Patient Bill Of Rights And Responsibilities

Protected Health Information (PHI) – you have the right:

• To review your PHI and obtain a copy.
• To request an amendment and correction of your PHI.
• To request limits or restrictions on ATI’s release of your PHI.
• To request an accounting to whom ATI released your PHI.

Your financial information is considered to be part of your PHI. Please read ATI’s Notice of Privacy Practices for a full disclosure of your rights under the Health Insurance Portability and Accountability Act of 1996.

You have the right to:

• Obtain service regardless of race, religion, color, age, gender, handicap, sexual orientation, veteran status or lifestyle.
• Be treated in such a manner that is free from any type of abuse, neglect, damage to or theft of property, and exploitation of any kind.
• Know maximum charges for services including fees covered by patient and those covered by Medicare, State Medicaid, Commercial
  insurance, and/or other third party.
• Receive considerate and respectful service.
• Be advised if charges increase from those stated at the time of service.
• Know that ATI is a privately held corporation that maintains liability insurance. Also know that ATI does not have any beneficial relationships that results in profit for referring organizations.
• Receive clear instructions in the use of all products, equipment and protocols ordered by your physician.
• Contact the Community Health Accreditation Program (CHAP) at 800-656-9656.
• Know the name and qualifications of the individual providing service.
• Receive a response to a lodged complaint in regard to the investigation review and resolution of the complaint.
• Express your concerns with any aspect of care, employees, products or equipment or any company related services by calling Customer
  Service at (859) 578-4822 (8:00am – 5:00 pm EST Monday – Friday) or writing to: Advanced Technologies, Inc. 7570 US Highway 42 Florence, KY. 41042

Your responsibilities include the following:

• Care for, use as instructed, and return equipment in good condition. Normal wear is expected at the end of the rental period.
• Pay for replacement cost of any rental equipment that was damaged, destroyed, or lost due to misuse, abuse, or neglect.
• Do Not modify any equipment without prior written consent of ATI.
• Do Not allow the use of any equipment by anyone other than the patient.
• Notify ATI promptly if any equipment malfunctions and/or allow an ATI representative to repair or provide replacement equipment within an agreed upon timeframe.
• Supply ATI with needed insurance information necessary to obtain payment for services and assume responsibility for charges not covered, including deductibles and co-payments. You are responsible for the bill regardless of insurance coverage.
• Make a payment within 15 days of receipt of the invoice; failure to pay could result in further collection activities including interest and
  collection fees.
• Make informed decisions about your services.
• You are responsible for contacting ATI promptly to arrange for rental pick-up. Please call (859) 578-4822 to schedule a pick-up.

INSURANCE AND BILLING INFORMATION

The ATI billing department will bill your insurance company for the services you receive from us. If you have coverage from more than one health insurance company, please specify which company is primary and should be billed first. Since each health insurance policy varies, we suggest you call your insurance company if you have any questions regarding coverage. We hope to make the billing process trouble free. Regardless of insurance coverage, you are responsible for your bill. If your insurance carrier has questions or requests additional information from you, please respond promptly. If you have any questions regarding the status of your claim, contact your insurance company directly. The billing department is ready to answer billing and insurance questions and can be reached at (859) 578-4822 Monday-Friday, 8:00 am – 5:00 pm (EST). You may leave a message outside of business hours and your call will be returned on the next business day.