Thank you for choosing Nia Health for your care. We are committed to providing you with quality, affordable health care. We appreciate you trusting us as your partner in decision-making regarding your care. We encourage you to ask questions and collaborate with us to determine a treatment plan that works best for you.

We have prepared the following information to help you understand how we work together to create the best experience for all parties involved in the care and services you receive.  

I. APPOINTMENTS

Nia Health is a specialty outpatient clinic that serves patients with non-life-threatening burn, wound, and minor traumatic injuries.

We are not an Emergency Department. If you are experiencing a life-threatening emergency, please call 9-1-1 or go to the nearest hospital or Emergency Department.

We see patients by appointment only. We do not accommodate walk-ins. Same day appointments are available. Reserving an appointment time reduces your wait time, ensures you are seen in a timely fashion, allows you time to make necessary arrangements and/or accommodations prior to your visit, and enables Nia Health to serve as many patients as we can who need specialty care services on a given day.

We offer in-person and telemedicine appointments.

·   Telemedicine visits can be used (a) after an injury to check how urgent the need for treatment is, (b) to determine what kind of treatment may be needed, (c) to develop a care plan, (d) for patient check-ins and follow-ups, (e) to answer patient and provider questions, and (f) by providers wanting to consult with a burn specialist. 

·   Telemedicine visits are also useful for those who live in distant and/or remote areas or have transportation difficulties.

·   During an in-person appointment, wound care including dressing changes will be performed directly by Nia Health staff. 

Late Cancellation / No Show Policy

When you book an appointment, we are holding a space on our calendar that is no longer available to other patients. We understand there are times when you must miss an appointment due to emergencies or obligations for work or family. However, when you do not call or leave a message to cancel an appointment, you may be preventing another patient from getting much needed treatment. Conversely, the situation may arise when another patient fails to cancel, and we are unable to schedule you for a visit due to a seemingly “full” appointment book.

A “no show” is a patient who misses an appointment without cancelling it, without prior notification, or is 15 minutes or more late to their appointment. Late cancellations are cancellations without sufficient notice as described below.

Due to the nature of burn and minor traumatic injuries, it is likely for appointments to be booked the same day for treatment of acute injuries. As a result, canceling a same-day appointment within 2 hours of the appointment time will incur a fifty-dollar ($50) fee. For all other appointments, if an appointment is not cancelled at least 24 hours in advance, you will be charged a fifty-dollar ($50) fee. These fees will not be covered by your insurance and are your responsibility.

Due to limited space available for each patient to help manage their medical needs, last minute cancellations for procedures can cause problems and added expenses for the practice. If a procedure is not cancelled at least 24 hours in advance, you will be charged a hundred and fifty-dollar ($150) fee. This fee will not be covered by insurance.

Alabama Medicaid patients are fee exempt for cancelled or missed appointments; please refer to Section X.

II. CREDIT OR DEBIT CARD ON FILE

The policy at Nia Health is to collect all payments and verify insurance at the time services are rendered. We require a valid credit or debit card on file for the patient at the time of appointment booking unless other arrangements have been made ahead of time with Nia Health. We accept major credit cards (MasterCard, Visa, American Express, Discover), debit and HSA cards. Your payment method information is kept confidential and HIPAA secure.

III. PATIENT AND PRACTICE COMMUNICATIONS

Nia Health uses a HIPAA compliant communication platform that meets industry standard security protocols to send and receive Short Message Service (SMS, sometimes referred to as “texts”) to/from patients. SMS may be used to send and receive follow-up photographs, complete check-ins, answer questions, and provide updates.

Nia Health uses a HIPAA compliant and secure Electronic Health Record (EHR) system called Jane through which appointment reminders, patient portal information, form intake and survey requests may be sent to you via email. Video visits are conducted through Jane’s telemedicine platform.

Electronic communication is used to improve efficiency of care, timeliness, and for convenience. For example, instead of patients returning for follow-up appointments every 3 to 5 days for wound evaluation and dressing change, wound assessment can be done daily with daily via digital photograph transmission with interval adjustments to wound care able to be made in real-time.

There are potential risks to confidentiality that may arise when communicating via these methods. We would like to ensure your understanding of the following:

·   Communication with Nia Health may be initiated by the patient under certain circumstances, most notably, for convenience.

·   Email and SMS messages may not be encrypted and therefore, there is potential that those messages could be read by someone for whom the message is not intended. Nia Health cannot guarantee that email and/or SMS messages are secure.

·   By using email and/or SMS when communicating with my provider at Nia Health, permission is given by the patient for the provider to determine the appropriateness to reply with a message that may include confidential information.

·   By acknowledging that Nia Health cannot guarantee security of emails or SMS messages, the patient shall not hold Nia Health liable for a breach of confidentiality resulting from an electronic security issue.

·   Nia Health providers will use their best professional judgment to limit email and SMS messages to that which is necessary, including inquires or responses regarding scheduling or coordination.

·   At times, my provider may send me information about resources via email or SMS that can enhance my treatment and I consent to receive this information.

·   All or part of email and SMS message communications may be input to my medical record which would then be accessible to anyone who has been granted access to those records by Nia Health.

IV. ELECTRONIC HEALTH RECORD, VIDEO/PHOTOGRAPHY, RESEARCH, SURVEYS

Your clinical chart will contain electronic information and may contain paper documentation. Any paper documents will be stored in a locked cabinet. You have the right to view the paper documents in your file unless it is determined that it would be clinically inappropriate to do so. Your documents and electronic records will be maintained for seven years after conclusion of services.

Please see the Notice of Privacy Practices document for a more complete description of the uses and disclosures of your health information. Nia Health has the right to change its Notice of Privacy Practices from time to time. Patients may contact Nia Health at any time for a current copy of this document.

Any pre-operative, post-operative, surgical and/or wound photographs received by SMS or email will be uploaded to your clinical chart.

Certain wound types and/or procedures are routinely videotaped or photographed at the request of the physician and may be used by him/her in the diagnosis and documentation of medical conditions and/or purpose of medical education. Your identity will be concealed, and your privacy maintained if the material is used for educational purposes.

Nia Health is interested in providing the best possible treatment(s) to achieve the best possible outcome(s). Our mission is to be able to drive change for better outcomes in burn care by providing solutions to make burn care available and affordable to all. By doing so, we will help you get back to doing what you love, with confidence and without limitation. To achieve this vision, it is important to know what works and what doesn’t, what outcomes have been achieved and how they were achieved. This is called clinical research and can be done by looking ahead (prospective) at data actively being collected or to be collected or by looking at what has already been collected (retrospective) to look for trends, associations, patterns, and/or significance. To do this research, we will need your consent.

If a prospective study is applicable to you and/or if you are interested in enrolling or being considered for a study, we will discuss the study details and you will be provided relevant resources prior to signing consent to participate.

With your consent, we will from time to time send you follow-up surveys to see how you are doing, evaluate your care experience, provide feedback, and evaluate your short-term and long-term outcomes with and after treatment.  

V. MEDICATIONS

There are no guarantees to the outcomes of medications, including pain medication(s). You will be involved in the choice of your prescribed medications and be provided with a rationale regarding treatment approaches. You have the right to refuse recommended medications, seek a second opinion, or terminate treatment at any time. We will discuss the possible consequences of stopping medications abruptly. Medications may produce side-effects, and some can cause undesired outcomes. We will discuss the most common side effects, and you will be provided resources and a discussion concerning each medication.

All patients being considered for controlled substances will need to review and sign a Controlled Substances Agreement prior to prescription writing and release.

VI. INSURANCE COVERAGE & BILLING

Health insurance coverage is a contract between you and your insurance company. It is best if you know which services your insurance will cover before you receive care. This ensures there are no surprises for either of us. If you are not sure about your coverage, you can contact the insurance company by referring to the information on the back of your insurance card.

1.  If you (a) have no insurance (self-pay), (b) do not give us correct insurance or policy information, or (c) have an inactive insurance policy, you will be responsible for the full cost of services you receive.

2.  Nia Health contracts with several insurance companies in Alabama. If we are in your health plan’s network, our billing office will submit claims to your insurance company for the care and services you receive from us. You will be expected to pay any cost shares at the time of service. 

3.  If Nia Health does not contract with your insurance plan, we will bill your insurance as a courtesy to you and may ask you for payment at the time you receive care. You are responsible for the full cost of the care and services you receive. If you owe a balance, or if your insurance company does not pay your claim within 45 days, the balance will be billed to you.

4.  Please plan to pay your copayment at the time you receive care or services. This amount is based on your specific insurance plan. We will also ask you to pay any deductibles, money owed for non-covered services, and any other cost shares at the time of service. If you are not able to pay these amounts at the time you receive care or services, you will receive a bill. The total amount you owe might change after your appointment, depending on the actual care or services you receive. You are responsible for all or part of the charges, based on your coverage and insurance plan. It is important to know that even if a service is covered, your insurance plan may not pay the charges in full.

5.  Not every service is covered by every insurance plan. Some or all of the care or services you receive may not be covered or might not meet medical necessity by your insurance plan. If that is the case, you will be responsible for the full cost. We will usually ask your insurance company to approve services in advance if there is any question about coverage. If you receive a service that is not covered, we will expect payment in full at the time of your visit.  

VII. SELF-PAY PATIENTS

Patients who do not have insurance, have inactive insurance policies, and/or provide incorrect insurance information are considered self-pay patients.

Patients may choose not to use their existing health insurance. Example reasons for opting out of using insurance is if the service or care you need is not covered or is less expensive to pay out of pocket. If you wish to opt-out of filing your health insurance for services or care rendered, you must (a) sign an election to self-pay form, and (b) pay the amount owed in full.

Our self-pay patients are eligible for discount pricing and bundled service pricing. The discount is applicable only if payment is made at the time of service. Please contact our billing department for a list of services and corresponding prices.  

VIII. PATIENT FINANCIAL RESPONSIBILITY - GENERAL POLICIES

This section outlines the guidelines and procedures for all patients who receive medical care and/or services at Nia Health.

Payments Due at the time of Service

1.  Co-payments are due in full at the time of service.

2.  Payments for self-pay patients are due in full at the time of service.

3.  Outstanding balances on your account

Charges

You will be charged for balances due for the following instances:

a.  For any amount of bills not covered by your insurance plan

b.  For paying all deductibles, fees, co-payments, and co-insurance payment amounts

c.  For those without insurance coverage, inactive insurance policies, or choosing to self-pay to pay for services in full at the time services are rendered.

d.  For cancellation and/or no-show fees

Care for Minors

An adult who brings in a minor (under 18 years of age) to Nia Health for care or services, or the patient or guardian, is responsible for any payments that are due at the time care or services are rendered. If a responsible adult is not present or payment has not been arranged in advance, treatment that is not urgent may be rescheduled.

Unable to Pay

If you cannot afford to pay your bill in full at the time of service, please speak with our billing department to discuss potential payment plan options.

Accepted Methods of Payment

1.  Telehealth Appointments – We accept major credit cards, debit, and HSA cards. Cash or check is not an accepted method of payment for telehealth visits at this time. 

2.  In-Person Appointments – We accept cash, check, major credit cards, debit, and HSA cards during the visit for in-person payment. Checks should be made payable to “Nia Health PLLC.”

During the appointment booking process, you will complete intake and consent forms, one of which is a Credit/Debit Card on File Authorization form. This authorization form saves time and allows for convenient charge of payments due. Your payment method information is kept confidential and HIPAA secure.

Billing

Payment for all bills is due within 30 days. You may pay by credit card, debit card, or HSA card using our online bill pay at https://weavebillpay.com/906813cc. If we do not receive payment, we will continue to send you bills until we receive payment in full. If you fail to pay your bills, your unpaid balance will be referred to a collection agency as explained under Nonpayment below. 

We may also ask for payment on any outstanding patient balances during any encounter with Nia Health. If you have an outstanding balance, you can expect to receive a statement.

Patients are responsible for the full cost of medical services they receive with Nia Health. Nia Health will submit an insurance claim on behalf of the patient, to their insurance company, for any qualified reimbursement based on the medical services rendered to the patient. Any reimbursement of these charges by your insurance provider will be applied to your Nia Health balance after the insurance company has fully adjudicated your claim. When total charges exceed the amount of reimbursement from your insurance company, Nia Health will bill those charges to your patient account. 

Nonpayment

Patients who ignore collection notices and fail to pay their balance risk negative credit ratings and possible dismissal from the practice. Past Due accounts may hinder your ability to schedule future appointments. Non-compliance or defaulting on payments may result in denial of service and/or a legal claim against the patient for non-payment.

If you are not approved for a payment plan program, and you do not pay your bills after 30 days of receiving a delinquency letter, we will refer your unpaid balances to an outside collection agency. You will be responsible for any collection agency fees that apply. If we need to take legal action to collect your outstanding balances, you might be charged legal fees. These will not be negotiated or refunded. If you have large unpaid collection agency balances and have made no payments, we might report you to a credit bureau and deny you any additional care or services from Nia Health. If this happens, we can help you transfer your care to a non-Nia Health provider.

Returned Checks

Nia Health accepts personal checks as a form of payment at the time services are rendered. If two or more checks are returned by your bank for insufficient funds, we will ask you to use a different payment method, such as a credit or debit card, for future services and payments on your account.

Overpayments

Before we refund a credit balance or overpayment on your account, we will apply that amount to any outstanding balance(s) for you or any dependent covered by your healthcare plan. We will refund you for any remaining credit balance.

IX. FEES

Fees for programs, consultations, and other services are subject to change at any time with 30 days’ notice.

If you miss an appointment or do not cancel your appointment in accordance with our Cancellation/No-Show Policy, we might charge you a cancellation or no-show fee, depending on the type of service. Your insurance will not pay these fees. They are your responsibility and will be billed directly to you.

X. ALABAMA MEDICAID

The following is taken from the FAQ section of the Alabama Medicaid website:

Physicians enrolled with Alabama Medicaid agree to accept Medicaid’s payment, plus any copayment, as payment in full. The physician or clinic may not charge or bill the patient for cancelled or missed appointments.

A patient may be billed for services that are non-covered and for which Medicaid will not make any payment. Services that are more than the set limitation (for example, physician visits, hospital visits, or eyeglasses limit) are considered non-covered services. Alabama Medicaid does not reimburse providers for completing forms for school, family medical leave, or other purposes not requested at the time of service. Providers may bill the patient for this service under certain conditions. Providers are requested to discuss with and tell patients before providing services about their responsibilities for payment of services not covered by the Alabama Medicaid program.

XI. OUT OF STATE PATIENTS

Dr. Jiwani is licensed to practice medicine in Alabama, New York, and Texas. Dr. Jiwani’s practice and brick-and-mortar clinic is located in Birmingham, Alabama.

If your primary residence is within Alabama, New York, or Texas, but you are out of state temporarily due to travel or other reasons, please be aware that there may be some limitations on the extent of care we are able to offer.

Telemedicine consultations are available for patients in New York and Texas. Dr. Jiwani does not accept Texas or New York insurance plans at this time. You may request Dr. Jiwani bill your insurance as a courtesy as an out-of-network provider. Patients are otherwise treated as self-pay. Please refer to Section VII. Self-Pay Patients.

Dr. Jiwani’s licensures to practice medicine in NY, AL, and TX do not transfer to any other state or jurisdiction to practice as a physician, and as such, you understand that she will not be serving in the capacity as one of your doctors should you choose to book a consultation with her. If you are outside of the states of AL, TX, or NY, Dr. Jiwani may only provide adjunct health support and consultation. You understand that Dr. Jiwani will not perform any physical exams, diagnose conditions, write prescriptions, or order lab tests.

You understand that Dr. Jiwani can offer health education consultation from a Burn Surgeon’s perspective. This comprises a mix of inquiry, listening, conversation, and education for choosing actions to design your own course of action, reach your medical care goals, and have an empowered relationship with your health.

You understand that you have the opportunity to ask questions and request education to your satisfaction about:

a.     Your condition,

b.     The nature, purpose, and potential benefit of self-treatment Dr. Jiwani suggests for your consideration, the material risks inherent in the therapies, the probability of those risks occurring, the likelihood of success,

c.     Reasonable alternatives to the proposed therapies, the material risks inherent in such alternatives and the probability of such risks occurring, the possible consequence(s) if advice is not followed an/or no therapies are undertaken.

You understand that we may discuss burn injury, affects to skin, signs and symptoms, resources, wound care, supplies, and products, and that all such discussion are points of education, and are not prescription, nor treatment for your condition nor a replacement for medication and/or medical care. You understand that health education consultation is neither medical care nor burn care. You understand that these sessions are not a substitute for professional medical care.

You understand that when the appointment time has run out, you have the option of scheduling a follow-up appointment to further discuss your questions.

You understand that nothing about our sessions forms a doctor-patient relationship, irrespective of whether Dr. Jiwani and you had a past doctor-patient relationship. You affirm that you are under active medical care with a local doctor or doctors, and that you should take all concerns about your health or safety to them, or an urgent or emergent medical facility if warranted. You understand in all circumstances you should continue to consult with your regular physician regarding any medical concerns.

You understand that Dr. Jiwani’s notes from our sessions will not be part of your medical record as this is not a medical visit or treatment. You understand that you may still request copies of these notes.

You agree that you are solely responsible for the action plan you create and to evaluate the safety of any self-treatment you undertake. You do not expect Dr. Jiwani to anticipate and explain all risks and potential complications.