Patient Resources

The Midwestern University Clinics are committed to providing quality care and service for our patients. As a health sciences university, we also provide training for future healthcare professionals who are supervised by our faculty. As a partner in this educational process, you have the right to:

1. Impartial access to treatment without regard to race, ethnicity, national origin, religion, gender, sexual orientation, age, disability, diagnosis, marital status, military and/or veteran status, or public assistance status.
2. Receive care in a safe setting, be treated with dignity, respect, and consideration; and receive treatment that supports and respects the patient’s individuality, choices, strengths, and abilities; and will not be subjected to abuse, neglect, exploitation, coercion, manipulation, sexual abuse, sexual assault, seclusion, restraint (if not necessary to prevent imminent harm to self or others), retaliation for submitting a complaint to either the Arizona Department of Health Services or the Illinois Department of Public Health, or another entity, or misappropriation of persona or private property by an outpatient treatment center.
3. Receive privacy in treatment and care for personal needs, including the right to request to have another person present during certain parts of a physical examination, treatment, or procedure performed by a health professional.
4. Review, upon written request, the patient’s own medical record as set forth in: Arizona, A.R.S. §§ 12-2293, 12-2294, and 12- 2294.01; or in Illinois, 735 ILCS 5/2001 and 2001.5; and ask that your doctor amend your record if it is not accurate, relevant, or complete.
5. Receive a referral to another healthcare provider if Midwestern University Clinics are not authorized, not able to or no longer able to provide the required physical or behavioral health services.
6. Participate or have the patient’s healthcare power of attorney/guardian on file participate in the development of or decisions concerning treatment, including an explanation of the prescribed treatment, treatment alternatives, the option to refuse or withdraw consent for treatment before treatment is initiated (except in an emergency), the risk of no treatment, expected outcomes of the treatment, and to be told, in language you can understand, the advantages and disadvantages of each.
7. Participate or refuse to participate in research or experimental treatment.
8. Receive assistance from a family member, the patient’s representative, or other individual in understanding, protecting, or exercising the patient’s rights.
9. Receive accurate and easily understood information about your healthcare professionals and healthcare facilities.
10. Ask for and receive an itemized bill and receive an explanation of your bills.
11. Consent to photographs before a patient is photographed.
12. Receive continuing care by your healthcare provider, under certain circumstances, when your health plan changes and your healthcare provider is not included in the new plan or your healthcare provider terminates his or her relationship with the health care plan.
13. A prompt and reasonable response to any complaint you have about your healthcare provider. This includes complaints about waiting times, operation hours, the actions of healthcare personnel, and the adequacy of healthcare facilities.

Ver la Carta de Derechos del Paciente en Español"

The effective date of this Notice of Privacy Practices is May 24, 2022.

This Notice of Privacy Practices describes your rights to access and control your protected health information. It also describes how we may use and disclose your protected health information. "Protected health information" is information about you, including demographic information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. Please review this notice carefully.

Ver las Prácticas de Privacidad del Paciente en Español

Your Protected Health Information Rights

You have the following rights with respect to your protected health information (PHI). You have the right to:

1. Inspect and copy all or any part of your medical or health record, as provided by federal regulations, including receiving an electronic copy of your PHI if Midwestern University maintains your PHI in an electronic health record. Midwestern University may charge you a reasonable fee to cover its costs for this service. You may also request that we provide a copy of your medical or health record to another person or entity.
2. Request restrictions on the use and disclosure of your PHI. However, Midwestern University is not required to agree to the restriction, except if you pay for a service entirely out-of-pocket. If you pay for a service entirely out-of-pocket, you may request that information regarding the service be withheld and not provided to a third party payor. Midwestern University is obligated by law to abide by such restriction. If you wish to request a restriction on the use and disclosure of your PHI, please provide a written request describing your requested disclosure to the Privacy Officer. We will notify you of our decision regarding the requested restriction.
3. Request that we amend your medical record, to the extent that such amendments are permissible under federal regulations.
4. Request and receive an accounting of disclosures made of your health information, except for disclosures made for the purpose of treatment, payment, health care operations and certain other purposes if such disclosures were made through a paper record or other health record that is not electronic, as set forth in federal regulations. If you request an accounting of disclosures of your PHI, the accounting may include disclosures made for the purpose of treatment, payment and health care operations to the extent that disclosures are made through an electronic health record.
5. Obtain a paper copy of this Notice from Midwestern University upon request.
6. Receive communications regarding your health information by alternative means or have such communications addressed to an alternative location. For example, at your request, we will mail items to a post office box instead of your residence.
7. If you execute any authorization(s) for the use and disclosure of your health information, revoke such authorization(s), except to the extent that action has already been taken in reliance on such authorization.

We may disclose your health information without your authorization for the following reasons

• We may disclose your PHI for the purpose of treatment, payment, or health care operations. Examples of these types of disclosures are provided below:
  • Treatment purposes example: Information obtained by your physician or by another member of your health care team will be recorded in your medical record and used to assess and monitor your health status, determine the appropriate care and treatment for you, and prescribe treatments and medications for you, as necessary.
  • Payment purposes example: A bill may be sent to you or to a third party payor. The information on the bill or accompanying the bill may include information that identifies you, your diagnosis, the treatments rendered to you, and the medications, supplies and equipment used to perform the treatments.
  • Healthcare operations example: Midwestern University and its staff may use information in your health record for business management and general administrative activities.
  • Healthcare operations example: Midwestern University and its staff may use information in your health record to assess the quality of the care and treatment they provide to you. The information will then be used in an effort to continually improve the quality and effectiveness of the health care and services that we provide to all of our patients.
• We may disclose your PHI for the purpose of research. We will only disclose your PHI for research purposes without your express authorization if (i) the research protocol has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information; or (ii) where we have received assurances from a researcher that the health information is sought solely for review as necessary to prepare a research protocol or for similar purposes preparatory to research and no health information will be removed from our premises in the course of the review.
• We may disclose your PHI to public health officials.
• We may disclose your PHI to law enforcement officials for law enforcement purposes.
• We may disclose your PHI to an appropriate governmental authority if we reasonably believe that you may be a victim of abuse, neglect, or domestic violence.
• If we believe it is necessary to avert a serious threat to the health or safety of yourself or the public, we may disclose your PHI to a person or persons who we believe are reasonably able to prevent or lessen the threat.
• We may disclose your PHI as required by federal and state laws and regulations.
• We may disclose your PHI to a health oversight agency, such as the Illinois Department of Public Health, the Illinois Department of Financial and Professional Regulation or the United States Department of Health and Human Services for purposes relating to the oversight of the health care system and government benefit programs such as Medicare or Medicaid.
• We may disclose your PHI in the course of a judicial or administrative proceeding in response to a court order, subpoena, discovery request or other lawful process.
• We may disclose your PHI to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other purposes as authorized by law. We may also disclose your PHI to funeral directors as necessary to carry out their duties.
• We may disclose your PHI to organizations involved in the procurement, banking, or transplantation of cadaveric organs, eyes or tissue, for the purpose of facilitating organ and tissue donation where applicable.
• If you are a member of the United States or foreign Armed Forces, we may disclose your PHI for activities that are deemed necessary by appropriate military command authorities to assure the proper execution of a military mission.
• We may disclose your PHI to authorized federal officials for the conduct of lawful intelligence, counter-intelligence and other national security functions authorized by law, or for the purpose of providing protective services to the President or foreign heads of state.
• We may disclose your PHI to a correctional institution or a law enforcement official having lawful custody of you.
• We may disclose your PHI as authorized by, and in compliance with, laws relating to workers’ compensation and similar programs established by law that provide benefits for work-related illnesses and injuries without regard to fault.
• We may contact you or provide certain information regarding your care to a third party for the purpose of raising funds for us. You have the right to opt out of receiving such communications

Examples of Other Permissible or Required Disclosures

Business Associates. Some activities of Midwestern University are provided on our behalf through contracts with business associates. Examples of when we may use a business associate include coding and claims submission performed by a third party billing company, consulting and quality assurance activities provided by an outside consultant, billing and coding audits performed by an outside auditor, and other legal and consulting services provided in response to billing and reimbursement matters that may arise from time to time. When we enter into contracts to obtain these services, we may need to disclose your health information to our business associate so that the associate may perform the job which we have requested. To protect your health information, however, we require our business associate to appropriately safeguard your information.

Communication with Family Members and for Location Purposes. We may disclose to your family member, friend or any other person that you identify who are involved with your care or payment for your care health information relative to that person’s involvement in your care or payment related to your care or of your location and general condition, unless you object to the disclosure.

Reporting Wrongdoing. Federal law allows for the release of your PHI to appropriate health oversight agencies, public health authorities or attorneys, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public. Any use or disclosure of your PHI that is not listed above will be made only with your written authorization, including the following uses and disclosures.

1. We must obtain an authorization from you to use or disclose psychotherapy notes unless the disclosure is for certain limited treatment, payment or health care operations, required by law, for health oversight activities, to a coroner or medical examiner, or to prevent a serious threat to health or safety.
2. We must obtain an authorization for any use or disclosure of your health information for any marketing communications to you about a product or service that encourages you to use or purchase the product or service unless the communication is either (a) a face-to-face communication or; (b) a promotional gift of nominal value. However, we do not need to obtain an authorization from you for the following communications: (i) to provide refill reminders or other information about a drug that is currently being prescribed for you, unless any payment we receive in exchange for making the communication unreasonably exceeds our cost of making the communication; (ii) any of the following, provided that we are not paid by a third party for making the communication: (1) communications regarding your course of treatment, case management or care coordination; (2) communications describing a health-related product or service that we provide; and (3) communications regarding treatment alternatives.
3. We must obtain an authorization for any disclosure of your health information which constitutes a sale of health information pursuant to federal regulations.

Midwestern University Clinic Responsibilities

We are required by law to:

1. Maintain the privacy of your health information;
2. Provide you with this Notice as to our legal duties and privacy practices with respect to the information we maintain and collect about you;
3. Abide by the terms of this Notice that are currently in effect; and
4. Notify you if we discover a breach of any of your PHI that is not secured in accordance with federal guidelines. Midwestern University reserves the right to change its privacy practices for all protected health information that we maintain. If our privacy practices materially change, Midwestern University will revise this Notice and make available to you a copy of the revised Notice. Unless you authorize us to do so, Midwestern University will not use or disclose your personal health information in a manner inconsistent with this Notice.

For More Information or to Report a Problem

If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer. Additionally, you may file a complaint with the Secretary of the Department of Health and Human Services. There will be no retaliation against you for filing a complaint.

If you have any questions or would like additional information, or if you wish to file a complaint with us regarding our use or disclosure of your PHI, please contact the Privacy Officer at Midwestern University via email at mcairo@midwestern.edu or phone at 623-572-3219. Please direct any written correspondence to: Privacy Officer, Midwestern University, 19555 N 59th Avenue, Glendale AZ, 85308.

You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.  

Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.  

• You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services.  This includes costs like medical tests, prescription drugs, equipment, and hospital fees.  
• If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care or provider or facility for a Good Faith Estimate before you schedule an item or service.  If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.  
• If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.  
• Make sure to save a copy or picture of your Good Faith Estimate and the bill. 

For questions or more information about your right to a Good Faith Estimate, 

• Visit the CMS.gov website
• Email FederalIPPDRQuestions@cms.hhs.gov, or 
• Call 1-800-985-3059

Ver el Derecho a una Estimación de Buena Fe en Español

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible.  You may have other costs or have to pay the entire bill of you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service.  This is called “balance billing.”  This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.  

“Surprise billing” is an unexpected balance bill.  This can happen when you can’t control who is involved in your care, like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.  

You are protected from balance billing for:

Emergency Services 
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance).  You can’t be balance billed for these emergency services.  This includes services you may get after you’re in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.  

Certain services at an in-network hospital or ambulatory surgical center 
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network.  In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount.  This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services.  These providers can’t balance bill you and may not ask you to give up your protections to be balance billed.  

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.  

You’re never required to give up your protections from balance billing.  You also aren’t required to get care out-of-network.  You can choose a provider or facility in your plan’s network.  

Under Arizona law, if you received health care services at an in-network facility you may seek arbitration of qualifying out-of-network bills. 

When balance billing isn’t allowed, you also have the following protections:

• You are only responsible for paying your share of the cost (like the copayments, coinsurance and deductibles that you would pay if the provider or facility was in-network).  Your health plan will pay out-of-network providers and facilities directly.  
• Your health plan generally must:
  • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
  • Cover emergency services by out-of-network providers.
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
  • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact:

• Midwestern University Clinics Billing Department: 1-623-537-6008 OR
• Visit the CMS.gov website for more information about your rights under federal law or call 1-800-985-3059.
• Visit the AZ Department of Insurance and Financial Institutions website for more information about your rights under Arizona law or call 1-602-364-3100.  
   

Ver Sus Derechos y Protecciones Contra Facturas Médicas Sorpresa en Español

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible.  You may have other costs or have to pay the entire bill of you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service.  This is called “balance billing.”  This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.  

“Surprise billing” is an unexpected balance bill.  This can happen when you can’t control who is involved in your care, like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.  

You are protected from balance billing for:

Emergency Services 
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance).  You can’t be balance billed for these emergency services.  This includes services you may get after you’re in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.  

Certain services at an in-network hospital or ambulatory surgical center 
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network.  In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount.  This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services.  These providers can’t balance bill you and may not ask you to give up your protections to be balance billed.  

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.  

You’re never required to give up your protections from balance billing.  You also aren’t required to get care out-of-network.  You can choose a provider or facility in your plan’s network.  

Under Illinois law, you may also be protected from balance billing.  If you have a health plan overseen by the State of Illinois and you receive anesthesiology, emergency, laboratory, pathology, or radiology services from an out-of-network provider at an in-network hospital or ambulatory surgical center, those providers can’t balance bill you under Illinois law.  

You’re never required to give up your protections from balance billing.  You also aren’t required to get care out-of-network.  You can choose a provider or facility in your plan’s network.  

When balance billing isn’t allowed, you also have the following protections:

• You are only responsible for paying your share of the cost (like the copayments, coinsurance and deductibles that you would pay if the provider or facility was in-network).  Your health plan will pay out-of-network providers and facilities directly.  
• Your health plan generally must:
  • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
  • Cover emergency services by out-of-network providers.
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
  • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact:

• Midwestern University Clinics Billing Department: 1-623-537-6008 OR
• Visit the CMS.gov website for more information about your rights under federal law or call 1-800-985-3059.
• Visit the Illinois Department of Insurance website for more information about your rights under Illinois law or call 1-866-323-5321.  

Ver Sus Derechos y Protecciones Contra Facturas Médicas Sorpresa en Español