Billing Procedure

As part of our service, we will initially contact your insurance company concerning coverage and bill your primary and secondary insurance company if information is provided. However, the contract concerning your insurance policy is between yourself and your insurance company; and depending on your policy, they (your insurance company) may not be responsible for your medical bills. If you have questions regarding your coverage, we recommend that you contact your insurance company. You will receive a statement each month. We will notify you on the statement or by phone if there is a problem, or the amount, if any, that you are responsible for each month. If your account balance reaches over 60 days, you may be required to make monthly payments on your account until your insurance company or responsible party pays on the account. All balances are due in 30 days after the insurance company or responsible party's payment is made unless arrangements are made. If a payment has not been made within 90 days after notification of responsibility, your account will be turned over to a collection agency for payment in full. We will make payment arrangements for non-insured patients if necessary. For non-insured, a payment is required each month as per arrangement. Accounts will be sent to a collection agency after 90 days if a payment is not made. Prescription Center Homecare by law cannot accept returns for credit.

Authorization/Responsibility Agreement

I authorize my insurance company to pay the proceeds of any benefits due to me directly to Prescription Center Homecare. A copy of this can be considered an original for insurance purposes.

Customer agrees to pay all costs of collections, including court costs and reasonable attorney fees. I acknowledge that I am responsible for all of the charges for services rendered to me or any member of my family. I hereby agree to pay my account for services provided.

I understand that Prescription Center Homecare is a licensed pharmacy and cannot accept returned prescription merchandise.

Although I have requested Prescription Center Homecare to bill my insurance company on my behalf, I clearly understand that it is still my responsibility to make sure the bill is paid in a reasonable time. If for any reason, any portion of my bill is not paid by insurance, I further agree to make arrangements for prompt payment of my bill.

As a Prescription Center Homecare Patient You Have the Right to:

1. Being informed in advance about care/service to be provided, including the disciplines that furnish care/service and the frequency of visits, as well as any modifications to the plan of care/service.
2. Being informed, in advance, of care/service being provided and their financial responsibility.
3. Receiving information about the scope of services that the organization will provide and specific limitations on those services.
4. Participating in the development and periodic revision of the plan of care/service.
5. Refusing care of treatment after the consequences of refusing care of treatment are fully presented.
6. Being informed of client/patient rights under state law to formulate an advance directive, if applicable.
7. Having one's property and person treated with respect, consideration, and recognition of client/patient dignity and individuality.
8. Being able to identify visiting personnel members through organization proper identification.
9. Being free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of client/patient property.
10. Voicing grievances/complaints, regarding treatment of care/service, lack of respect of property or recommended changes in policy, personnel, or care/service without restraint, interference coercion, discrimination, or reprisal.
11. Having grievances/complaints regarding treatment or care/service that is (or fails to be) furnished, or lack of respect of property investigated.
12. Having confidentiality and privacy of all information contained in the client/patient record and of Protected Health Information.
13. Being advised of the organization's policies and procedures regarding the disclosure of client/patient records.
14. Choosing a healthcare provider, including a physician, if applicable.
15. Receiving appropriate care/service without discrimination in accordance with provider's orders, if applicable.
16. Being informed of any financial benefits when referred to an organization.
17. Being fully informed of one's responsibilities.

As a Prescription Center Homecare patient you have the responsibility to:

1. Give accurate and complete health information concerning your past illness, hospitalizations, allergies, and a list of all medications (prescribed, over the counter, herbals, vitamins, etc) that you are currently taking.
2. Assist in developing and maintaining a safe environment.
3. Inform Prescription Center Homecare when you will not be able to keep a visit.
4. Participate in the development and update of your care plan and in maintaining an accurate, current medication list.
5. Adhere to your developed/updated care plan.
6. Follow instructions regarding the use of equipment or the performance of a procedure.
7. Request further information concerning anything you do not understand.
8. Give information regarding concerns and problems you have to a Prescription Center Homecare staff member.
9. Communicate with your physician and Prescription Center Homecare staff regarding unexpected changes in your condition.

TO VOICE A GRIEVANCE WITH and/or TO SUGGEST CHANGE IN SERVICES and/or STAFF WITHOUT BEING THREATENED, RESTRAINED, and/or DISCRIMINATED AGAINST, CALL THE ASSISTANCE DIRECTOR OR DESIGNEE AT 208-528-7979 AT ANY TIME TO INITIATE THE RESOLUTION PROCESS FOR ANY GRIEVANCE, CONCERN, and/or COMPLAINT YOU MAY HAVE ABOUT ANY ASPECT OF PCHC CARE OR SERVICES.

YOU MAY ALSO CONTACT ACHC WITH QUALITY OF CARE OR SAFETY CONCERNS 24 HOURS A DAY, 7 DAYS A WEEK AT 855-937-2242 OR THE IDAHO STATE BOARD OF PHARMACY HOTLINE 208-334-2356.