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PELLEGRINO HEALING CENTER
NOTICE OF PRIVACY PRACTICES
YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.
This notice describes how your health information may be used and disclosed, how we protect it, and how you can access it. Please review it carefully.
Pellegrino Healing Center is committed to protecting the privacy of your health information. We are required by law to maintain the privacy and security of your protected health information (PHI), provide you with this notice of our legal duties and privacy practices, and follow the terms of the notice currently in effect.
In this notice, “health information” means information about your health, the care you receive, or payment for your care that can identify you.
1. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have certain rights regarding the health information we maintain about you.
Access your records
You may ask to see or receive a paper or electronic copy of your health records and other health information we maintain about you. Please contact us to make a request. We will respond within the time required by law. We may charge a reasonable, cost-based fee when permitted.
Ask us to correct your records
You may ask us to correct health information that you believe is incorrect or incomplete. We may deny your request in certain circumstances, but if we do, we will explain the reason in writing and tell you about your options.
Request confidential communications
You may ask us to contact you in a particular way or at a specific location. For example, you may ask us to contact you by telephone rather than by mail, or to use a different mailing address. We will accommodate reasonable requests as required by law.
Ask us to limit what we use or disclose
You may ask us not to use or disclose certain health information for treatment, payment, or health care operations. We are not required to agree to every request.
If you pay for a service or health care item entirely out of pocket, you may ask us not to disclose information about that service to your health insurer for payment or health care operations purposes. We must agree to this request unless disclosure is otherwise required by law.
Request an accounting of disclosures
You may ask for a list of certain disclosures of your health information made during the six years before your request. This list does not include every disclosure; for example, it generally excludes disclosures for treatment, payment, and health care operations, as well as certain other disclosures permitted by law. We will provide one accounting per year at no charge, with a reasonable, cost-based fee potentially applying to additional requests within 12 months.
Receive a copy of this notice
You may request a paper copy of this notice at any time, even if you have agreed to receive it electronically.
Choose someone to act for you
If someone has legal authority to act on your behalf, that person may exercise your privacy rights as permitted by law. We will verify that person's authority before acting on the request.
File a complaint
If you believe your privacy rights have been violated, you may file a complaint with Pellegrino Healing Center using the contact information listed at the beginning of this notice. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at:
https://www.hhs.gov/hipaa/filing-a-complaint/index.html
You will not be penalized or retaliated against for filing a complaint.
2. HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
We may use or disclose your health information without your written authorization for certain purposes permitted or required by law.
Treatment
We may use your health information to provide, coordinate, or manage your care and may share relevant information with other health care professionals involved in your treatment when permitted by law.
Payment
We may use or disclose your health information to obtain payment for services we provide. This may include billing, payment processing, and activities needed to determine whether services are covered by a health plan.
Health care operations
We may use or disclose health information as necessary to operate our practice, manage our services, review the quality of care, support administrative activities, and carry out other health care operations permitted by law.
Appointment reminders and communications
We may use your contact information to remind you of appointments, communicate scheduling information, or contact you about your care. If you prefer a particular method of communication or have concerns about privacy, you may ask us to contact you in another reasonable way.
Business associates
We may share health information with service providers who perform certain functions for us, such as billing, electronic record management, or administrative support. These service providers must agree to protect your information as required by law.
3. OTHER USES AND DISCLOSURES PERMITTED OR REQUIRED BY LAW
In certain circumstances, we may use or disclose health information without your written authorization when the law permits or requires it. Depending on the circumstances, this may include:
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Public health and safety: For activities such as preventing disease, reporting certain conditions, addressing product recalls, or reducing a serious threat to health or safety.
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Abuse or neglect: When reporting suspected abuse, neglect, or domestic violence as required or permitted by law.
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Health oversight: For authorized audits, investigations, inspections, or other oversight activities.
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Legal requirements: When a federal, state, or local law requires disclosure.
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Law enforcement and government requests: In certain circumstances allowed by law.
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Workers’ compensation: For claims or activities authorized by workers’ compensation laws.
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Court proceedings: In response to a court or administrative order, subpoena, or other lawful process when applicable legal requirements are met.
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Research: When permitted by law and any required conditions or approvals are satisfied.
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Medical examiners and funeral directors: When needed to carry out legally authorized duties.
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Organ and tissue donation: When applicable to authorized donation or transplantation activities.
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Other legally authorized purposes: Such as certain specialized government functions or activities involving serious threats to health or safety.
We will limit disclosures to what is permitted or required by applicable law.
Specially protected information: Certain types of health information may be subject to additional federal or New York State protections. Where applicable, we will follow those additional requirements. If we maintain substance use disorder patient records protected by federal Part 2 regulations, additional restrictions may apply to their use and disclosure, including for certain investigations and legal proceedings.
4. USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION
Uses and disclosures not described in this notice will be made only with your written authorization when required by law.
For example, we generally need your written authorization to use or disclose your health information for marketing purposes when the law requires authorization, or to sell your health information. Certain other uses and disclosures may also require your authorization.
If you give us written authorization, you may revoke it in writing at any time. Revocation will not affect uses or disclosures we have already made in reliance on your authorization, or any actions that cannot legally be reversed.
5. YOUR CHOICES ABOUT CERTAIN INFORMATION
For certain situations, you may have the opportunity to tell us your preferences about sharing information with family members, friends, or others involved in your care, or about sharing information during disaster-relief efforts.
When you are unable to express a preference, we may use our professional judgment and act in your best interests, to the extent permitted by law.
We will obtain your authorization when required for uses or disclosures that are not otherwise permitted by law.
6. OUR RESPONSIBILITIES
Pellegrino Healing Center is required by law to:
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Protect the privacy and security of your protected health information.
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Provide you with this notice explaining our legal duties and privacy practices.
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Follow the terms of the notice currently in effect.
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Notify you as required by law if a breach occurs that may have compromised the privacy or security of your information.
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Use or disclose your health information only as described in this notice or as otherwise permitted or required by law.
We will not use or disclose your health information for a purpose that requires your authorization without first obtaining that authorization.
7. CHANGES TO THIS NOTICE
We may change the terms of this notice, and the changes may apply to all health information we maintain about you. Any revised notice will be available upon request, at our practice, and on our website, if applicable.
8. CONTACT US OR FILE A COMPLAINT
If you have questions about this notice, want to exercise your privacy rights, or believe your privacy rights have been violated, please contact:
Pellegrino Healing Center
Attention: Christine Pellegrino
Address: 4307 Albany Post Road Hyde Park, NY 12538
Phone: 845-233-5672
Email: heal@pellegrinohealingcenter.com
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at https://www.hhs.gov/hipaa/filing-a-complaint/index.html.
We will not retaliate against you for filing a complaint.
This notice is effective as of 01/01/2020
OTHER office POLICies & info
Pricing Policy Reminder
Please note: We may occasionally adjust the prices of our services, whether increasing or decreasing them. Please note that these changes can occur at any time and without prior notice. We reserve the right to modify our service prices as needed. Please call our office for the most up-to-date pricing information.
Notice of Rescheduling and Cancellation Policy
Your health and the health of all of our patients matters to us. To ensure that all of our patients are treated fairly and can receive treatment on time, Pellegrino Healing Center asks that you provide at least 24 hours notice if you need to change, reschedule, or cancel your appointment. If you change, reschedule, or cancel your appointment without providing us with 24-hours advance notice or fail to keep your appointment (if you are a no-show) the following fees will apply:
For appointments that are rescheduled, changed, or canceled with less than 24 hours notice:
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50% of treatment price
If you are a no-call/no-show for your session:
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100% of the treatment price
Any charges incurred for late cancellation/changes/rescheduling/no call/no show must be paid prior to the next scheduled appointment. If there is credit on your account (i.e., pre-paid sessions/package, gift certificates, etc), the full amount of the late cancellation/no-show fee will be removed from your account. Your understanding is appreciated.
Late Arrivals: If you are late, your session may be shortened in order to accommodate others whose appointments follow yours. Regardless of the length of the treatment actually given, you will be responsible for the full session price.
To change or cancel an existing appointment, please contact us at 845-233-5672 or email heal@pellegrinohealingcenter.com or reschedule your appointment online.
Thank you for your consideration and understanding.
Financial Policy
Collection of Payment
All payments must be collected at the front desk at the time your services are rendered. We take checks, cash and credit cards. Please write all checks to Pellegrino Healing Center.
All co-payments and non-covered items are to be paid at the time of visit. You are responsible for payment of all charges, including any balance due following insurance payment.
Insurance Patients (acupuncture only): If you have an acupuncture benefit through your health insurance, you may receive an estimate for your patient responsibility prior to or at the time of your service. If there is a difference in the estimated patient responsibility, we will send you a statement for any balance due. If a credit balance results after insurance pays, we will apply the credit to any open balance on your account. If there are no open balances, we will hold the credit on your account to use for future visits.
Your insurance policy is a contract between you and your insurance company. This office holds no party to that contract and will not be held responsible in the event that your insurance denies your claim. In the event that insurance benefits are paid directly to the patient, patient agrees to endorse to Pellegrino Healing Center all checks for such payments.
The massage therapy services that you receive at Pellegrino Healing Center are not sent to your insurance company and therefore, it is your sole responsibility to pay for the services you receive at the time they are rendered. If you require a superbill to send to your insurance company, we ask that you request this prior to going into your massage. We will do our best to have it printed for you before you leave, otherwise it will be emailed before the end of business day.
Security & Privacy
We take your privacy seriously, so rest assured that your credit card information will be securely stored, and our clinic adheres to strict privacy and security protocols to protect your sensitive data.
About our scheduling software system, Jane
No credit card data is stored in Jane. When you enter credit card information into Jane, Jane creates and keeps a token that can be used to reference that information. However, the actual sensitive data is sent to and stored within our payment solution partner Stripe, who holds the highest security certification in the industry.
Is it Safe to Store my Credit Card information with Pellegrino Healing Center?
We want to protect all of your patient data. This includes your patient health records, intake forms, and credit card information. This is why we use a secure platform called Jane App. Through the Jane integrated payment system called Jane Payments, we are able to keep your information safe. Jane Payments is the PCI-compliant solution designed to help health and wellness practices conduct their businesses with a set of flexible, fully integrated features like secure online payments, terminal payments, online booking policies, memberships, and more!
Is Jane compliant with PCI standards?
Jane Payments, which is Jane’s payment solution, is PCI-compliant. Any client cards you store on file or payments you take through Jane Payments are done in a PCI-compliant manner. Being that Jane only stores a token of the credit card and that the processing of the credit card actually takes place outside of Jane directly within the payment processors, this all means that Jane is PCI-compliant in the way that it is set up as an application and a company.
We reserve the right to review and revise this policy as needed to maintain fairness and consistency in our service delivery.
ACUPUNCTURE
New acupuncture patients: If this will be your first time receiving acupuncture at Pellegrino, you will be booked in for an Initial Consultation, where a customized treatment plan will be created especially for you. If you wish, you can start care immediately after the consultation. Initial Acupuncture appointments need to be scheduled either via phone call to our front desk or by filing out this form in order to get the process started, and one of our front desk staff will get in touch with you to schedule you in for your first appointment.
When you call us, please have your health insurance information handy, so that our billing department can verify your insurance coverage for acupuncture. Different insurance companies and plans vary in deductibles, copays, & visit limits. Insurance information and coverage will be reviewed at your initial consultation.*
*We are covered by an ever-growing number of insurances. As a courtesy to you, we will verify your insurance benefits and go over your coverage during your consultation.
We want you to be informed and prepared for your visits with us. Below are answers to the most commonly asked questions about acupuncture. If there is anything not covered here that you have a question about, please do not hesitate to call our front desk at 845-233-5672.
FAQ's For Your Acupuncture Visit
How should I prepare for my session?
We recommend wearing loose, comfortable clothing. You should be aware that the acupuncturist may need to access points on your torso, arms and legs.
Try to avoid the following:
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Fasting for more than six hours before your appointment
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Eating a big meal within one hour of your appointment
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Using alcohol, tobacco, food or drinks that color your tongue (such as coffee) immediately prior to treatment or just following a treatment
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Vigorous exercise within the hour before treatment
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Consuming alcohol before your treatment.
Afterwards:
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Refrain from overexertion, exercise, or alcohol for up to 6 hours after the visit.
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Drink plenty of water
Does acupuncture hurt?
Acupuncture treatments are not painful. Most people barely feel anything when the needles are inserted. Some people feel a slight pinch, and others ask “Is it in yet?” Acupuncture needles are solid, flexible, and very, very thin (about the width of two hairs). Patients often fall asleep and are in deep relaxation on the table.
Are the needles safe?
Yes. Sterile disposable needles are used. They are used once and then disposed of.
How often do I need to come in for treatment?
The frequency of treatment depends on your medical condition. Many conditions respond faster to frequent acupuncture treatments, while other patients only need to come in once a week. Once your condition is stabilized, you won’t need to come in as frequently. When you come in for your first treatment, we’ll formulate a specific treatment plan for you.
INTEGRATIVE MEDICINE
Some of our integrative services involve acquiring some of your past medical information and records from previous doctors. You will need to fill out a medical release form as well as our intake forms so that we can receive the necessary medical records to review your case:
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To start the process please call our office at (845) 233-5672.
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Our patient care coordinators will explain the intake steps specific to your visit.
Please Note: You will not be scheduled for an appointment until all of your intake documents are completed, your required medical records are received, and we have reviewed your paperwork. You may be asked for additional information before scheduling your appointment. -
Please download and fill out the medical release form and email it back to us.
All other intake forms will be sent to you by our front desk.
Payment will be collected at the time of service. Depending on the service, a superbill with relevant codes can be provided to you at your visit so you can submit it to your insurance for potential reimbursement (depends on your insurance coverage). IV & Vitamin Booster Shots are not covered by insurance. However, you may be able to put several of our integrative services towards your Health Savings Account (HSA) and Flexible Spending Accounts (FSA).
All other integrative services can be scheduled by calling our office at (845) 233-5672 or utilizing our online scheduling.
