Pease Integrative Medicine Office is committed to meeting our patient’s healthcare needs and keeping their insurance and other financial arrangements simple, secure, and efficient. In order to accomplish this in a cost effective manner we have set forth the following terms outlining how patient financial accounts are established and maintained.

1. Pease Integrative Medicine Office utilizes an Electronic Medical Record (EMR) and Electronic Practice Management (PM) system to store all patient health and financial information related to services provided at the practice.

2. The practice will use its EMR and PM system to automatically assign a unique Patient ID number to all patients upon creation of a patient in the system according to the Practice Patient ID Creation Policy.

3. The practice will utilize Family Accounts assigning all members of a family to a single financial account. An Account ID number will be assigned to each family account that is separate from the Patient ID number of the patient. Each patient under the family account will have the same Account ID number but will always retain their individual and unique Patient ID number.

4. The practice EMR and PM system will automatically generate Account ID numbers upon creation of a new account. The system will generate Account ID numbers in whole integers starting at 1 and increasing by 1 each time a new account is created.

5. Family account members will consist of all members of a household residence and/or those having coverage under the same insurance policy.

6. Patients must designate a single individual as Guarantor who will agree in writing to be responsible for payment of all services relating to the patient within the Family Account by signing the Guarantor Agreement.

7. Guarantors must provide a secure method of payment to be kept on file and sign the Practice Secure Payment Method Authorization form

8. Pease Integrative Medicine Office will employ a third party payment agent to maintain the security of the payment method for each account according to the rules and standards set forth by applicable federal and state laws.

9. Pease Integrative Medicine Office reserves the right to deny service if a secure payment method is not current and or if a guarantor is not established.

10. Pease Integrative Medicine Office considers the following to be acceptable secure methods of payment: Credit/Debit/HSA/FSA card, Bank Account/Bank Draft, and cash.

11. Pease Integrative Medicine Office has the right to approve or deny any requests for assignment to a specific Family Account of a patient that does not reside with the other members in the Family Account nor is covered under the same health insurance policy.

12. A patient may be removed from a family account and assigned to a new or different family account only if the patient has separated from the family residence and or is no longer covered under the same health insurance policy.

13. In the event an existing patient is assigned to a new or different family account, the patient will retain their original Patient ID number but a new Financial Account ID number will be assigned in accordance with the terms of this policy.

14. Account Activity and History Reports will include financial account information for all members of the family account as of the date of the report. Pease Integrative Medicine Office will use only the minimally necessary identifiable information to keep the charges and credits under the account identifiable to each individual patient’s services. Any member of the account will have the ability to request and receive financial information on the account and will be able to view all of the account information.