration: We may disclose your PHI to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.

Legal Proceedings: We may disclose PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

Law Enforcement: We may also disclose PHI, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the clinic, and (6) medical emergency (not on the Clinic’s premises) and it is likely that a crime has occurred.

Coroners, Funeral Directors, and Organ Donation: We may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose PHI to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. PHI may be used and disclosed for cadaveric organ, eye, or tissue donation purposes.

Research: We may disclose your PHI to researches when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.

Criminal Activity: Consistent with applicable federal and state laws, we may disclose your PHI, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.

Military Activity and National Security: When the appropriate conditions apply, we may use or disclose PHI of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities including for the provision of protective services to the President or others legally authorized.

Workers’ Compensation: We may disclose your PHI as authorized to comply with workers’ compensation laws and other similar legally established programs.

Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and your physician created or received your PHI in the course of providing care to you.

Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human services to investigate or determine our compliance with the requirements of Section 164.500 et. Seq.

Your Rights
Following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights.
You have the right to inspect and copy your PHI. This means you may inspect and obtain a copy of PHI about you that is contained in a designated record set for as long as we maintain the PHI. There will be a reasonable fee imposed for duplicating your personal copy of your PHI. A “designated record set” contains medical and billing records and any other records that your physician and the clinic uses for making decisions about you. Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI.

Depending on the circumstances, a decision to deny access may be revisable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Medical Records Dept. if you have questions about access to your medical record.

You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment, or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

Your physician is not required to agree to a restriction that you may request. If physician believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. If your physician does agree to the requested restriction, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, you may discuss with your physician any restrictions you wish to request; however, you are required to request a restriction in writing to your physician. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to your physician.

You may have the right to have your physician amend your PHI. This means you may request an amendment of PHI about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact your physician to determine if you have questions about amending your medical record.

You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI. This right applies to disclosures for purposes other than treatment, payment, or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter time frame. The right to receive this information is subject to certain exceptions, restrictions, and limitations.

You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.

Complaints
You may complain to us or to the Secretary of Health and Human Services if you believe we have violated your privacy rights.
You may file a complaint with us by notifying our Medical HIPAA Advisor of your complaint. We will not retaliate against you for filing a complaint. You may contact our Medical HIPAA Advisor at (304) 536-4870. This notice was published and becomes effective on April 14, 2003.