Office Policies & Procedures

Thank you for choosing Nurture Pediatrics as your child’s medical home. We are committed to providing quality and evidence-based medical care. As one of our patients, we would like to inform you of our current office financial policies. Once you have carefully read the following, please sign this document and return to our office staff. If you have any questions, do not hesitate to ask one of our staff members. A copy will be provided to you upon request.

Our practice is committed to providing the best treatment and services for our patients. Our prices are representative of the usual and customary charges for our area.

INSURANCE. We participate in most insurance plans, including Medicaid. If you are not insured by a plan with which we do business, payment in full is expected at each visit. If you are insured by a plan with which we do business, but don’t have an up-to-date insurance card, payment in full is required for each visit until we can verify your coverage. Knowing your child’s insurance benefits is your responsibility. Please contact your insurance company with any questions you may have regarding your coverage.

NON-COVERED SERVICES. Please be aware that some – and perhaps all – of the services you receive may be not be covered or not considered reasonable or necessary by insurers. You must pay for these services in full at the time of visit.

PROOF OF INSURANCE. All patients must complete our patient information form before seeing the provider. We must obtain a copy of your driver’s license and current valid insurance to provide proof of insurance. If you fail to provide us with the correct insurance information in a timely manner, you may be responsible for the balance of a claim.

CLAIMS SUBMISSION. We will submit your claims and assist you in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim. Your insurance benefit is a contract between you and your insurance company; we are not party to that contract.

COVERAGE CHANGES. If your insurance changes, please notify us before your next visit so we can make the appropriate changes to help you receive your maximum benefits. If your insurance company does not pay your claim in 45 days, the balance will automatically be billed to you.

NON-PAYMENT. If your account is over 90 days past due, you will receive a letter stating that you have 20 days to pay your account in full. Partial payments will not be accepted unless otherwise negotiated. Please be aware that if a balance remains unpaid, we may refer your account to a collection agency and you and your immediate family members may be discharged from this practice. If this is to occur, you will be notified by regular and certified mail that you have 30 days to find alternative medical care. During that 30-day period, our physician will only be able to treat you on an emergency basis.

MISSED APPOINTMENTS. Our policy is to charge $35.00 for missed appointments canceled within 24 hours of the appointment time. These charges will be your responsibility and billed directly to you. Please help us to serve you better by keeping your regularly scheduled appointment. Patients with three (3) “no-show” appointments within  six (6) months, are subject to discharge from Nurture Pediatrics. 

CREDIT/DEBIT CARD ON FILE. Nurture Pediatrics requires a credit card to be on file, effective August 1, 2022. Our credit Card transaction company is Waystar. Waystar stores the information on a separate, secure site. This enables us to run credit card transactions within our system. Office personnel will not have access to your card. Only the last 4 digits of your card will show in our system. Waystar is certified as a Level One Service Provider with the Payment Card Industry (PCI), Data Security Standard, as well as the VISA Cardholder Information Security Program (CISP). They are audited and scanned for PCI compliance and is regularly scanned for vulnerabilities by ScanAlerT and is a member of their HACKER SAFE program.  Patients and/or responsible parties will be required to complete and sign a Credit Card Authorization form. 

PAYMENT PLANS. In the event of financial hardship or other extenuating circumstances, a payment plan can be arranged to keep the account current. Payment plans are individualized and may be set up over the phone with our billing department. Payment plans must provide for the payment in full of any unpaid balance. A valid credit card number is required to establish a payment plan: payment plan payments cannot be made by cash or check. Failure to make a payment as agreed will void your payment plan and your balance will be due in full.

Thank you for reading and understanding our financial policy. Once you have carefully read the policy, please sign below and return to our office staff. If you have any questions or concerns, do not hesitate to ask one of our staff members.

Your Information. Your Rights. Our Responsibilities.

This notice describes how medical information about your child may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights

When it comes to your child’s health information, you and your child have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record 

• You can ask to see or get an electronic or paper copy of your child’s medical record and other health information we have about your child. Ask us how to do this. 
• We will provide a copy or a summary of your child’s health information, within 10 days of your request, as required by Tennessee state law. We may charge a reasonable, cost-based fee.
• Access to your child’s medical record via https://patientportal.intelichart.com/. Please note not all information will be stored on the patient portal.  All records and health information can be access and/or requested. 

Ask us to correct your medical record

• You can ask us to correct health information about your child that you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. 
• We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
• We will never share any substance abuse treatment records without your written permission.

Get a list of those with whom we’ve shared information

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your child’s health information.
• We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

You can complain if you feel we have violated your rights by contacting the Privacy Officer listed on the last page of this Notice.

You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

Our Uses and Disclosures

How do we typically use or share your health information? 

We typically use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating your child for an injury asks another doctor about your overall health condition.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about your child to manage your treatment and services. 

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities. 

Example: We give information about you to your child’s health insurance plan so it will pay for your services. 

How else can we use or share your health information? 

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

We never market or sell personal information.

Help with public health and safety issues

We can share health information about your child for certain situations such as: 

Preventing disease

• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

Do research

We can use or share your child’s information for health research.

Comply with the law

We will share information about your child if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about your child with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about your child:

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information. 
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it. 
•  We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. 

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

Acknowledgement of Notice of Privacy Practices

By signing this form, you acknowledge that you have received our “Notice of Privacy Practices” (the “Notice”).  This Notice describes in detail how we might use or disclose your protected health information.  The Notice also discusses your rights and our duties with respect to your protected health information.  You have the right to review the Notice before signing this acknowledgment.  By signing this form, you further acknowledge that medical information collected at the Nurture Pediatrics, PLLC will be stored in a medical record system operated by Office Practicum, and kept securely in line with state and federal regulations.  

The providers of Nurture Pediatrics follow the recommendations of the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices (ACIP), and the Centers of Disease Control (CDC) by encouraging our patients to vaccinate against diseases that can cause significant illness and even death.

Effective April 2018, Nurture no longer accepts new patients who do not plan to vaccinate their children.

The providers of Nurture Pediatrics do not believe that an alternate vaccination schedule is necessary.

If it is the parent/guardian’s desire to pursue a delayed vaccination schedule, it will be accepted as long as patients are caught up on recommended vaccines by 12 months old, then again by 2 years old, again by 5 years old, and finally the required school immunizations by 12 years old.

As medical professionals, we feel very strongly that vaccinating children on schedule with currently available vaccines is absolutely the right thing to do for all children and young adults. We are making you aware of these facts not to scare you or coerce you, but to emphasize the importance of vaccinating your child. We are more than willing to discuss any questions you may have about vaccines, but do require all new patients to our practice to adhere to the vaccination schedule endorsed by the American Academy of Pediatrics (AAP)

• We firmly believe in the effectiveness of vaccines to prevent serious illness and to save lives.
• We firmly believe in the safety of our vaccines.
• We firmly believe that all children and young adults should receive all of the recommended vaccines according to the schedule published by the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP).
• We firmly believe, based on all available literature, evidence, and current studies, that vaccines do not cause autism or other developmental disabilities.
• We firmly believe that thimerosal, a preservative that has been in vaccines for decades and remains in some vaccines, does not cause autism or other developmental disabilities.
• We firmly believe that vaccinating children and young adults may be the single most important health promoting intervention we perform as health care providers, and that you can support as parents/caregivers.

The recommended vaccines and the schedule of administration are the results of years and years of scientific study and data-gathering on millions of children by thousands of our brightest scientists and physicians.

The vaccine campaign is truly a victim of its own success. It is precisely because vaccines are so effective at preventing illness that we are even discussing whether or not they should be given. Because of vaccines, many of you have never seen a child with polio, tetanus, whooping cough, bacterial meningitis, or even chickenpox, or known a friend or family member whose child died of one of these diseases. Such success can make us complacent or even lazy about vaccinating. But such an attitude, if it becomes widespread, can only lead to tragic results.

Over the past several years, many people in Europe have chosen not to vaccinate their children with the MMR (measles, mumps, rubella) vaccine after publication of an unfounded suspicion (later retracted) that the vaccine caused autism. As a result of under-immunization, there have been small outbreaks of measles and several deaths from complications of measles in Europe over the past several years. The United States experienced a record number of measles cases during 2019, with 1282 cases from 31 states reported to CDC's National Center for Immunization and Respiratory Diseases (NCIRD). This is the greatest number of cases since measles elimination was documented in the U.S. in 2000.

Furthermore, we firmly believe that by not vaccinating your child, you are taking selfish advantage of thousands of others who do vaccinate their children, which decreases the likelihood that a child will contract one of these diseases. We feel such an attitude to be self-centered and unacceptable. Even delaying or “breaking up the vaccines” to give one or two at a time over additional visits goes against expert recommendations, is not supported by any scientific data, can lead to unnecessary delays and errors, and can put your child, other children, and adults at risk for serious illness (or even death). It is therefore against our medical advice as professionals at Nurture Pediatrics.