Current Patients
Thank you for choosing Collier Medical Specialists, Inc. for your Primary Care needs. We are dedicated to providing you and your family with personalized, quality care in an elegant environment.
Login with the username and password provided to you by our office. If you do not remember your username and password, please call us at 239-774-0345.
Clicking the Portal Login button will bring you to a page where you are able to view and edit your records in a completely secure database prior to your appointment, including the following items:
basic past medical history
current medications
medication allergies
social history
local pharmacy information
Should you need to update your contact information, such as telephone number and/or address, please contact our office directly.
New Patients
Thank you for choosing Collier Medical Specialists, Inc for your Primary Care needs. We are dedicated to providing you and your family with personalized, quality care in a elegant environment.
For your convenience, please click Download Forms to download and print our New Patient Registration Forms.
If you have medical insurance, we recommend that you contact your insurance company prior to your appointment to verify that our office is contracted with your particular health plan.
Thank you and we look forward to meeting you soon!
Payment Policy
At Collier Medical Specialists, Inc. we make every effort to provide you with the finest care and the most convenient financial options.
It is the policy of our practice that payment is due at the time of service, unless other financial arrangements are made in advance. We require all patients to pay their deductible, copay and/or coinsurance payment at the beginning of each visit. For your convenience we accept Visa, MasterCard and American Express.
We participate with many PPOs and other health insurance plans including Medicare. Although we are contracted with many insurance carriers, our services may not be covered by your particular insurance plan. Being referred to our clinic by another physician does not necessarily guarantee that your insurance will cover our services. Each plan contains unique rules which must be followed by patients. We highly recommend that you familiarize yourself with the particular benefits and rules of your health care plan since the contract is between you (the patient) and your health insurance carrier. Please remember that you are 100% responsible for all charges incurred.
As a courtesy to you, we will file claims with your health insurance plan and assist you in every way we can. Please contact your insurance company prior to your visit to clarify your covered benefits for services. Please bring your insurance information with you to the consultation so that we can expedite reimbursement.
We do our best to verify your benefits prior to your appointment to make sure we collect the appropriate amount owed and to make sure your visit will be covered by your insurance plan. However, it remains the policy holder’s responsibility to know their insurance policies, as Collier Medical Specialists, Inc. cannot know every detail of your specific plan. Ultimately, you are responsible for knowing what services are covered, how often, and how much of the cost is your responsibility.
Our office does not guarantee that your insurance will pay. Please understand that if, for whatever reason, the company does not pay for the services, you will be responsible for the unpaid balance.
Our practice utilizes an Electronic Health Recording system. Occasionally, progress notes may be in a preliminary state and awaiting final review from the provider when a patient checks out. In the event your billing status changes from time of check out, a refund will be issued and/or you will be responsible for the balance. Only finalized notes that have been reviewed and signed by a provider are submitted to insurance companies.
Prompt payment of mailed invoices is required. In the event you receive a statement in the mail from us for payment, it is your responsibility to pay that amount within 10 days.
We reserve the right to refuse to see patients with an account balance and who are not making regular payments on their account balance.
If you have questions regarding your account, please contact our billing department at 239-774-0345 Option 4 or use the contact form. Many times, a simple telephone call will clear any misunderstandings.
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW TO GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
If you have any questions regarding this notice, you may contact our Privacy Officer at the following location:
Collier Medical Specialists, Inc
Attention Privacy Officer
6615 Hillway Circle, Suite 200
Naples, FL 34112
239-774-0345 (phone)
239-774-1783 (fax)
We are committed to protect the privacy of your personal health information (PHI).
This Notice of Privacy Practices (Notice) describes how we may use within our practice or network and disclose (share outside of our practice or network) your PHI to carry out treatment, payment or health care operations. This notice describes our practice’s policies, which extend to:
Any health care professional authorized to enter information into your chart (including physicians, PAs, RNs, etc.);
All areas of the practice (front desk, administration, billing and collection, etc.);
All employees, staff and other personnel that work for or with our practice;
Our business associates (including a billing service, or facilities to which we refer patients), on-call physicians, and so on.
We may also share your information for other purposes that are permitted or required by law. This Notice also describes your rights to access and control your PHI.
Collier Medical Specialists, Inc. provides this Notice to comply with the Privacy Regulations issued by the Department of Health and Human Services in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). We will follow the terms outlined in this Notice.
We may change our Notice, at any time. Any changes will apply to all PHI. Upon your request, we will provide you with any revised Notice by:
Posting the new Notice in our office.
If requested, making copies of the new Notice available in our office or by mail.
Posting the revised Notice on our website :(www.colliermedicalspecialists.com).
Our Thoughts About Your Protected Heath Information:
We understand that your medical information is personal to you, and we are committed to protecting the information about you.
As our patient, we create paper and electronic medical records about your health, our care for you, and the services and/or items we provide to you as our patient. We need this record to provide for your care and to comply with certain legal requirements. We are required by law to:
make sure that the protected health information about you is kept private;
provide you with Notice of our Privacy Practices and your legal rights with respect to protected health information about you; and
follow the conditions of the Notice that is currently in effect.
How We May Use and Disclose Medical Information About You
The following categories describe different ways that we use and disclose protected health information that we have and share with others.
Each category of uses or disclosures provides a general explanation and provides some examples of uses. Not every use or disclosure in a category is either listed or actually in place. The explanation is provided for your general information only.
Uses and Disclosures of Protected Health Information
We may use or disclose (share) your PHI to provide health care treatment for you.
Your PHI may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you.
EXAMPLE: Your PHI may be provided to a physician to whom you have been referred for evaluation to ensure that the physician has the necessary information to diagnose or treat you. We may also share your PHI from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician.
We may also share your PHI with people outside of our practice that may provide medical care for you such as home health agencies.
We may use and disclose your PHI to obtain payment for services.
We may provide your PHI to others in order to bill or collect payment for services. There may be services for which we share information with your health plan to determine if the service will be paid for.
PHI may be shared with the following:
Billing companies
Insurance companies, health plans
Government agencies in order to assist with qualification of benefits
Collection agencies
EXAMPLE: You are seen at our practice for a visit or a procedure. We will need to provide a listing of services such as x-rays, MRI or even sharing our visit notes etc. to your insurance company so that we can get paid for the procedure or visit. We may at times contact your health care plan to receive approval PRIOR to performing certain procedures or test to ensure the services will be paid for. This will require sharing of your PHI.
We may use or disclose, as-needed, your PHI in order to support the business activities of this practice which are called health care operations.
EXAMPLES:
Training students, other health care providers, or ancillary staff such as billing personnel to help them learn or improve their skills.
Quality improvement processes which look at delivery of health care and for improvement in processes which will provide safer, more effective care for you.
Use of information to assist in resolving problems or complaints within the practice.
We may use and disclosure your PHI in other situations without your permission:
If required by law: The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. For example, we may be required to report gunshot wounds or suspected abuse or neglect.
Public health activities: The disclosure will be made for the purpose of controlling disease, injury or disability and only to public health authorities permitted by law to collect or receive information. We may also notify individuals who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition.
Health oversight agencies: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
Legal proceedings: To assist in any legal proceeding or in response to a court order, in certain conditions in response to a subpoena, or other lawful process.
Police or other law enforcement purposes: The release of PHI will meet all applicable legal requirements for release.
Coroners, funeral directors: We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law.Organ and tissue donation: If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Medical research: We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
Special government purposes: Information may be shared for national security purposes, or if you are a member of the military, to the military under limited circumstances.Correctional institutions: Information may be shared if you are an inmate or under custody of law which is necessary for your health or the health and safety of other individuals.
Workers’ Compensation: Your protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally-established programs.
Other uses and disclosures of your health information.
Business Associates: Some services are provided through the use of contracted entities called “business associates”. We will always release only the minimum amount of PHI necessary so that the business associate can perform the identified services. We require the business associate(s) to appropriately safeguard your information. Examples of business associates include billing companies or transcription services.
Health Information Exchange: We may make your health information available electronically to other healthcare providers outside of our facility who are involved in your care.
Fundraising activities: We may contact you in an effort to raise money. You may opt out of receiving such communications.
Treatment alternatives: We may provide you notice of treatment options or other health related services that may improve your overall health.
Appointment reminders: We may contact you as a reminder about upcoming appointments or treatment.
We may use or disclose your PHI in the following situations UNLESS you object.
We may share your information with friends or family members, or other persons directly identified by you at the level they are involved in your care or payment of services. If you are not present or able to agree/object, the healthcare provider using professional judgment will determine if it is in your best interest to share the information. For example, we may discuss post procedure instructions with the person who drove you to the facility unless you tell us specifically not to share the information.
We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death.
We may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts.
The following uses and disclosures of PHI require your written authorization:
Marketing
Disclosures of for any purposes which require the sale of your information
Release of psychotherapy notes: Psychotherapy notes are notes by a mental health professional for the purpose of documenting a conversation during a private session. This session could be with an individual or with a group. These notes are kept separate from the rest of the medical record and do not include: medications and how they affect you, start and stop time of counseling sessions, types of treatments provided, results of tests, diagnosis, treatment plan, symptoms, prognosis.
All other uses and disclosures not recorded in this Notice will require a written authorization from you or your personal representative.
Written authorization simply explains how you want your information used and disclosed. Your written authorization may be revoked at any time, in writing. Except to the extent that your doctor or this practice has used or released information based on the direction provided in the authorization, no further use or disclosure will occur.
Your Privacy Rights
You have certain rights related to your protected health information. All requests to exercise your rights must be made in writing and submitted to the practice manager.
You have the right to see and obtain a copy of your protected health information.
This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. If requested we will provide you a copy of your records in an electronic format. There are some exceptions to records which may be copied and the request may be denied. We may charge you a reasonable cost based fee for a copy of the records.
You have the right to request a restriction of your protected health information.
You may request for this practice not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. We are not required to agree with these requests. If we agree to a restriction request we will honor the restriction request unless the information is needed to provide emergency treatment.
There is one exception.
We must accept a restriction request to restrict disclosure of information to a health plan if you pay out of pocket in full for a service or product unless it is otherwise required by law.
You have the right to request for us to communicate in different ways or in different locations.
We will agree to reasonable requests. We may also request alternative address or other method of contact such as mailing information to a post office box. We will not ask for an explanation from you about the request.
You may have the right to request an amendment of your health information.
You may request an amendment of your health information if you feel that the information is not correct along with an explanation of the reason for the request. In certain cases, we may deny your request for an amendment at which time you will have an opportunity to disagree.
You have the right to a list of people or organizations who have received your health information from us.
This right applies to disclosures for purposes other than treatment, payment or healthcare operations. You have the right to obtain a listing of these disclosures that occurred after April 14, 2003. You may request them for the previous six years or a shorter timeframe. If you request more than one list within a 12 month period you may be charged a reasonable fee.
Additional Privacy Rights
You have the right to obtain a paper copy of this notice from us, upon request. We will provide you a copy of this Notice the first day we treat you at our facility. In an emergency situation we will give you this Notice as soon as possible.
You have a right to receive notification of any breach of your protected health information.
Complaints
If you think we have violated your rights or you have a complaint about our privacy practices you can contact:
Collier Medical Specialists, Inc.
Attention Privacy Officer
2235 Venetian Court, Suite 1
Naples, FL 34109
239-774-0345 (phone)
239-774-1783 (fax)
You may also complain to the United States Secretary of Health and Human Services if you believe your privacy rights have been violated by us. If you file a complaint we will not retaliate against you for filing a complaint. This notice was published and becomes effective August of 2013.
Medical Records Request Policy
The purpose of this policy is to:
Ensure that our patients’ medical records are not released to any unauthorized individuals. Develop a tracking system to document an accounting of disclosures in order to be compliant with HIPAA.
Medical records can be released to healthcare providers who are participating in your care. If we have referred you to another doctor, we will send them your records prior to your appointment.
You can request a copy of your own medical record. A medical release form can be used, or you can write a letter with all of the appropriate information. Faxes are accepted for patient requests, as long as your signature can be validated. NO emails or telephone/verbal requests can be made. We get your signature for your protection.
Patients are the only ones who can authorize release of records—not spouses, grown children or friends, unless they have power of attorney.
Requests for medical records may take up to 30 days to process.We may charge a reasonable fee to offset the costs associated with specific categories of requests. Assessments of fees are based on such factors as the costs of equipment and supplies, employee costs, and administrative overhead and shall include postage, including express mail costs when incurred at the request of the authorizing party.
The State of Florida has set out a fee schedule of charges for medical records. We determine our charges based on this fee schedule.
We may waive fees under certain circumstances.
Collier Medical Specialists, Inc. is aware that HIPAA does not require written consent for all releases of medical information but chooses to implement this policy to assure the confidentiality and privacy of our patients.
The practice shall take appropriate disciplinary action against members of the workforce (employees, volunteers, trainees, etc.) who fail to comply with the HIPAA Privacy Rule and the practice’s policies and procedures for protecting the confidentiality of patient health information.
DOWNLOAD MEDICAL RECORDS RELEASE FORM
For payment and fee schedules, please contact the office.
Section 1557 of the Affordable Care Act Grievance
It is the policy of Collier Medical Specialists, Inc. not to discriminate on the basis of race, color, national origin, sex, age or disability.
Collier Medical Specialists, Inc. has adopted an internal grievance procedure providing for prompt and equitable resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act (42 U.S.C. § 18116) and its implementing regulations at 45 C.F.R. pt. 92, issued by the U.S. Department of Health and Human Services.
Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of:
Jessica Solem, 6615 Hillway Cir, #200, Naples, FL 34112, email: office@colliermedicalspecialists.com, who has been designated to coordinate the efforts of Collier Medical Specialists, Inc. to comply with Section 1557.
Any person who believes someone has been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for Collier Medical Specialists, Inc. to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance.
• Jessica Solem, Practice Administrator and Section 1557 Coordinator, shall conduct an investigation of the complaint. This investigation may be informal, but it will be thorough, affording all interested persons an opportunity to submit evidence relevant to the complaint. The Section 1557 Coordinator will maintain the files and records of Collier Medical Specialists, Inc. relating to such grievances. To the extent possible, and in accordance with applicable law, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know.
• The Section 1557 Coordinator will issue a written decision on the grievance, based on a preponderance of the evidence, no later than 30 days after its filing, including a notice to the complainant of their right to pursue further administrative or legal remedies.
• The person filing the grievance may appeal the decision of the Section 1557 Coordinator by writing to the U.S. Department of Health and Human Services, Office for Civil Rights. A person can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
Or by mail or phone at:
U.S. Department of Health and Human Service
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
Complaint forms are available at:
http://www.hhs.gov/ocr/office/file/index.html
Such complaints must be filed within 180 days of the date of the alleged discrimination. The Woodruff Institute will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process.
Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.